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
基本信息
- 批准号:10391517
- 负责人:
- 金额:$ 20.15万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 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:
- 关键词:Academic Medical CentersAccountingAdoptedAmerican College of Obstetricians and GynecologistsBirthBirth RateBlack PopulationsBlack raceCaringCategoriesCervicalCesarean sectionCharacteristicsClinicalCohort StudiesCommunicationDataData CollectionData SetDecision MakingDiagnosisDiagnosticDiscipline of obstetricsDystociaElementsFetusGuidelinesHealth Care CostsHospitalizationHospitalsInstitutionInterventionLabor DystociaLabor OnsetLogisticsMaternal-fetal medicineMeasuresMedicalMethodsMidwifeModelingNulliparityOutcomePatientsPerceptionPerinatal mortality demographicsPolynomial ModelsPostpartum PeriodPregnancyProviderPublic HealthPublishingRaceResearchRiskSafetySamplingSocietiesTestingUnited StatesWomanbaseblack patientblack womenclinical caredisparity eliminationexperiencehealth care settingshealth equityimplicit biasimprovedintrapartumpatient-clinician communicationperinatal morbidityperinatal outcomespopulation healthpreventprovider adherenceracial differenceracial disparityrecruitsatisfactionshared decision makingtreatment disparity
项目摘要
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.
项目概要
低风险黑人和白人足月初产妇女初次剖宫产率的差异,
美国的单顶胎儿 (NTSV) 数量比以往任何时候都多。这令人担忧,因为 NTSV
进入医院的妇女剖腹产的基线风险相似。安全地降低剖宫产率,
消除差距和实现所有群体的健康公平是当前的国家优先事项。未知
为什么种族之间剖腹产率存在差异,但分娩进展、提供者层面的实践存在差异,
或者提供者与患者之间的沟通和决策质量可能会有所贡献。难产(缓慢、异常
产程进展)是 NTSV 妇女中一半剖宫产的指征,但此诊断类别
仍然不明确,并为安全减少初次剖腹产提供了关键机会。有
关于黑人和白人 NTSV 女性在分娩期间是否具有相似的扩张率的矛盾证据。
如果分娩进展存在种族差异,这将对难产的诊断和临床产生重大影响。
进行剖腹产的决定。此外,目前还不清楚美国的提供商是否可以申请
妇产科医师学会和母胎医学学会安全指南
根据母亲的种族,预防初次剖宫产的应用有所不同。最后,不同的提供者-患者
沟通和决策以及提供者的隐性偏见可能会导致更高的剖腹产率
对于黑人 NTSV 女性,尽管尚未对此进行研究。本研究的目的是比较黑人
自然临产的白人 NTSV 妇女的 (1) 临产进度,(2) 临产期间接受的护理,
(3)医患沟通和决策质量指标。回顾性和交叉性
本研究将收集截面数据。分娩和出生数据将从黑人追溯收集
以及在范德比尔特大学医学中心分娩的白人 NTSV 妇女
自 2015 年起自然分娩 (n ≈ 7,150)。对于横截面数据收集,黑色 (n = 140) 和白色
(n = 140) 自然分娩后 NTSV 妊娠后分娩的妇女将被招募并
在产后住院期间采取完整的措施。回归方法(多项式、多重逻辑回归、
和线性),主要用于检验假设。助产士类型、产妇和怀孕
特征和常见的分娩干预措施将是模型协变量。如果研究假设得到支持,
可能需要根据种族评估进展和诊断难产的具体指南
剖宫产率的差异。此外,研究结果将是第一个描述黑人与白人提供者-患者的研究结果
高容量学术医疗中心产科环境中的沟通和决策质量。
这项 R21 研究的结果将为改善临床护理和关闭所需的下一步研究步骤提供信息
剖腹产中黑人与白人的差异。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
数据更新时间:{{ journalArticles.updateTime }}
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
数据更新时间:{{ journalArticles.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ monograph.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ sciAawards.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ conferencePapers.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ patent.updateTime }}
JEREMY L NEAL其他文献
JEREMY L NEAL的其他文献
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
{{ truncateString('JEREMY L NEAL', 18)}}的其他基金
