Differences in Labor Progress, Care Received During Labor, and Provider-Patient Communication and Decision-Making Quality among Low-Risk Black vs. White Nulliparous Women with Spontaneous Labor Onset

自然分娩的低风险黑人与白人初产妇女在分娩进展、分娩期间接受的护理以及医患沟通和决策质量方面的差异

• 批准号: 10218513
• 负责人: JEREMY L NEAL
• 金额: $ 25.55万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-12 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10218513
• 关键词: Academic Medical Centers; Accounting; Adopted; American College of Obstetricians and Gynecologists; Birth; Birth Rate; Caring; Categories; Cervical; Cesarean section; Characteristics; Clinical; Cohort Studies; Communication; Data; Data Collection; Data Set; Decision Making; Diagnosis; Diagnostic; Discipline of obstetrics; Dystocia; Elements; Fetus; Guidelines; Health Care Costs; Hospitalization; Hospitals; Institution; Intervention; Labor Dystocia; Labor Onset; Logistics; Maternal-fetal medicine; Measures; Medical; Methods; Midwife; Modeling; Nulliparity; Outcome; Patients; Perception; Perinatal mortality demographics; Polynomial Models; Postpartum Period; Pregnancy; Provider; Public Health; Publishing; Race; Research; Risk; Safety; Sampling; Societies; Testing; United States; Woman; base; black patient; black women; clinical care; disparity elimination; experience; health care settings; health equity; implicit bias; improved; intrapartum; patient-clinician communication; perinatal morbidity; perinatal outcomes; population health; prevent; provider adherence; racial difference; racial disparity; recruit; satisfaction; shared decision making; treatment disparity

PROJECT SUMMARY The disparity in primary cesarean birth rates between low-risk Black and White nulliparous women with a term, single, vertex fetus (NTSV) in the United States is greater than ever before. This is concerning because NTSV women enter hospitals with similar baseline risks for cesarean birth. Safely lowering the cesarean rate, eliminating disparities, and achieving health equity for all groups are ongoing national priorities. It is unknown why disparities in cesarean rates exist between races but differences in labor progress, provider-level practice, or provider-patient communication and decision making quality may be contributory. Dystocia (slow, abnormal progression of labor) is the indication for half of cesareans among NTSV women, yet this diagnostic category remains poorly defined and provides a key opportunity to safely reduce primary cesarean births. There is contradictory evidence regarding whether Black and White NTSV women have similar dilation rates during labor. If racial differences in labor progress exist, this would have major implications for diagnosing dystocia and clinical determinations for performing cesarean births. Furthermore, it is unclear if provider application of American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine guidelines for safely preventing primary cesareans are applied differently based on maternal race. Finally, disparate provider-patient communications and decision making as well as provider implicit bias may contribute to higher cesarean rates for Black NTSV women although this has not yet been studied. The purpose of this study is to compare Black and White NTSV women with spontaneous labor onset on (1) labor progress, (2) care received during labor, and (3) indicators of provider-patient communication and decision making quality. Retrospective and cross- sectional data will be collected for this study. Labor and birth data will be retrospectively collected from Black and White NTSV women who birthed at Vanderbilt University Medical Center following a pregnancy with spontaneous labor onset since 2015 (n ≈ 7,150). For cross-sectional data collection, Black (n = 140) and White (n = 140) women who birthed following a NTSV pregnancy with spontaneous labor onset will be recruited and complete measures during their postpartum hospitalizations. Regression methods (polynomial, multiple logistic, and linear) and will primarily be used to test hypotheses. Labor attendant type, maternal and pregnancy characteristics, and common labor interventions will be model covariates. If study hypotheses are supported, specific guidelines for assessing progress and diagnosing dystocia based on race may be necessary for closing the cesarean rate disparity. Moreover, study findings will be the first to describe Black vs. White provider-patient communication and decision making quality in an obstetrical setting at a high-volume, academic medical center. Findings from this R21 study will inform next research steps necessary for improving clinical care and closing the Black vs. White disparity in cesarean births.

项目摘要 低风险的黑人和白色无效的妇女的原发性剖宫产差异的差异， 美国的单个顶点胎儿（NTSV）比以往任何时候都要大。这是因为NTSV 妇女进入具有剖宫产的基线风险的医院。安全降低剖宫产， 消除差距和实现所有团体的健康公平性是持续的国家优先事项。这是未知的 为什么种族之间存在剖宫产的分布，而劳动进度的差异，提供者级实践， 或提供者与患者的沟通和决策质量可能是贡献的。障碍赛（慢，异常 劳动进展）是NTSV妇女中一半的剖宫产的指示，但是该诊断类别 仍然定义不佳，并提供了一个关键的机会，可以安全地减少原发性剖宫产。有 关于黑人和白人NTSV妇女在劳动期间是否具有相似的词典率的矛盾证据。 如果存在劳动进步的种族差异，这将对诊断性障碍和临床产生重大影响 进行剖宫产的确定。此外，目前尚不清楚提供商是否应用美国 产科医生和妇科医生学院以及安全的孕产妇医学协会安全的指南 根据孕产妇种族，预防原发性剖宫产的应用不同。最后，不同的提供者患者 通信和决策以及提供者的隐性偏见可能会导致更高的剖宫产 对于黑人NTSV妇女来说，虽然尚未对此进行研究。这项研究的目的是比较黑色 和白人NTSV妇女（1）劳动进展，（2）在分娩期间接受的护理，（2） （3）提供者与患者交流和决策质量的指标。回顾和交叉 该研究将收集分段数据。劳动和出生数据将回顾性地从黑色收集 怀孕后在范德比尔特大学医学中心出生的白人NTSV妇女 自2015年以来的发作发作（N≈7,150）。对于横截面数据收集，黑色（n = 140）和白色 （n = 140）招募NTSV怀孕后出生后出生的妇女将被招募，并且 在产后住院期间采取的措施。回归方法（多项式，多逻辑， 和线性），主要用于检验假设。劳动服务员类型，孕产妇和怀孕 特征和常见的劳动干预将是模型协变量。如果支持研究假设， 可能需要根据种族来评估进度和诊断性障碍的具体指南 剖宫产差异。此外，研究结果将是第一个描述黑人与白人提供者患者的发现 在大批学术医学中心的产科环境中的沟通和决策质量。 这项R21研究的发现将为改善临床护理和关闭所需的下一个研究步骤提供信息 剖宫产中的黑色与白色差异。