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40万名早产儿，新生儿重症监护病房(NICU)对 为新生儿提供高质量的护理和确保最佳的健康结果。新生儿重症监护 单元(NICU)一开始是开放式的(大房间，大小可变，允许多名新生儿进入)，但 NICU的最新设计和日益增长的趋势是单人家庭房间，通常只有一个婴儿进入 每间客房至少容纳一位家长同住。学术文献提供了混合的- NICU设计变化对患者健康结局和患者体验影响的证据 关心。此外，最近的一项社区需求评估呼吁减少孕产妇和儿童的差距 按种族和民族划分的健康状况。这些导致我们进行混合方法的过程和结果 评估NICU从开放式房间过渡到单人家庭房间的影响 发生在北卡罗来纳州格林斯伯勒的Cone Health。从理论上讲，单人房设计的好处是 增加了父母与新生儿之间的联系时间，但这假设父母经常与新生儿同住一室。 黑人和低收入父母可能会经历经济和交通困难，这限制了 他们有机会像白人和经济上有特权的父母那样住在一起。因此，我们 假设单人家庭房间不成比例地从经济特权中受益于新生儿 家庭(主要是白人)与来自低收入家庭(主要是白人)的新生儿 我们社区中的黑人和拉丁裔)。我们将进行一项混合方法的研究，对患者进行三角测量 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，以探索 不同的患者亚群是否不同地受益于或无意地受到 NICU的设计从开放式房间改为单人家庭房间。二次数据分析将帮助我们 确定患者的健康结果和患者的护理体验在治疗前和治疗后是否发生变化 NICU从开放式房间过渡到单人家庭房间。我们将检查患者之间的健康差异 亚群，特别注意种族/族裔和社会经济地位。然后我们会收集 并分析定性数据，以提供复制健康差异的过程的丰富细节；我们将 探索实施战略以减轻意外后果的障碍和促进者， 改善护理服务，改善健康结果，缩小亚健康人群之间的健康差距 人口。使用社区参与的方法和利益相关者咨询委员会，我们将制定 关于NICU设计变化的影响的概念框架，并传播经验教训和 可采取行动的建议，推动卫生系统政策和程序的系统性变化，以 提高患者护理质量，改善健康结果，缩小健康差距。