Disparities in Processes and Outcomes of Care Across Asian/Pacific Islander Populations at Childbirth

亚洲/太平洋岛民分娩护理过程和结果的差异

• 批准号: 10455642
• 负责人: Elliott K Main
• 金额: $ 66.99万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10455642
• 关键词: Accounting; Acculturation; Address; Affect; Area; Asian; Asian Americans; Asian Pacific Islander; Asian population; Attention; Benchmarking; Biological; Birth; Birth Rate; Black Populations; California; Caring; Cesarean section; Cessation of life; Childbirth; Chinese; Clinical; Collaborations; Communities; Country; Data; Data Set; Data Sources; Epidemiology; Episiotomy; Ethnic Origin; Ethnic group; Filipino; Future; Geography; Health; Heterogeneity; Hispanic Populations; Hospitalization; Hospitals; Human Milk; Immigration; Individual; Infant; Infant Care; Infrastructure; Interview; Japanese; Joints; Knowledge; Laceration; Link; Literature; Masks; Maternity Hospitals; Measures; Medical; Methods; Monitor; Morbidity - disease rate; Mothers; National Health Policy; Neighborhoods; Neonatal Intensive Care Units; Newborn Infant; Not Hispanic or Latino; Nulliparity; Outcome; Pacific Islander; Parents; Patients; Performance; Perinatal; Persons; Policies; Population; Positioning Attribute; Process; Provider; Quality of Care; Race; Recording of previous events; Reporting; Research; Research Personnel; Risk; Risk Factors; Sampling; Small for Gestational Age Infant; Socioeconomic Status; Structure; Subgroup; Surveys; Testing; Translating; United States; Variant; Very Low Birth Weight Infant; Vulnerable Populations; Work; base; breastfed newborn; care delivery; care outcomes; collaborative care; comparative; data resource; design; disparity reduction; experience; health care disparity; high risk population; hospital performance; improved; innovation; insight; member; mortality; multidisciplinary; policy recommendation; population based; quality improvement organization; racial and ethnic; racial and ethnic disparities; severe maternal morbidity; social; social culture; sociodemographics; success; Accounting; Acculturation; Address; Affect; Area; Asian; Asian Americans; Asian Pacific Islander; Asian population; Attention; Benchmarking; Biological; Birth; Birth Rate; Black Populations; California; Caring; Cesarean section; Cessation of life; Childbirth; Chinese; Clinical; Collaborations; Communities; Country; Data; Data Set; Data Sources; Epidemiology; Episiotomy; Ethnic Origin; Ethnic group; Filipino; Future; Geography; Health; Heterogeneity; Hispanic Populations; Hospitalization; Hospitals; Human Milk; Immigration; Individual; Infant; Infant Care; Infrastructure; Interview; Japanese; Joints; Knowledge; Laceration; Link; Literature; Masks; Maternity Hospitals; Measures; Medical; Methods; Monitor; Morbidity - disease rate; Mothers; National Health Policy; Neighborhoods; Neonatal Intensive Care Units; Newborn Infant; Not Hispanic or Latino; Nulliparity; Outcome; Pacific Islander; Parents; Patients; Performance; Perinatal; Persons; Policies; Population; Positioning Attribute; Process; Provider; Quality of Care; Race; Recording of previous events; Reporting; Research; Research Personnel; Risk; Risk Factors; Sampling; Small for Gestational Age Infant; Socioeconomic Status; Structure; Subgroup; Surveys; Testing; Translating; United States; Variant; Very Low Birth Weight Infant; Vulnerable Populations; Work; base; breastfed newborn; care delivery; care outcomes; collaborative care; comparative; data resource; design; disparity reduction; experience; health care disparity; high risk population; hospital performance; improved; innovation; insight; member; mortality; multidisciplinary; policy recommendation; population based; quality improvement organization; racial and ethnic; racial and ethnic disparities; severe maternal morbidity; social; social culture; sociodemographics; success

