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。