Disparities in Processes and Outcomes of Care Across Asian/Pacific Islander Populations at Childbirth

在分娩住院期间向母亲和婴儿提供的护理质量方面的种族/族裔差异 直接导致可避免的死亡和发病。亚裔美国人和太平洋岛民（AAPI） 增长最快的种族/族裔群体（25%生活在加州），他们在几个方面经历了显着的差异 这些领域是强大的，值得政策和临床关注。不幸的是，对AAPI人群的研究 相当大的局限性。首先，很少有研究报告AAPI人群，而那些研究报告，通常汇总为 “亚洲人”或“亚裔美国人和太平洋岛民”，掩盖了生物和社会文化的异质性。第- 其次，社会人口学和邻里因素很少用于分娩医院质量的研究。 第三，缺乏多层次的调整，损害了质量比较评估的有效性， 照顾弱势群体的医院。 为了了解AAPI母亲/婴儿在护理过程和结果方面的差异，我们将进行一项比较， 对影响分娩住院护理质量的多层次因素进行综合评价， 通过明确社会人口和邻里影响进行更公平的比较;并评估 使用关键绩效指标为母亲、低风险新生儿和出生时非常 低出生体重儿（VLBW; <1500 g）。 创新的方法包括利用我们独特的多层次数据源提供全面的评估， 以前所未有的粒度为AAPI人群提供医院质量，通过关键指标评估质量 和综合措施，并使用混合方法的方法，以提供独特的见解， 社会文化和邻里因素优化或降低质量的机制。具体目标： 1)测试亚太裔母亲和婴儿在护理过程和结果方面的差异，并确定相关性 有患者和邻里水平的社会危险因素; 2)评估医院绩效对AAPI孕产妇/婴儿人群护理流程和结果的影响- ;及 3)了解AAPI人群的出生和出生住院经历以及差异的驱动因素 护理过程和结果。 我们的建议的一个特殊优势是我们能够利用加州周边地区独特的基础设施， 纳塔尔和产妇优质护理协作组织。在我们之前将免费的高质量 临床，行政和基于调查的数据集包含多层次的因素，我们将研究一个大的人群， 在238名产妇中，对160万名母亲和新生儿（包括约8，000名极低出生体重婴儿）进行了大规模的AAPI样本 医院和138新生儿重症监护病房在加州之间2011-23.这项建议的结果是 预计将产生直接的积极影响，因为在利用我们的专业知识，积极提高质量- 这些评估旨在确定医院和社区可以改进的务实领域。

Racial/ethnic disparities in the quality of care provided to mothers and infants during the birth hospitalizations result directly in avoidable death and morbidity. Asian American and Pacific Islanders (AAPI) represent the fastest growing racial/ethnic group (25% living in California) and they experience significant disparities in several areas that are robust and merit policy and clinical attention. Unfortunately, research of AAPI populations suffers considerable limitations. First, few studies report on AAPI populations and those that do, usually aggregate to “Asian” or “Asian American and Pacific Islander”, masking the biological and sociocultural heterogeneity. Sec- ond, sociodemographic and neighborhood factors are rarely available for studies of hospital quality at childbirth. Third, lack of multilevel adjustment undermines the validity of comparative assessments of quality by penalizing hospitals that care for vulnerable populations. To understand disparities in care processes and outcomes for AAPI mother/infants, we will undertake a compre- hensive appraisal of the multilevel factors associated with quality of care during the birth hospitalization, promote fairer comparisons by making sociodemographic and neighborhood influences explicit; and assess key areas of quality using key performance metrics for care provided to mothers, low-risk newborns, and infants born very low-birth-weight (VLBW; <1500g). Innovative methods include leveraging our unique multilevel data sources to provide comprehensive assess- ments of hospital quality for AAPI populations with unprecedented granularity, assessing quality via key indi- vidual and composite measures, and using a mixed-methods approach to provide unique insights into the mechanisms by which sociocultural and neighborhood factors optimize or degrade quality. Specific aims: 1) Test for disparities in care processes and outcomes among AAPI mothers and infants and identify associations with patient and neighborhood level social risk factors; 2) Assess the impact of hospital performance on care processes and outcomes of AAPI maternal/infant popula- tions; and 3) Understand the birth and birth hospitalization experiences of AAPI populations alongside drivers of disparities in care processes and outcomes. An exceptional strength of our proposal is our ability to leverage the unique infrastructure of the California Peri- natal and Maternal Quality Care Collaboratives. Building on our prior work in linking complimentary high-quality clinical, administrative, and survey-based data sets containing multi-level factors, we will study a large popula- tion-scale AAPI sample of 1.6 million mothers and newborns (including ~8,000 VLBW infants) in 238 maternity hospitals and 138 neonatal intensive care units in California between 2011-23. Results of this proposal are expected to have an immediate positive impact because in leveraging our expertise as active quality improve- ment organizations, they are designed to identify pragmatic areas where hospitals and communities can improve.