Racial/ethnic disparities in the quality of care provided to mothers and infants during the birth hospitalizations result directly in avoidable death and morbidity. Asian American and Pacific Islanders (AAPI) represent the fastest growing racial/ethnic group (25% living in California) and they experience significant disparities in several areas that are robust and merit policy and clinical attention. Unfortunately, research of AAPI populations suffers considerable limitations. First, few studies report on AAPI populations and those that do, usually aggregate to “Asian” or “Asian American and Pacific Islander”, masking the biological and sociocultural heterogeneity. Sec- ond, sociodemographic and neighborhood factors are rarely available for studies of hospital quality at childbirth. Third, lack of multilevel adjustment undermines the validity of comparative assessments of quality by penalizing hospitals that care for vulnerable populations. To understand disparities in care processes and outcomes for AAPI mother/infants, we will undertake a compre- hensive appraisal of the multilevel factors associated with quality of care during the birth hospitalization, promote fairer comparisons by making sociodemographic and neighborhood influences explicit; and assess key areas of quality using key performance metrics for care provided to mothers, low-risk newborns, and infants born very low-birth-weight (VLBW; <1500g). Innovative methods include leveraging our unique multilevel data sources to provide comprehensive assess- ments of hospital quality for AAPI populations with unprecedented granularity, assessing quality via key indi- vidual and composite measures, and using a mixed-methods approach to provide unique insights into the mechanisms by which sociocultural and neighborhood factors optimize or degrade quality. Specific aims: 1) Test for disparities in care processes and outcomes among AAPI mothers and infants and identify associations with patient and neighborhood level social risk factors; 2) Assess the impact of hospital performance on care processes and outcomes of AAPI maternal/infant popula- tions; and 3) Understand the birth and birth hospitalization experiences of AAPI populations alongside drivers of disparities in care processes and outcomes. An exceptional strength of our proposal is our ability to leverage the unique infrastructure of the California Peri- natal and Maternal Quality Care Collaboratives. Building on our prior work in linking complimentary high-quality clinical, administrative, and survey-based data sets containing multi-level factors, we will study a large popula- tion-scale AAPI sample of 1.6 million mothers and newborns (including ~8,000 VLBW infants) in 238 maternity hospitals and 138 neonatal intensive care units in California between 2011-23. Results of this proposal are expected to have an immediate positive impact because in leveraging our expertise as active quality improve- ment organizations, they are designed to identify pragmatic areas where hospitals and communities can improve.

在出生住院期间向母亲和婴儿提供的护理质量的种族/种族差异 直接导致可避免的死亡和发病率。亚裔美国人和太平洋岛民（AAPI）代表 增长最快的种族/族裔（25％居住在加利福尼亚州），他们在几个 强大而优异的政策和临床关注的领域。不幸的是，对AAPI人群的研究受到了影响 很大的限制。首先，很少有研究报告AAPI人群和那些人群，通常汇总 “亚洲”或“亚裔美国人和太平洋岛民”，掩盖了生物学和社会文化异质性。秒 OND，社会人口统计学和邻里因素很少用于分娩时的医院质量研究。 第三，缺乏多层次调整会通过惩罚来破坏质量比较评估的有效性 照顾脆弱人群的医院。 要了解AAPI母亲/婴儿的护理过程和成果的分布，我们将进行综合 HASIVE评估与出生住院期间与护理质量相关的多层次因素，促进 通过使社会人口统计学和邻里影响显式来进行更公平的比较；并评估关键领域 使用关键绩效指标的质量为母亲，低风险的新生儿和婴儿提供的护理质量 低出生体重（VLBW; <1500G）。 创新方法包括利用我们独特的多层次数据源来提供全面的评估 - AAPI人群的医院质量具有前所未有的颗粒状，通过关键Indi-评估质量 视觉和复合措施，并使用混合方法方法来提供独特的见解 社会文化和邻里因素优化或降低质量的机制。具体目的： 1）测试AAPI母亲和婴儿的护理过程和结果中的分布并确定关联 与患者和邻里水平的社会风险因素； 2）评估医院绩效对AAPI MATER/婴儿Popula的护理过程和结果的影响 ;和 3）了解AAPI人群的出生和出生住院经历以及分配驱动因素 在护理过程和结果中。 我们提案的特殊优势是我们能够利用加利福尼亚围场的独特基础设施 出生和孕产妇的质量护理协作。在我们先前在链接免费高质量的工作的基础上建立 临床，行政和基于调查的数据集包含多层因素，我们将研究大量的人群 tion级的AAPI样本为160万母亲和新生儿（包括约8,000名VLBW婴儿） 2011 - 23年间，加利福尼亚州的医院和138个新生儿重症监护病房。该提议的结果是 预计将立即产生积极的影响，因为在利用我们的专业知识作为积极质量提高时 - 他们旨在确定医院和社区可以改善的务实领域。