Do Obstetrical Quality Measures Explain Racial Disparities in Perinatal Outcomes

描述（由申请人提供）：新生儿和孕产妇死亡率的持续黑人/白色差异是一个主要的公共卫生问题，与其他国家相比，美国在这些指标上的排名仍然很差。尽管每年在保健方面花费数十亿美元，少数群体妇女几乎占所有分娩的一半，但产科护理的业绩和质量措施尚未得到彻底审查。尽管医院质量与新生儿极低出生体重（VLBW）死亡率和产科结局相关，但很少有研究涉及当前产科质量措施在解释新生儿死亡率和其他孕产妇健康结局（特别是孕产妇死亡率）的种族/民族差异方面的作用。我们提出了一项研究，以调查变异的35个建议产科质量措施，在医院和使用这些措施进行分析，调查种族/民族的差异，新生儿和孕产妇死亡率。我们的目标是：1）在常规数据来源中试用当前产科质量指标，以衡量医院之间的差异; 2）确定产科质量指标是否因种族/民族而异; 3）检查种族/民族差异是否解释了孕产妇和新生儿死亡率中种族/民族差异的变化。研究方法：我们将使用全国住院患者样本（NIS）、纽约州出院摘要数据（SPARCS）和西奈山仓库（电子病历）调查指定医院之间产科质量指标的差异。我们还将使用人口普查局的数据作为社区社会经济地位变量，使用AMA的数据作为医院特征。我们将使用联合委员会和其他国家质量领导人确定的衡量这些质量指标所需的具体数据要素。还将评估质量指标与社会经济状况和临床风险因素之间的关系，以确定最易受偏倚影响的指标。最后，我们将进行分析，以检查产科质量是否因种族/民族而异，以及这些差异是否解释了孕产妇和极低出生体重新生儿死亡率的种族/民族差异。这项研究的信息将提供一个更好的了解在医院的新生儿和产妇护理的质量，并揭示了具体的护理过程，可以改善后，以减少种族/民族的差距在产科相关的结果在未来。

DESCRIPTION (provided by applicant): Persistent Black/White disparities in neonatal and maternal mortality rates are a major public health concern and the United States continues to rank poorly on these measures when compared to other nations. Despite billions of dollars spent in health care annually and nearly half of all births occurring to minority women, performance and quality measures in obstetrical care have yet to be thoroughly examined. Although hospital quality has been associated with neonatal very low birth weight (VLBW) mortality and obstetrical outcomes, little research has addressed the role of current obstetrical quality measures in explaining racial/ethnic disparities in neonatal mortality and other maternal health outcomes, specifically maternal mortality. We propose a study to investigate variability of 35 recommended obstetrical quality measures across hospitals and to conduct analyses using these measures to investigate racial/ethnic disparities in neonatal and maternal mortality rates. Our objectives are to: 1) Pilot the use of current obstetrical quality indicators in routine data sources to measure variability across hospitals; 2) determine whether obstetrical quality measures differ by race/ethnicity and 3) examine whether racial/ethnic differences explain variation in racial/ethnic disparities in maternal and neonatal mortality rates. Methods: We will use the National Inpatient Sample (NIS), New York State Discharge Abstract Data (SPARCS), and the Mount Sinai Warehouse (electronic medical records) to investigate variation in obstetrical quality indicators among designated hospitals. We will also use Census Bureau data for community socio-economic status variables and AMA data for hospital characteristics. We will use the specific data elements required for measurement of these quality indicators as defined by the Joint Commission and other national quality leaders. The relationship between quality indicators and socio-economic status and clinical risk factors will also be assessed in order to identify those indicators most susceptible to bias. Lastly, we will conduct analyses to examine whether obstetrical quality differs by race/ethnicity, and whether such differences explain racial/ethnic disparities in maternal and VLBW neonatal mortality rates. Information from this study will provide a better understanding of quality in neonatal and maternity care in hospitals and reveal specific processes of care that could be improved upon to reduce racial/ethnic disparities in obstetrical-related outcomes in the future.