Newborn Circumcision Care Redesign

项目总结/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，降低泌尿道风险， 性传播感染）是最大的包皮环切术时，作为新生儿包皮环切术（NC） 在局部麻醉下，而不是在以后的生活中在全身麻醉下进行手术包皮环切术（OC）。 然而，需要进行婴儿包皮环切术的年轻男孩通常在手术后出现选择性OC。 新生儿期先前的研究表明，社会经济地位较低的男孩在学习上更困难， 获得NC，使OC的风险增加和健康益处减少对男孩产生不利影响 社会经济地位较低。最近的数据显示，医疗补助覆盖面的变化不成比例的NC 与其他种族/民族背景的男孩相比，黑人/非洲裔美国男孩受到的影响更大。可用数据 指出，医疗保健业务和保险覆盖面因素都是造成获得医疗保健机会不平等的原因， NC.芝加哥地区的临床医生访谈已经确定了NC的多种操作障碍，包括临床 物流挑战和缺乏标准化流程，导致NC中存在大量差异 报销，这不利于一些生产医院统一提供NC。 拟议的研究旨在解决的操作障碍，提供NC的愿望的家庭。的 世界卫生组织高质量、高容量NC的循证标准和程序 计划将被用作一个框架（为低收入和中等收入国家制定），并根据 在美国（US）的多个临床环境中使用。本提案的目标是（1）利用 世界卫生组织标准和程序，以制定和实施安全、有效和适应环境的NC 3家医院促进NC公平性的计划;（2）评估每个NC计划对患者的影响 结果;（3）提供NC计划的成本分析，以支持传播。一个多学科 团队（儿科、产科、小儿泌尿科、卫生服务研究、卫生经济学和全球卫生） 已经被召集起来执行研究。这项研究的结果将为美国分娩医院提供 安全、有效和适应环境的NC程序的例子，基于以证据为基础的WHO 标准和程序。这些例子将包括医院和病人的成本分析 以促进传播。最终，通过实施克服这两个问题的NC程序， 由于存在结构性和卫生系统方面的障碍，应改善NC的公平性。

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.