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 解决黑人妇女严重孕产妇发病率居高不下的问题是一个紧迫的公共问题。 健康优先。在美国每年380万的新生儿中，近三分之一是通过剖腹产分娩的，这是一个很大的风险。 严重孕产妇发病率的危险因素，剖宫产率在黑人妇女中高于 白色女人。对于剖腹产后分娩的妇女，阴道分娩的产妇发病率最低， 但计划外（与计划内）重复剖宫产的比例更高。在出生方面存在种族和民族差异 在有剖腹产史的妇女中，黑人妇女更有可能有计划外的重复剖腹产 与白色女性相比，这些差异很少被理解。最常见的适应症 初次剖宫产是主观的，并因种族而异-这表明护理质量和 护理过程中的种族-但鲜为人知的是，在妇女计划外剖宫产的迹象， 剖腹产后分娩先前的工作也已经确定了医院的特点与住院率有关 剖宫产后的劳动利用和剖宫产后的阴道分娩成功，并有大量的 医院一级产妇发病率的差异以及产妇发病率的种族和族裔差异。 然而，目前还不清楚医院的特点和护理质量如何导致出生的种族差异 模式的妇女与先前剖腹产，以及如何黑人妇女与先前剖腹产认为他们的照顾。 这项混合方法研究将使用联合的生命统计和出院数据以及来自半 对有剖腹产史的黑人妇女进行结构化访谈。具体目标是：1）表征 既往有生育史妇女中医院特征与生育方式种族差异之间的关系 2）探讨有剖宫产史的黑人妇女的围产期保健经验。 尽管黑人（比白色）妇女有更高的计划外剖宫产风险， 人们对为什么会发生这种情况知之甚少。确定促成这些结果的因素和过程， 鉴于在严重孕产妇发病率方面持续存在的种族差异，这一问题尤为紧迫。这项研究的结果将 有助于更好地了解剖宫产后分娩的情况， 剖腹产，并帮助确定潜在的干预措施，以提高妇女的护理质量， 既往剖腹产。