Differences in Labor Progress, Care Received During Labor, and Provider-Patient Communication and Decision-Making Quality among Low-Risk Black vs. White Nulliparous Women with Spontaneous Labor Onset

自然分娩的低风险黑人与白人初产妇女在分娩进展、分娩期间接受的护理以及医患沟通和决策质量方面的差异

• 批准号: 10391517
• 负责人: JEREMY L NEAL
• 金额: $ 20.15万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-12 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10391517
• 关键词: Academic Medical Centers; Accounting; Adopted; American College of Obstetricians and Gynecologists; Birth; Birth Rate; Black Populations; Black race; Caring; Categories; Cervical; Cesarean section; Characteristics; Clinical; Cohort Studies; Communication; Data; Data Collection; Data Set; Decision Making; Diagnosis; Diagnostic; Discipline of obstetrics; Dystocia; Elements; Fetus; Guidelines; Health Care Costs; Hospitalization; Hospitals; Institution; Intervention; Labor Dystocia; Labor Onset; Logistics; Maternal-fetal medicine; Measures; Medical; Methods; Midwife; Modeling; Nulliparity; Outcome; Patients; Perception; Perinatal mortality demographics; Polynomial Models; Postpartum Period; Pregnancy; Provider; Public Health; Publishing; Race; Research; Risk; Safety; Sampling; Societies; Testing; United States; Woman; base; black patient; black women; clinical care; disparity elimination; experience; health care settings; health equity; implicit bias; improved; intrapartum; patient-clinician communication; perinatal morbidity; perinatal outcomes; population health; prevent; provider adherence; racial difference; racial disparity; recruit; satisfaction; shared decision making; treatment disparity

PROJECT SUMMARY The disparity in primary cesarean birth rates between low-risk Black and White nulliparous women with a term, single, vertex fetus (NTSV) in the United States is greater than ever before. This is concerning because NTSV women enter hospitals with similar baseline risks for cesarean birth. Safely lowering the cesarean rate, eliminating disparities, and achieving health equity for all groups are ongoing national priorities. It is unknown why disparities in cesarean rates exist between races but differences in labor progress, provider-level practice, or provider-patient communication and decision making quality may be contributory. Dystocia (slow, abnormal progression of labor) is the indication for half of cesareans among NTSV women, yet this diagnostic category remains poorly defined and provides a key opportunity to safely reduce primary cesarean births. There is contradictory evidence regarding whether Black and White NTSV women have similar dilation rates during labor. If racial differences in labor progress exist, this would have major implications for diagnosing dystocia and clinical determinations for performing cesarean births. Furthermore, it is unclear if provider application of American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine guidelines for safely preventing primary cesareans are applied differently based on maternal race. Finally, disparate provider-patient communications and decision making as well as provider implicit bias may contribute to higher cesarean rates for Black NTSV women although this has not yet been studied. The purpose of this study is to compare Black and White NTSV women with spontaneous labor onset on (1) labor progress, (2) care received during labor, and (3) indicators of provider-patient communication and decision making quality. Retrospective and cross- sectional data will be collected for this study. Labor and birth data will be retrospectively collected from Black and White NTSV women who birthed at Vanderbilt University Medical Center following a pregnancy with spontaneous labor onset since 2015 (n ≈ 7,150). For cross-sectional data collection, Black (n = 140) and White (n = 140) women who birthed following a NTSV pregnancy with spontaneous labor onset will be recruited and complete measures during their postpartum hospitalizations. Regression methods (polynomial, multiple logistic, and linear) and will primarily be used to test hypotheses. Labor attendant type, maternal and pregnancy characteristics, and common labor interventions will be model covariates. If study hypotheses are supported, specific guidelines for assessing progress and diagnosing dystocia based on race may be necessary for closing the cesarean rate disparity. Moreover, study findings will be the first to describe Black vs. White provider-patient communication and decision making quality in an obstetrical setting at a high-volume, academic medical center. Findings from this R21 study will inform next research steps necessary for improving clinical care and closing the Black vs. White disparity in cesarean births.

项目总结