A Dashboard of Racial/Ethnic Disparity in Care Provided by NICUs

NICU 提供的护理中种族/民族差异的仪表板

• 批准号: 9188087
• 负责人: Jochen Profit
• 金额: $ 62.62万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-12-01 至 2020-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9188087
• 关键词: Achievement; Address; Admission activity; Affect; Age; Area; Asians; Automobile Driving; Benchmarking; Birth; California; Caring; Clinical; Cluster Analysis; Comorbidity; Data; Data Collection; Data Set; Dimensions; Ethnic group; Feedback; Foundations; Health Personnel; Hispanics; Hospitalization; Individual; Infant; Infant Care; Knowledge; Light; Link; Measurement; Measures; Methodology; Morbidity - disease rate; Motivation; National Institute of Child Health and Human Development; Neighborhoods; Neonatal Intensive Care Units; Newborn Infant; Nurses; Observational Study; Online Systems; Outcome; Outcome Measure; Pacific Island Americans; Parents; Patients; Perinatal; Play; Population; Positioning Attribute; Pregnancy; Premature Infant; Process; Process Measure; Provider; Quality of Care; Reporting; Research; Research Infrastructure; Research Personnel; Resources; Risk; Risk Factors; Role; Science; Scientific Advances and Accomplishments; Social Environment; Socioeconomic Status; Source; Surveys; System; Tern; Testing; Time; Translating; Validity and Reliability; Variant; Vermont; Very Low Birth Weight Infant; Work; base; built environment; care delivery; collaborative care; contextual factors; dashboard; design; ethnic difference; ethnic disparity; experience; health care disparity; improved; innovation; interest; member; mortality; neonatal care; novel; parity; prospective; public health relevance; racial and ethnic; racial and ethnic disparities; racial difference; social; social organization; success

 DESCRIPTION (provided by applicant): Several studies have shown racial and ethnic disparities in the quality of care provided by neonatal intensive care units (NICUs) to very low-birth-weight (VLBW; 1500g) infants. However, no routine comprehensive assessment of this problem exists, depriving health care providers of a roadmap to improvement. Feedback of information about quality has been used successfully to improve care and outcomes for VLBW infants and may be applied to reduce or eliminate disparity in outcomes. We therefore propose to study racial and ethnic differences in quality of care provided by NICUs to VLBW infants and to translate our findings into a web-based real-time disparity dashboard. Employing unique existing resources and linked data sets not available elsewhere, we submit an unprecedented opportunity to address this high-priority topic. We propose a large population-scale observational study to analyze routinely collected data from 2008 to 2018 from ~350,000 VLBW infants in more than 700 NICUs that are members of the California Perinatal Quality Care Collaborative or the Vermont Oxford Network. Together, these NICUs cover 85 percent of the VLBW infant birth hospitalizations in the US. Our analysis will use the Baby-MONITOR, a novel, valid and reliable composite measure of NICU quality developed by us in prior work, and its nine subcomponents, which together span quality of care delivery throughout the birth hospitalization. Our rationale for using the composite and its subcomponents is that comprehensive measurement will promote comprehensive improvement. This study is designed to achieve 3 specific aims: 1) Identify racial/ethnic differences and contributing factors in the quality of care provided within and between NICUs; 2) Identify racial/ethnic disparity profiles based on Baby-MONITOR sub-components within NICUs; and 3) Develop benchmarking reports of racial/ethnic disparity in quality of care delivery for NICUs. The datasets we will use afford more extensive opportunities to control for co-morbidities, social, and organizational risk factors than have been available in previous large-scale analyses of newborn outcome disparities, presenting the opportunity to study the role played by neighborhood level factors in VLBW quality of care delivery. Our work will focus on Black-White differences, disparities for Hispanics, and disparities for Asian and Pacific Islanders. As we conduct our analysis of disparities in NICU quality of care delivery, we will also advance the science of quality improvement by employing Bayesian longitudinal and prospective methodologies that allow NICU providers to assess and forecast disparities in care delivery.

 描述（由适用提供）：几项研究表明，新生儿重症监护病房（NICUS）提供的护理质量的赛车和种族差异（vlbw; 1500G）婴儿提供了赛车和种族差异。但是，对此问题没有常规的全面评估，剥夺了医疗保健提供者的改进路线图。有关质量的信息的反馈已成功地用于改善VLBW婴儿的护理和结果，并可以用于减少或消除结果的差异。因此，我们建议研究NICU为VLBW婴儿提供的护理质量的种族和种族差异，并将我们的发现转化为基于网络的实时差异仪表板。我们采用独特的现有资源和链接的数据集，我们提交了一个前所未有的机会来解决这个高优先级主题。我们提出了一项大量的人口规模的观察性研究，以分析2008年至2018年的常规收集数据，从约有700多名NICU的350,000名VLBW婴儿是加利福尼亚围产期质量护理协作或佛蒙特州牛津网络的成员。这些NICUS共同覆盖了美国VLBW婴儿出生住院的85％。我们的分析将使用Baby-Monitor，这是我们在先前工作中开发的新型，有效且可靠的NICU质量的复合度量，以及其9个子组件，在整个出生住院期间，它将涵盖了护理质量的质量。我们使用该复合材料及其子组件的理由是，全面的测量将促进全面的改进。这项研究旨在实现3个具体目标：1）确定NICUS和NICUS之间提供的护理质量的种族/种族差异以及促成因素； 2）根据NICUS内的婴儿监测子组件确定种族/种族差异概况； 3）制定基准报告，在NICUS的护理质量提供质量方面的种族/种族差异。与以前对新生儿结果差异的大规模分析相比，我们将使用的数据集可为控制合并症，社会和组织风险因素提供更多的广泛机会，这提供了研究邻里水平因素在VLBW护理质量交付质量中所起的作用的机会。我们的工作将集中于黑白差异，西班牙裔差异以及亚洲和太平洋岛民的差异。当我们对NICU护理质量交付方面的差异进行分析时，我们还将通过采用贝叶斯纵向和前瞻性方法来提高质量改进的科学，从而使NICU提供者能够评估和预测护理交付中的分布。