The impact of delivery hospital organizational structure and culture on perinatal outcomes

项目摘要 与分娩住院相关的妊娠患者和婴儿的不良结局是 在美国的医院中，这种情况很常见，而且各不相同。组织因素，如 结构和文化，在出生医院是护理和结果的变化的潜在驱动力。孕产妇和 新生儿护理水平是一种组织结构，是医院提供的基于风险的服务， 分别是母亲和婴儿。组织文化是指组织中的信念、观念和价值观， 在医院的产科和新生儿病房，一个关键组成部分是以病人为中心的护理文化。的 母亲和婴儿的护理和健康是相互关联的，但研究尚未正式评估围产期 组织因素，即医院一级孕产妇和新生儿护理交叉产生的因素。 本研究的总体目标是确定产科和新生儿的组织因素 单位，正式由本提案作为围产期概况的组织结构和文化，影响围产期 母亲和婴儿的结果，并驱动医院的变化。汉德利博士将通过以下方式实现这一目标： 评估围产期护理水平概况的影响，2）评估以围产期患者为中心的 护理文化概况，以及3）检查围产期结构和围产期文化概况的相互作用 结果。她的分析将利用一个九个州的回顾性母婴队列，以及主要的 她对加州分娩医院的组织文化调查的数据，将与州数据联系起来， 产生新的数据集。 这个提议是为了让汉德利博士成为一名独立的调查员， 专注于整合卫生服务研究和组织科学，以了解如何 产科和新生儿单位的组织因素影响围产期结局。她的研究将是 辅之以关于观测数据和主要组织数据的先进统计方法的培训， 文化调查数据，以及获取组织行为，动态和变化的深入知识。 与多学科的导师和顾问团队合作， 管理，产科和生物统计学将为她完成这项工作提供宝贵的指导， 规划未来的研究。 了解围产期组织结构和文化概况对围产期的影响 结果对改善围产期护理至关重要。通过更好地了解结果变化的驱动因素 跨医院和组织因素的识别易于改变，这项工作有可能 制定围产期护理政策，为改善组织文化和协调 孕产妇和新生儿护理，并指导未来的变化，在医院，州和国家一级，这是 采取可行的战略，以改善母婴二分体的结果。

PROJECT SUMMARY Adverse outcomes for pregnant patients and infants associated with the hospitalization for childbirth are frequent and vary across hospitals in the United States. Organizational factors, such as organizational structure and culture, in birth hospitals are potential drivers of variation in care and outcomes. Maternal and neonatal levels of care, an organizational structure, are the risk-based services available at a hospital for mothers and infants, respectively. Organizational culture refers to the beliefs, perceptions, and values on obstetric and neonatal units in a hospital, a key component of which is the culture of patient-centered care. The care and health of the mother and infant are interrelated, yet studies have not formally assessed perinatal organizational factors, those created by the intersection of maternal and neonatal care at the hospital level. The overall objective of this study is to determine how organizational factors of obstetric and neonatal units, formalized by this proposal as perinatal profiles of organizational structure and culture, impact perinatal outcomes of mothers and infants and drive hospital variation. Dr. Handley will achieve this objective by 1) assessing the impact of perinatal level of care profiles, 2) assessing the impact of perinatal patient-centered care culture profiles, and 3) examining the interaction of perinatal structure and culture profiles on perinatal outcomes. Her analysis will leverage a nine-state, retrospective cohort of mother-infant pairs as well as primary data from her organizational culture survey of California birth hospitals, which will be linked with state data to produce a novel dataset. This proposal was designed to prepare Dr. Handley to become an independent investigator, specifically focused on integrating health services research and organizational science in order to understand how organizational factors on obstetric and neonatal units affect perinatal outcomes. Her research will be complemented by training in advanced statistical methods for observational data and primary organizational culture survey data as well as acquiring in-depth knowledge of organizational behavior, dynamics, and change. Working with a multidisciplinary team of mentors and advisors with experts from neonatology, health care management, obstetrics, and biostatistics will provide her valuable guidance in the completion of this work and planning of future studies. Understanding the implications of perinatal organizational structure and culture profiles on perinatal outcomes is critical to improving perinatal care. Through better understanding of drivers of outcome variation across hospitals and identification of organizational factors amenable to change, this work has the potential to shape perinatal level of care policies, inform initiatives to improve organizational culture and coordination of maternal and neonatal care, and guide future change at the hospital, state, and national levels, which are actionable strategies to improve outcomes of the mother-infant dyad.