Hospital quality, processes of care, and racial disparities in birth mode for individuals with a prior cesarean

曾进行剖腹产手术的患者的医院质量、护理流程以及出生方式的种族差异

• 批准号: 10740979
• 负责人: Laura B Attanasio
• 金额: $ 26.09万
• 依托单位: UNIVERSITY OF MASSACHUSETTS AMHERST
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-15 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10740979
• 关键词: Accounting; Address; Atopobium vaginae; Birth; Black race; Caring; Cesarean section; Characteristics; Communication; Data; Decision Making; Disparity; Educational process of instructing; Goals; Healthcare; Hospitals; Individual; Intervention; Interview; Joints; Labor Dystocia; Massachusetts; Measures; Medicaid; Medical; Methods; Midwife; Morbidity - disease rate; Outcome; Perception; Perinatal; Perinatal Care; Population; Process; Provider; Qualifying; Quality of Care; Race; Research Personnel; Risk; Risk Factors; Rural; Shapes; Structure; Testing; Vaginal Birth after Cesarean; Vaginal delivery procedure; Variant; Vital Statistics; Woman; Work; black women; disparity reduction; ethnic disparity; experience; fetal; high risk; improved; maternal morbidity; member; public health priorities; racial disparity; severe maternal morbidity; success

PROJECT SUMMARY Addressing the persistently high rates of severe maternal morbidity among Black women is an urgent public health priority. Of the 3.8 million U.S. births each year, nearly a third occur via cesarean delivery, which is a risk factor for severe maternal morbidity, and cesarean rates are higher among Black women than among White women. For women giving birth after a prior cesarean, maternal morbidity is lowest with a vaginal birth, but higher with an unplanned (vs. planned) repeat cesarean. There are racial and ethnic disparities in birth mode among women with a prior cesarean, with Black women more likely to have unplanned repeat cesareans compared to White women, but these disparities are poorly understood. The most common indications for primary cesarean are subjective and differ by race – suggesting potential differences in care quality and processes of care by race – but little is known about indications for unplanned cesarean among women with labor after cesarean. Prior work has also established that hospital characteristics are related to hospital rates of labor after cesarean utilization and vaginal birth after cesarean success, and that there is substantial hospital-level variation in maternal morbidity rates and racial and ethnic disparities in maternal morbidity rates. However, it is unclear how hospital characteristics and quality of care contribute to racial disparities in birth mode among women with a prior cesarean, and how Black women with a prior cesarean perceive their care. This mixed-methods study will use combined vital statistics and hospital discharge data and data from semi- structured interviews with Black women with a prior cesarean. The specific aims are: 1) To characterize the association between hospital characteristics and racial disparities in birth mode among women with a prior cesarean; and 2) To explore the experiences of perinatal care among Black women with a prior cesarean. Despite the higher risk of unplanned cesarean birth among Black (vs. White) women with a prior cesarean, little is known about why this occurs. Identifying factors and processes that contribute to these outcomes is particularly urgent given persistent racial disparities in severe maternal morbidity. Results from this study will contribute to a better understanding of the circumstances associated with labor after cesarean ending in cesarean delivery, and help to identify potential interventions to improve the quality of care for women with a prior cesarean.

项目摘要 紧急公众解决黑人妇女的严重孕产妇发病率的持续高率 健康优先级。在每年380万美国出生中，几乎通过剖宫产进行了几乎三分之一的事件，这是 黑人妇女的严重孕产妇发病率和剖宫产的危险因素高于 白人妇女。对于先前剖宫产后出生的妇女，孕产妇的发病率最低，阴道出生， 但是，有计划外（与计划中的）重复剖宫产更高。出生中存在种族和种族差异 有剖宫产的女性的模式，黑人女性更有可能是计划外的重复剖宫产 与白人妇女相比，这些差异知之甚少。最常见的适应症 原发性剖宫产是主观的，并且因种族而不同 - 表明护理质量的潜在差异和 种族护理过程 - 但对有计划外的剖宫产的适应症知之甚少 剖宫产后的劳动。先前的工作还确定医院特征与医院费率有关 剖宫产后的劳动和剖宫产成功后的阴道出生，并且存在大量 孕产妇发病率以及孕产妇发病率的种族和种族差异的医院水平差异。 但是，目前尚不清楚医院特征和护理质量如何促进出生的种族分布 有剖宫产的女性的模式，以及先前剖宫产的黑人妇女如何看待她们的护理。 这项混合方法研究将使用重要的统计数据和医院出院数据以及半 对黑人妇女的结构化访谈与先前的剖宫产。具体目的是：1）表征 与先前的女性，医院特征与种族差异之间 剖宫产； 2）探索与先前剖宫产的黑人妇女中围产期护理的经历。 尽管黑人（与白人）的剖宫产较高的剖宫产风险更高 关于为什么发生这种情况的知之甚少。确定对这些结果造成这些结果的因素和过程是 鉴于严重的孕产妇发病率的持续种族分布特别紧急。这项研究的结果将 有助于更好地了解剖宫产结束后与劳动相关的情况 剖宫产，并有助于确定潜在的干预措施，以提高患有妇女的护理质量 先前的剖宫产。