Newborn Circumcision Care Redesign

项目摘要/摘要 包皮环切术是美国最常见的外科手术之一。 围手术期风险最低，成本最低，健康益处(例如，减少尿路风险和 当包皮环切术作为新生儿包皮环切术(NC)时，性传播感染是最严重的 在局部麻醉下，而不是在生命后期在全身麻醉下进行包皮环切术。 然而，希望进行婴儿包皮环切术的年轻男孩通常会在术后参加选择性OC 新生儿期。先前的研究表明，社会经济地位较低的男孩有更多的困难 接触NC，使OC的风险增加和健康益处减少不成比例地影响男孩 社会经济地位较低的人。最近的数据显示，北卡罗来纳州医疗补助覆盖面的变化不成比例 与其他种族/民族背景的男孩相比，影响黑人/非裔美国男孩。可用数据 表明医疗保健业务和保险覆盖范围的因素都是造成获得医疗服务机会差距的原因 北卡罗来纳州。芝加哥地区临床医生访谈确定了NC的多个操作障碍，包括临床 物流挑战和缺乏标准化流程加剧了NC的巨大差异 报销使一些产科医院不再统一提供NC。 这项拟议的研究旨在解决向有意愿的家庭提供NC的操作障碍。这个 世界卫生组织关于高质量、大批量NC的循证标准和程序 方案将被用作一个框架(为低收入和中等收入国家制定)，并对其进行调整 在美国(美国)的多种临床环境中使用。这项提议的目标是(1)利用 开发和实施安全、高效和适应环境的NC的WHO标准和程序 3家医院促进NC公平的计划；(2)评估每个NC计划对患者的影响 结果；以及(3)提供NC程序的成本分析以支持传播。一个多学科的 团队(儿科、产科、儿科泌尿外科、卫生服务研究、卫生经济学和全球卫生) 已经被组装起来进行这项研究。这项研究的发现将为美国的分娩医院提供 基于基于证据的WHO的安全、高效和上下文适应性NC程序的例子 标准和程序。这些例子将包括来自医院和患者的成本分析 为传播提供便利的视角。最终，通过执行NC程序来克服这两个 结构性和卫生体制障碍，北卡罗来纳州的公平性应该得到改善。

PROJECT SUMMARY/ABSTRACT Circumcision is one of the most common surgical procedures performed in the United States. Periprocedural risk is lowest, costs are lowest, and health benefits (e.g., decreased risk of urinary tract and sexually transmitted infections) are greatest when circumcision is performed as a neonatal circumcision (NC) under local anesthesia, rather than as an operative circumcision (OC) under general anesthesia later in life. However, young boys for whom an infant circumcision was desired commonly present for elective OC after the neonatal period. Previous research indicates that boys of lower socioeconomic status have more difficulty accessing NC such that the increased risks and decreased health benefits of OC disproportionally affect boys of lower socioeconomic status. Recent data show that changes in Medicaid coverage of NC disproportionately affect Black/African American boys compared with boys of other racial/ethnic backgrounds. Available data indicate that both healthcare operational and insurance coverage factors contribute to the disparity in access to NC. Chicago-Area clinician interviews have identified multiple operational barriers to NC, including clinical logistical challenges and lack of standardized processes that compound substantial variation in NC reimbursement that dis-incentivizes some birth hospitals from uniformly offering NC. The proposed study aims to address the operational barriers to providing NC to desirous families. The World Health Organization’s evidence-based Standards and Procedures for high-quality, high-volume NC programs will be used as a framework (developed for low- and middle-income countries) and adapted for utilization in multiple clinical settings in the United States (US). The goals of this proposal are to (1) leverage the WHO Standards and Procedures to develop and implement safe, efficient, and contextually-adapted NC programs at 3 hospitals that promote equity of NC; (2) evaluate each NC program’s impact on patient outcomes; and (3) provide a cost analysis of the NC program to support dissemination. A multidisciplinary team (pediatrics, obstetrics, pediatric urology, health services research, health economics, and global health) has been assembled to execute the study. Findings from this study will provide US birthing hospitals with examples of safe, efficient, and contextually adaptable NC programs, based on the evidence-based WHO Standards and Procedures. These examples will include cost analyses from both hospital and patient perspectives to facilitate dissemination. Ultimately, by implementing NC programs that overcome both structural and health system barriers, equity in NC should improve.