The impact of delivery hospital organizational structure and culture on perinatal outcomes

分娩医院组织结构和文化对围产儿结局的影响

• 批准号: 10660312
• 负责人: Sara Christine Handley
• 金额: $ 15.52万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-18 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10660312
• 关键词: 37 weeks gestation; Accounting; Affect; Behavior; Belief; Biometry; Birth; Birth Certificates; California; Caring; Case Mixes; Childbirth; Complement; Complex; Complication; Data; Data Set; Death Certificates; Discipline of obstetrics; Ethnic Origin; Future; Goals; Health Services; Health Services Research; Healthcare; Hospitalization; Hospitals; Individual; Infant; Infant Care; Knowledge; Link; Maternal Health Services; Mentors; Methodology; Mothers; Neonatal; Neonatology; Newborn Infant; Organizational Culture; Outcome; Patient Preferences; Patient-Centered Care; Patients; Perception; Perinatal; Perinatal Care; Policies; Population; Pregnancy; Proliferating; Provider; Race; Research; Research Personnel; Retrospective cohort; Risk; Safety; Science; Services; Shapes; Statistical Methods; Structure; Surveys; System; Training; United States; Variant; Work; adverse outcome; care outcomes; cohort; comorbidity; congenital anomaly; cost; design; health management; high risk; hospital organization; improved; improved outcome; individual patient; infant outcome; innovation; maternal outcome; multidisciplinary; neonatal care; neonatal outcome; novel; organizational structure; perinatal outcomes; population based; pregnant; primary outcome; secondary outcome; service organization; severe maternal morbidity; skill acquisition; structural determinants; study population; theories

PROJECT SUMMARY Adverse outcomes for pregnant patients and infants associated with the hospitalization for childbirth are frequent and vary across hospitals in the United States. Organizational factors, such as organizational structure and culture, in birth hospitals are potential drivers of variation in care and outcomes. Maternal and neonatal levels of care, an organizational structure, are the risk-based services available at a hospital for mothers and infants, respectively. Organizational culture refers to the beliefs, perceptions, and values on obstetric and neonatal units in a hospital, a key component of which is the culture of patient-centered care. The care and health of the mother and infant are interrelated, yet studies have not formally assessed perinatal organizational factors, those created by the intersection of maternal and neonatal care at the hospital level. The overall objective of this study is to determine how organizational factors of obstetric and neonatal units, formalized by this proposal as perinatal profiles of organizational structure and culture, impact perinatal outcomes of mothers and infants and drive hospital variation. Dr. Handley will achieve this objective by 1) assessing the impact of perinatal level of care profiles, 2) assessing the impact of perinatal patient-centered care culture profiles, and 3) examining the interaction of perinatal structure and culture profiles on perinatal outcomes. Her analysis will leverage a nine-state, retrospective cohort of mother-infant pairs as well as primary data from her organizational culture survey of California birth hospitals, which will be linked with state data to produce a novel dataset. This proposal was designed to prepare Dr. Handley to become an independent investigator, specifically focused on integrating health services research and organizational science in order to understand how organizational factors on obstetric and neonatal units affect perinatal outcomes. Her research will be complemented by training in advanced statistical methods for observational data and primary organizational culture survey data as well as acquiring in-depth knowledge of organizational behavior, dynamics, and change. Working with a multidisciplinary team of mentors and advisors with experts from neonatology, health care management, obstetrics, and biostatistics will provide her valuable guidance in the completion of this work and planning of future studies. Understanding the implications of perinatal organizational structure and culture profiles on perinatal outcomes is critical to improving perinatal care. Through better understanding of drivers of outcome variation across hospitals and identification of organizational factors amenable to change, this work has the potential to shape perinatal level of care policies, inform initiatives to improve organizational culture and coordination of maternal and neonatal care, and guide future change at the hospital, state, and national levels, which are actionable strategies to improve outcomes of the mother-infant dyad.

项目总结 与住院分娩相关的孕妇和婴儿的不良后果是 在美国的不同医院之间，这种情况经常发生，而且各不相同。组织因素，如组织 分娩医院的结构和文化是导致护理和结果不同的潜在驱动因素。母性和 新生儿护理水平是一种组织结构，是医院提供的基于风险的服务 分别是母亲和婴儿。组织文化指的是组织的信念、观念和价值观 医院的产科和新生儿病房，其中一个重要组成部分是以病人为中心的护理文化。这个 母亲和婴儿的护理和健康是相互关联的，但研究尚未正式评估围产期。 组织因素，由医院一级产妇和新生儿护理的交集所产生的因素。 本研究的总体目标是确定产科和新生儿的组织因素 由本提案正式确定为围产期组织结构和文化概况的单位，对围产期的影响 母亲和婴儿的结局，并推动医院的变化。汉德利博士将在1)年前实现这一目标 评估围产期护理档案水平的影响，2)评估以围产期患者为中心的影响 护理培养谱，以及3)检验围产期结构和培养谱对围产儿的交互作用 结果。她的分析将利用九个州的母婴配对和初级母婴的回顾队列 来自她对加州分娩医院的组织文化调查的数据，将与州数据联系起来，以 生成一个新的数据集。 这项提议的目的是让汉德利博士做好准备，成为一名独立的调查员，特别是 侧重于整合卫生服务研究和组织科学，以了解如何 产科和新生儿病房的组织因素影响围产儿结局。她的研究将是 辅以关于观测数据和主要组织的高级统计方法的培训 文化调查数据以及对组织行为、动态和变化的深入了解。 与来自新生儿、医疗保健等领域的专家组成的多学科导师和顾问团队合作 管理学、产科和生物统计学将为她完成这项工作提供宝贵的指导 对未来研究的规划。 了解围产期组织结构和文化特征对围产儿的影响 结果对改善围产期护理至关重要。通过更好地了解结果差异的驱动因素 在医院和确定可改变的组织因素方面，这项工作有可能 制定围产期护理政策，为改善组织文化和协调 孕产妇和新生儿护理，并指导医院、州和国家各级的未来变化，这些变化是 改善母婴二体结局的可行策略。