Hospital Quality and Racial/Ethnic Disparities in Severe Maternal Morbidity

严重孕产妇发病率中的医院质量和种族/民族差异

• 批准号: 8890200
• 负责人: Elizabeth A Howell
• 金额: $ 41.75万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-10 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8890200
• 关键词: Address; Affect; American College of Obstetricians and Gynecologists; Area; Cardiomyopathies; Caring; Case Fatality Rates; Cessation of life; Characteristics; Communication; Communities; Community Hospitals; Complication; Country; Data; Decision Making; Diagnosis; Discipline of obstetrics; Disease; Eclampsia; Educational process of instructing; Embolism; Employee Strikes; Future; Geographic Locations; Health; Hemorrhage; High Prevalence; Hospitals; Inpatients; Intervention; Joints; Kidney Failure; Knowledge; Latino; Leadership; Life; Live Birth; Maternal Mortality; Mechanical ventilation; Medicine; Methods; Minority; Minority Groups; Morbidity - disease rate; Mothers; Neonatal Mortality; New York City; Newborn Infant; Outcome; Patients; Phase; Population; Pregnancy; Pregnancy Complications; Procedures; Process; Quality of Care; Research; Risk; Septicemia; Shock; Time; Transfusion; United States; Urban Hospitals; Variant; Very Low Birth Weight Infant; Woman; Work; World Health Organization; ethnic minority population; experience; health care quality; high risk; improved; maternal morbidity; member; mortality; patient oriented; pregnancy disorder; racial and ethnic; racial and ethnic disparities; risk perception; uptake

DESCRIPTION (provided by applicant): Black women are 3 to 4 times more likely to suffer a pregnancy-related death than are white women. The maternal mortality ratio-the number of maternal deaths per 100,000 live births-in the U.S. is high compared to other countries. In New York City the maternal mortality ratio has been above the national average for 40 years and currently ranks among the highest in the US. Racial/ethnic disparities in New York City are more alarming as black women are 7 times more likely to die from pregnancy-related causes than white women. Potentially fatal complications of pregnancy include hemorrhage, hypertensive disorders of pregnancy, and cardiomyopathy and black women suffer greater mortality from all of them. Deaths associated with pregnancy in the United States are the "tip of the iceberg"; for every maternal death, 100 women experience severe maternal morbidity-potentially life-threatening diagnosis or receipt of a life-saving procedure. Severe maternal morbidity affects approximately 52,000 women annually in the US. Similar to racial/ethnic disparities in maternal mortality, black women are much more likely to suffer from severe maternal morbidity than white women. Since a significant proportion of maternal mortality and morbidity is considered preventable, quality of health care delivered in hospitals may represent a major lever for improving outcomes. We propose a mixed methods study to investigate the extent to which improving hospital quality could reduce racial/ethnic disparities in severe maternal morbidity. The objectives of this study are to: 1) Rank New York City hospitals by risk-adjusted severe maternal morbidity and examine disparities in the distribution of white, black, and Latino deliveries among these hospitals; 2) Use mixed methods to explore processes of care, unit characteristics, organizational factors, and patient factors associated with high and low rates of severe maternal morbidity hospitals; 3) Explore patients' perspectives on barriers to receipt of high quality care including their decision- making regarding delivery hospital, and perception of risk; and 4) Disseminate findings among key community and hospital stakeholders who have the power to promote uptake of the best practices and address the patient concerns. In the final phase of this project, we will bring leaders of obstetrics, NYC and State Department of Health officials, The Joint Commission, the American College of Obstetricians and Gynecologists, hospital quality leaders, community leaders, and mothers to discuss our results. We will explore interventions to improve care for women in NYC and narrow racial/ethnic maternal morbidity disparities and develop patient- centered strategies to reduce barriers to receipt of high quality care. This study aims to produce knowledge about organizational factors and processes of care that are of high relevance for the provision of quality inpatient maternity care; this information will be specifically tailored to units serving minority populations and applicable to other areas i the U.S. where racial/ethnic disparities exist between hospitals.

描述（由申请人提供）：黑人妇女遭受与怀孕有关的死亡的可能性是白人妇女的3倍。与其他国家相比，孕产妇死亡率是美国每10万活产的孕产妇死亡人数很高。在纽约市，孕产妇死亡率已超过全国平均水平已有40年了，目前在美国最高。纽约市的种族/族裔差异更令人震惊，因为黑人妇女因与白人妇女的死亡可能性高7倍。怀孕的潜在致命并发症包括出血，怀孕的高血压疾病以及心肌病和黑人妇女的死亡人数更大。与美国怀孕有关的死亡是“冰山一角”。对于每一次孕产妇死亡，有100名妇女都会经历严重的母亲发病率，以肯定生命的诊断或挽救生命的程序。在美国，严重的孕产妇发病率每年影响约52,000名妇女。与孕产妇死亡率中的种族/种族差异相似，黑人妇女比白人妇女更有可能患有严重的孕产妇发病率。由于孕产妇死亡率和发病率的很大一部分被认为是可预防的，因此医院提供的医疗保健质量可能代表改善预后的主要杠杆。我们提出了一项混合方法研究，以研究改善医院质量可以减少严重孕产妇发病率的种族/种族差异的程度。这项研究的目标是：1）通过风险调整的严重孕产妇发病率对纽约市医院进行排名，并检查这些医院中白人，黑人和拉丁裔分娩的分布差异； 2）使用混合方法来探索与高和低孕产妇发病率医院相关的护理过程，单位特征，组织因素和患者因素； 3）探讨患者对接受高质量护理的障碍的观点，包括他们关于分娩医院的决策以及对风险的看法； 4）在有权促进最佳实践并解决患者担忧的主要社区和医院利益相关者之间传播发现。在该项目的最后阶段，我们将带您的妇产科，纽约市和州卫生部，联合委员会，美国产科医生和妇科学院，医院质量领导人，社区领导者和母亲的领导人讨论我们的结果。我们将探讨采取干预措施，以改善纽约市女性的护理和狭窄的种族/族裔母体发病率差异，并制定以患者为中心的策略，以减少获得高质量护理的障碍。这项研究旨在提供有关组织因素和护理过程的知识，这些知识与提供高质量的住院产妇护理具有很高的相关性；该信息将专门针对为少数族裔人口提供服务的部门，并适用于美国在医院之间存在种族/族裔差异的其他领域。