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.

项目摘要 低风险黑人和白色未产妇初次剖宫产率的差异， 在美国，单胎头顶胎儿（NTSV）比以往任何时候都要多。这是因为NTSV 进入医院的妇女具有相似的剖腹产基线风险。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国家当前的优先事项。尚不清楚 为什么不同种族之间的剖宫产率存在差异，但在分娩进展，提供者水平的做法， 或提供者-患者沟通和决策质量可能是有贡献的。难产（缓慢，异常 产程进展）是NTSV妇女中一半剖腹产的指征，但这一诊断类别 仍然不明确，并提供了一个关键的机会，以安全地减少初次剖腹产。有 关于黑人和白色NTSV妇女在分娩期间是否具有相似的扩张率的矛盾证据。 如果产程进展存在种族差异，这将对诊断难产和临床 决定进行剖腹产。此外，目前还不清楚供应商是否申请美国 妇产科医师学院和母胎医学会的安全指南 预防初次剖腹产的做法因母亲种族而异。最后，不同的提供者-患者 沟通和决策以及供应商的隐性偏见可能会导致更高的剖宫产率 虽然尚未对此进行研究。本研究的目的是比较布莱克 和白色NTSV妇女在（1）分娩进展，（2）分娩期间接受护理， （3）医患沟通和决策质量指标。回顾和交叉- 本研究将收集部分数据。分娩和出生数据将回顾性收集自布莱克 和白色NTSV妇女谁出生在范德比尔特大学医学中心后，怀孕与 自2015年开始自然分娩（n = 7，150）。对于横断面数据收集，黑人（n = 140）和白色 将招募（n = 140）在NTSV妊娠后分娩并发生自然分娩的女性， 在产后住院期间采取完整措施。回归方法（多项式，多元逻辑， 和线性），并将主要用于测试假设。助产士类型，孕产妇和妊娠 特征和常见的劳动力干预措施将是模型协变量。如果研究假设得到支持， 根据种族评估进展和诊断难产的具体指南可能是必要的， 剖宫产率的差异此外，研究结果将首次描述黑人与白色提供者-患者 沟通和决策质量在产科设置在高容量，学术医疗中心。 这项R21研究的结果将为改善临床护理和关闭 黑人和白色人剖腹产的差异