A Dashboard of Racial/Ethnic Disparity in Care Provided by NICUs

 描述(由申请人提供)：一些研究表明，新生儿重症监护病房(NICU)为极低出生体重(VLBW；1500克)婴儿提供的护理质量存在种族和民族差异。然而，不存在对这一问题的常规全面评估，剥夺了卫生保健提供者改善的路线图。有关质量信息的反馈已成功地用于改善极低出生体重儿的护理和结局，并可用于减少或消除结局的差异。因此，我们建议研究NICU为极低出生体重儿提供的护理质量的种族和民族差异，并将我们的发现转化为基于网络的实时差异仪表板。利用独特的现有资源和其他地方没有的相关数据集，我们提供了一个前所未有的机会来解决这一高度优先的主题。我们建议进行一项大规模的人口观察研究，以分析从2008年到2018年从700多个NICU中收集的约350,000名VLBW婴儿的常规数据，这些NICU是加州围产期质量护理合作组织或佛蒙特州牛津网络的成员。这些NICU总共覆盖了美国85%的VLBW婴儿住院分娩。我们的分析将使用婴儿监护仪，这是我们在之前的工作中开发的一种新颖、有效和可靠的NICU质量综合衡量标准，及其九个子组件，它们一起跨越了分娩住院期间的护理提供质量。我们使用复合体及其子组件的理由是，综合测量将促进综合改进。这项研究旨在实现3个具体目标：1)确定在NICU内和NICU之间提供的护理质量方面的种族/民族差异和促成因素；2)根据NICU内的婴儿监控子部分确定种族/民族差异情况；以及3)制定NICU在提供护理质量方面的种族/民族差异的基准报告。与以前对新生儿结局差异的大规模分析相比，我们将使用的数据集提供了更广泛的机会来控制共病、社会和组织风险因素，这为研究邻里水平因素在极低出生体重儿护理提供质量中所起的作用提供了机会。我们的工作将集中在黑人和白人的差异，拉美裔的差异，以及亚洲和太平洋岛民的差异。随着我们对NICU护理服务质量差异的分析，我们还将通过使用贝叶斯纵向和前瞻性方法来推进质量改进的科学，使NICU提供者能够评估和预测护理服务提供方面的差异。

 DESCRIPTION (provided by applicant): Several studies have shown racial and ethnic disparities in the quality of care provided by neonatal intensive care units (NICUs) to very low-birth-weight (VLBW; 1500g) infants. However, no routine comprehensive assessment of this problem exists, depriving health care providers of a roadmap to improvement. Feedback of information about quality has been used successfully to improve care and outcomes for VLBW infants and may be applied to reduce or eliminate disparity in outcomes. We therefore propose to study racial and ethnic differences in quality of care provided by NICUs to VLBW infants and to translate our findings into a web-based real-time disparity dashboard. Employing unique existing resources and linked data sets not available elsewhere, we submit an unprecedented opportunity to address this high-priority topic. We propose a large population-scale observational study to analyze routinely collected data from 2008 to 2018 from ~350,000 VLBW infants in more than 700 NICUs that are members of the California Perinatal Quality Care Collaborative or the Vermont Oxford Network. Together, these NICUs cover 85 percent of the VLBW infant birth hospitalizations in the US. Our analysis will use the Baby-MONITOR, a novel, valid and reliable composite measure of NICU quality developed by us in prior work, and its nine subcomponents, which together span quality of care delivery throughout the birth hospitalization. Our rationale for using the composite and its subcomponents is that comprehensive measurement will promote comprehensive improvement. This study is designed to achieve 3 specific aims: 1) Identify racial/ethnic differences and contributing factors in the quality of care provided within and between NICUs; 2) Identify racial/ethnic disparity profiles based on Baby-MONITOR sub-components within NICUs; and 3) Develop benchmarking reports of racial/ethnic disparity in quality of care delivery for NICUs. The datasets we will use afford more extensive opportunities to control for co-morbidities, social, and organizational risk factors than have been available in previous large-scale analyses of newborn outcome disparities, presenting the opportunity to study the role played by neighborhood level factors in VLBW quality of care delivery. Our work will focus on Black-White differences, disparities for Hispanics, and disparities for Asian and Pacific Islanders. As we conduct our analysis of disparities in NICU quality of care delivery, we will also advance the science of quality improvement by employing Bayesian longitudinal and prospective methodologies that allow NICU providers to assess and forecast disparities in care delivery.