Identifying and Mitigating Health Disparities Following a Neonatal Intensive Care Unit (NICU) Design Change from Open Bay to Single Family Rooms

新生儿重症监护病房 (NICU) 设计从开放式病房改为单户家庭病房后，确定并减轻健康差异

• 批准号: 10672384
• 负责人: Stephanie Teixeira-Poit
• 金额: $ 14.22万
• 依托单位: NORTH CAROLINA AGRI & TECH ST UNIV
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10672384
• 关键词: Admission activity; African American student; Anecdotes; Area; Attention; Black race; Caring; Child Health; Communities; Cone; Data; Data Analyses; Data Collection; Decision Making; Development; Disadvantaged; Economics; Ensure; Environment; Ethnic Origin; Evaluation; Family; Frequencies; Health; Health system; Historically Black Colleges and Universities; Inequality; Interview; Latinx; Learning; Lighting; Literature; Low income; Maternal and Child Health; Medical; Methods; Mothers; Needs Assessment; Neonatal Intensive Care Units; Newborn Infant; Noise; Nurses; Outcome; Parents; Patient Care Team; Patients; Perception; Policies; Premature Birth; Procedures; Process; Quality of Care; Race; Recommendation; Reduce health disparities; Research; Review Literature; Safety; Sensory Deprivation; Socioeconomic Status; Structure; Students; Surveys; Time; Transportation; Woman; Workload; care delivery; community engagement; design; disparity reduction; experience; graduate school; health care delivery; health disparity; improved; job market; neonate; patient subsets; professional students; racial disparity; skills; social health determinants; trend

Project Abstract With over 400,000 preterm births in the US annually, neonatal intensive care units (NICUs) are critical to providing high quality care and ensuring optimal health outcomes for neonates. Neonatal intensive care units (NICUs) began as open-bays (large rooms, variable size, and multiple newborns admitted), but the latest NICU design and a growing trend is single family rooms that typically have only one baby admitted per room and accommodate at least one parent rooming-in. The scholarly literature provides mixed- evidence on the impact of NICU design changes on patient health outcomes and patient experience of care. Also, a recent community needs assessment called to reduce disparities in maternal and child health by race and ethnicity. These lead us to conduct a mixed-methods process and outcome evaluation examining the impact of a NICU transition from open bay to single family rooms that occurred at Cone Health in Greensboro, NC. A theoretical benefit of single family room designs is increased parent-neonate bonding time, yet this assumes that parents routinely room-in with neonates. Black and low income parents may experience economic and transportation hardships that constrain their opportunity to room-in at the frequency of white and economically privileged parents. Thus, we hypothesize that single family rooms disproportionately benefit neonates from economically privileged families (predominantly white) compared to neonates from families with low incomes (predominantly Black and LatinX in our community). We will conduct a mixed-methods study that triangulates patient health outcome data, patient experience surveys, and in-depth interviews with NICU staff to explore whether different patient sub-populations unequally benefited from or were unintentionally harmed by a NICU design change from open-bay to single family rooms. A secondary data analysis will help us determine whether patient health outcomes and patient experience of care changed before vs. after the NICU transition from open-bay to single family rooms. We will examine health disparities across patient sub-populations, with special attention to race/ethnicity and socioeconomic status. We will then collect and analyze qualitative data to provide rich detail on processes that reproduce health disparities; we will explore barriers and facilitators to implementing strategies to mitigate unintended consequences, improve care delivery, improve health outcomes, and reduce health disparities among patient sub- populations. Using a community engaged approach with a Stakeholder Advisory Board, we will develop a conceptual framework on the impact of NICU design changes and disseminate lessons learned and actionable recommendations to drive systemic changes to policies and procedures at health systems to improve patient quality of care, improve health outcomes, and reduce health disparities.

项目摘要 美国每年有超过40万例早产，新生儿重症监护病房（NICU）对 提供高质量的护理，确保新生儿的最佳健康结果。新生儿重症监护 新生儿重症监护病房（NICU）最初是开放式的（大房间，大小不等，多个新生儿入院），但 最新的新生儿重症监护室设计和日益增长的趋势是单一的家庭房间，通常只有一个婴儿承认 每个房间，并容纳至少一个父母的房间。学术文献提供了混合- NICU设计变更对患者健康结局和患者经历影响的证据 在乎此外，最近的一项社区需求评估呼吁减少孕产妇和儿童 按种族和族裔分列的健康状况。这些导致我们进行混合方法的过程和结果 评估检查NICU从开放式病房过渡到单家庭病房的影响， 发生在北卡罗来纳州格林斯伯勒的Cone Health。一个理论上的好处单家庭室设计是 增加了父母与新生儿的联系时间，但这是假设父母经常与新生儿共处一室。 黑人和低收入父母可能会经历经济和交通困难， 他们有机会与白色和经济上有特权的父母同住。因此我们 假设单家庭房间不成比例地使新生儿受益于经济特权， 与低收入家庭（主要是白色）的新生儿相比， 黑人和拉丁裔在我们的社区）。我们将进行一项混合方法研究， 健康结果数据、患者体验调查以及与NICU工作人员的深入访谈， 不同的患者亚群是否不平等地受益于或无意中受到伤害 新生儿重症监护室的设计从开放式病房改为单家庭病房。二级数据分析可以帮助我们 确定患者的健康结果和患者的护理体验在治疗前后是否发生了变化。 NICU从开放式病房过渡到单人家庭病房。我们将研究患者之间的健康差异， 分人群，特别注意种族/民族和社会经济地位。我们将收集 并分析定性数据，以提供再现健康差异的过程的丰富细节;我们将 探讨执行减轻意外后果战略的障碍和促进因素， 改善医疗服务，改善健康结果，减少亚健康人群之间的健康差距。 人口。通过利益相关者咨询委员会的社区参与方式，我们将开发 关于新生儿重症监护室设计变更影响的概念框架，并传播经验教训， 提出可行的建议，推动卫生系统政策和程序的系统性变革， 提高患者护理质量，改善健康结果，减少健康差距。