Identifying and Mitigating Health Disparities Following a Neonatal Intensive Care Unit (NICU) Design Change from Open Bay to Single Family Rooms

新生儿重症监护病房 (NICU) 设计从开放式病房改为单户家庭病房后，确定并减少健康差异

• 批准号: 10412626
• 负责人: Stephanie Teixeira-Poit
• 金额: $ 14.22万
• 依托单位: NORTH CAROLINA AGRI & TECH ST UNIV
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10412626
• 关键词: African American student; Anecdotes; Area; Attention; Black race; Caring; Child Health; Communities; Cone; Data; Data Analyses; Data Collection; Development; Disadvantaged; Economics; Ensure; Environment; Ethnic Origin; Evaluation; Family; Frequencies; Health; Health system; Historically Black Colleges and Universities; Inequality; Interview; Latinx; Lead; Learning; Lighting; Literature; Low income; Maternal and Child Health; Medical; Methods; Mothers; Needs Assessment; Neonatal Intensive Care Units; Newborn Infant; Noise; Nurses; Outcome; Parents; Patient Care Team; Patients; Perception; Policies; Premature Birth; Procedures; Process; Quality of Care; Race; Recommendation; Reduce health disparities; Research; Review Literature; Safety; Schools; Sensory Deprivation; Socioeconomic Status; Structure; Students; Surveys; Time; Transportation; Woman; Workload; care delivery; design; disparity reduction; experience; health care delivery; health disparity; improved; job market; neonate; patient subsets; racial disparity; skills; social health determinants; trend

Project Abstract With over 400,000 preterm births in the US annually, neonatal intensive care units (NICUs) are critical to providing high quality care and ensuring optimal health outcomes for neonates. Neonatal intensive care units (NICUs) began as open-bays (large rooms, variable size, and multiple newborns admitted), but the latest NICU design and a growing trend is single family rooms that typically have only one baby admitted per room and accommodate at least one parent rooming-in. The scholarly literature provides mixed- evidence on the impact of NICU design changes on patient health outcomes and patient experience of care. Also, a recent community needs assessment called to reduce disparities in maternal and child health by race and ethnicity. These lead us to conduct a mixed-methods process and outcome evaluation examining the impact of a NICU transition from open bay to single family rooms that occurred at Cone Health in Greensboro, NC. A theoretical benefit of single family room designs is increased parent-neonate bonding time, yet this assumes that parents routinely room-in with neonates. Black and low income parents may experience economic and transportation hardships that constrain their opportunity to room-in at the frequency of white and economically privileged parents. Thus, we hypothesize that single family rooms disproportionately benefit neonates from economically privileged families (predominantly white) compared to neonates from families with low incomes (predominantly Black and LatinX in our community). We will conduct a mixed-methods study that triangulates patient health outcome data, patient experience surveys, and in-depth interviews with NICU staff to explore whether different patient sub-populations unequally benefited from or were unintentionally harmed by a NICU design change from open-bay to single family rooms. A secondary data analysis will help us determine whether patient health outcomes and patient experience of care changed before vs. after the NICU transition from open-bay to single family rooms. We will examine health disparities across patient sub-populations, with special attention to race/ethnicity and socioeconomic status. We will then collect and analyze qualitative data to provide rich detail on processes that reproduce health disparities; we will explore barriers and facilitators to implementing strategies to mitigate unintended consequences, improve care delivery, improve health outcomes, and reduce health disparities among patient sub- populations. Using a community engaged approach with a Stakeholder Advisory Board, we will develop a conceptual framework on the impact of NICU design changes and disseminate lessons learned and actionable recommendations to drive systemic changes to policies and procedures at health systems to improve patient quality of care, improve health outcomes, and reduce health disparities.

项目摘要 每年在美国拥有超过40万名早产，新生儿重症监护病房（NICUS）对于 提供高质量的护理并确保新生儿的最佳健康状况。新生儿重症监护 单位（NICUS）以开放式阳离子（大房间，可变大小和多个新生儿）开始，但是 最新的NICU设计和增长趋势是单个家庭房，通常只有一个婴儿承认 每个房间，至少可容纳一个父室。学术文献提供了混合 关于NICU设计变化对患者健康结果的影响的证据和患者的经验 关心。此外，最近的社区需求评估被称为减少孕产妇和儿童的差异 通过种族和种族进行健康。这些导致我们进行混合方法和结果 评估检查NICU从开放式海湾过渡到单个家庭房的影响 发生在北卡罗来纳州格林斯伯勒的Cone Health。单个家庭房设计的理论上好处是 增加了父母的封建时间，但这假定父母通常会与新生儿一起房间。 黑人和低收入的父母可能会遇到经济和运输困难来限制 他们有机会以白人和经济特权的父母的频率进行房间。因此，我们 假设单个家庭房从经济特权中受益不成比例 与收入低的家庭相比，家庭（主要是白人）（主要是 我们社区中的黑色和拉丁裔）。我们将进行一项混合方法研究，该研究对患者进行三角调节 健康结果数据，患者体验调查和与NICU员工的深入访谈探索 不同的患者子人群是否不平等受益或无意中受到的伤害 NICU设计从开放式湾变为单个家庭房。二级数据分析将帮助我们 确定患者的健康状况和护理患者的护理经验是否发生了变化 NICU从开放式湾过渡到单个家庭房。我们将检查患者的健康差异 子人群，特别关注种族/种族和社会经济地位。然后我们将收集 并分析定性数据，以提供有关再现健康差异的过程的丰富细节；我们将 探索实施策略以减轻意外后果的障碍和促进者 改善医疗服务，改善健康结果并减少患者子的健康差异 人群。使用利益相关者顾问委员会使用社区参与的方法，我们将开发 关于NICU设计影响的概念框架改变并传播了经验教训，并 可行的建议将卫生系统政策和程序的系统性更改推向 提高患者护理质量，改善健康结果并减少健康差异。