Hospital Quality and Racial/Ethnic Disparities in Severe Maternal Morbidity

描述（由申请人提供）：黑人妇女因怀孕死亡的可能性是白人妇女的3至4倍。与其他国家相比，美国的产妇死亡率（每10万例活产的产妇死亡人数）很高。纽约市的孕产妇死亡率40年来一直高于全国平均水平，目前在美国名列前茅。纽约市的种族/民族差异更令人担忧，因为黑人妇女死于与怀孕有关的原因的可能性是白人妇女的7倍。可能致命的妊娠并发症包括出血、妊娠高血压疾病和心肌病，黑人妇女在所有这些方面的死亡率都更高。在美国，与怀孕有关的死亡只是“冰山一角”；每有一名产妇死亡，就有100名妇女出现严重的产妇发病率——可能危及生命的诊断或接受挽救生命的手术。在美国，每年约有5.2万名妇女罹患严重的孕产妇疾病。与产妇死亡率的种族/族裔差异类似，黑人妇女比白人妇女更有可能患严重的产妇发病率。由于很大一部分产妇死亡率和发病率被认为是可以预防的，因此医院提供的保健服务的质量可能是改善结果的一个主要杠杆。我们提出了一项混合方法研究，以调查改善医院质量在多大程度上可以减少严重孕产妇发病率的种族/民族差异。本研究的目的是：1)根据风险调整后的严重产妇发病率对纽约市医院进行排名，并检查这些医院中白人、黑人和拉丁裔分娩分布的差异；2)采用混合方法探讨重症孕产妇发病率高、低医院的护理过程、单位特点、组织因素和患者因素；3)探讨患者对接受高质量护理的障碍的看法，包括他们对分娩医院的决策和风险感知；4)在社区和医院的主要利益相关者中传播调查结果，他们有能力促进采用最佳做法并解决患者的问题。在这个项目的最后阶段，我们将邀请妇产科的领导、纽约市和州卫生部的官员、联合委员会、美国妇产科医师学会、医院质量领导、社区领导和母亲们来讨论我们的结果。我们将探索干预措施，以改善纽约市妇女的护理，缩小种族/民族产妇发病率差异，并制定以患者为中心的策略，以减少接受高质量护理的障碍。本研究的目的是产生知识的组织因素和护理过程，是高相关性的提供优质住院产妇护理；这些信息将专门针对为少数民族人口服务的单位，并适用于美国医院之间存在种族/民族差异的其他地区。

DESCRIPTION (provided by applicant): Black women are 3 to 4 times more likely to suffer a pregnancy-related death than are white women. The maternal mortality ratio-the number of maternal deaths per 100,000 live births-in the U.S. is high compared to other countries. In New York City the maternal mortality ratio has been above the national average for 40 years and currently ranks among the highest in the US. Racial/ethnic disparities in New York City are more alarming as black women are 7 times more likely to die from pregnancy-related causes than white women. Potentially fatal complications of pregnancy include hemorrhage, hypertensive disorders of pregnancy, and cardiomyopathy and black women suffer greater mortality from all of them. Deaths associated with pregnancy in the United States are the "tip of the iceberg"; for every maternal death, 100 women experience severe maternal morbidity-potentially life-threatening diagnosis or receipt of a life-saving procedure. Severe maternal morbidity affects approximately 52,000 women annually in the US. Similar to racial/ethnic disparities in maternal mortality, black women are much more likely to suffer from severe maternal morbidity than white women. Since a significant proportion of maternal mortality and morbidity is considered preventable, quality of health care delivered in hospitals may represent a major lever for improving outcomes. We propose a mixed methods study to investigate the extent to which improving hospital quality could reduce racial/ethnic disparities in severe maternal morbidity. The objectives of this study are to: 1) Rank New York City hospitals by risk-adjusted severe maternal morbidity and examine disparities in the distribution of white, black, and Latino deliveries among these hospitals; 2) Use mixed methods to explore processes of care, unit characteristics, organizational factors, and patient factors associated with high and low rates of severe maternal morbidity hospitals; 3) Explore patients' perspectives on barriers to receipt of high quality care including their decision- making regarding delivery hospital, and perception of risk; and 4) Disseminate findings among key community and hospital stakeholders who have the power to promote uptake of the best practices and address the patient concerns. In the final phase of this project, we will bring leaders of obstetrics, NYC and State Department of Health officials, The Joint Commission, the American College of Obstetricians and Gynecologists, hospital quality leaders, community leaders, and mothers to discuss our results. We will explore interventions to improve care for women in NYC and narrow racial/ethnic maternal morbidity disparities and develop patient- centered strategies to reduce barriers to receipt of high quality care. This study aims to produce knowledge about organizational factors and processes of care that are of high relevance for the provision of quality inpatient maternity care; this information will be specifically tailored to units serving minority populations and applicable to other areas i the U.S. where racial/ethnic disparities exist between hospitals.