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:
10218513 - 财政年份:2021
- 资助金额:
$ 20.15万 - 项目类别:
Inflammatory markers as predictors of active labor onset among nulliparous women
炎症标志物作为未产妇主动临产的预测因子
- 批准号:
7990663 - 财政年份:2010
- 资助金额:
$ 20.15万 - 项目类别:
Inflammatory markers as predictors of active labor onset among nulliparous women
炎症标志物作为未产妇主动临产的预测因子
- 批准号:
8131013 - 财政年份:2010
- 资助金额:
$ 20.15万 - 项目类别:
Maternal physiological factors influencing labor length
影响产程长度的产妇生理因素
- 批准号:
7339023 - 财政年份:2007
- 资助金额:
$ 20.15万 - 项目类别:
Maternal physiological factors influencing labor length
影响产程长度的产妇生理因素
- 批准号:
7156819 - 财政年份:2007
- 资助金额:
$ 20.15万 - 项目类别:
相似海外基金
Unraveling the Dynamics of International Accounting: Exploring the Impact of IFRS Adoption on Firms' Financial Reporting and Business Strategies
揭示国际会计的动态:探索采用 IFRS 对公司财务报告和业务战略的影响
- 批准号:
24K16488 - 财政年份:2024
- 资助金额:
$ 20.15万 - 项目类别:
Grant-in-Aid for Early-Career Scientists
Mighty Accounting - Accountancy Automation for 1-person limited companies.
Mighty Accounting - 1 人有限公司的会计自动化。
- 批准号:
10100360 - 财政年份:2024
- 资助金额:
$ 20.15万 - 项目类别:
Collaborative R&D
Accounting for the Fall of Silver? Western exchange banking practice, 1870-1910
白银下跌的原因是什么?
- 批准号:
24K04974 - 财政年份:2024
- 资助金额:
$ 20.15万 - 项目类别:
Grant-in-Aid for Scientific Research (C)
A New Direction in Accounting Education for IT Human Resources
IT人力资源会计教育的新方向
- 批准号:
23K01686 - 财政年份:2023
- 资助金额:
$ 20.15万 - 项目类别:
Grant-in-Aid for Scientific Research (C)
An empirical and theoretical study of the double-accounting system in 19th-century American and British public utility companies
19世纪美国和英国公用事业公司双重会计制度的实证和理论研究
- 批准号:
23K01692 - 财政年份:2023
- 资助金额:
$ 20.15万 - 项目类别:
Grant-in-Aid for Scientific Research (C)
An Empirical Analysis of the Value Effect: An Accounting Viewpoint
价值效应的实证分析:会计观点
- 批准号:
23K01695 - 财政年份:2023
- 资助金额:
$ 20.15万 - 项目类别:
Grant-in-Aid for Scientific Research (C)
Accounting model for improving performance on the health and productivity management
提高健康和生产力管理绩效的会计模型
- 批准号:
23K01713 - 财政年份:2023
- 资助金额:
$ 20.15万 - 项目类别:
Grant-in-Aid for Scientific Research (C)
CPS: Medium: Making Every Drop Count: Accounting for Spatiotemporal Variability of Water Needs for Proactive Scheduling of Variable Rate Irrigation Systems
CPS:中:让每一滴水都发挥作用:考虑用水需求的时空变化,主动调度可变速率灌溉系统
- 批准号:
2312319 - 财政年份:2023
- 资助金额:
$ 20.15万 - 项目类别:
Standard Grant
New Role of Not-for-Profit Entities and Their Accounting Standards to Be Unified
非营利实体的新角色及其会计准则将统一
- 批准号:
23K01715 - 财政年份:2023
- 资助金额:
$ 20.15万 - 项目类别:
Grant-in-Aid for Scientific Research (C)
Improving Age- and Cause-Specific Under-Five Mortality Rates (ACSU5MR) by Systematically Accounting Measurement Errors to Inform Child Survival Decision Making in Low Income Countries
通过系统地核算测量误差来改善特定年龄和特定原因的五岁以下死亡率 (ACSU5MR),为低收入国家的儿童生存决策提供信息
- 批准号:
10585388 - 财政年份:2023
- 资助金额:
$ 20.15万 - 项目类别: