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

基本信息

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
项目类别：
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

项目摘要

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.

产妇住院期间为母亲和婴儿提供的护理质量存在种族/民族差异直接导致本可避免的死亡和发病率。增长最快的种族/族裔群体（25% 居住在加利福尼亚州），他们在一些方面经历了巨大的差异不幸的是，AAPI 人群的研究受到了影响。首先，很少有研究报告 AAPI 人群，而那些报告的研究通常汇总到 “亚洲人”或“亚裔美国人和太平洋岛民”，掩盖了生物和社会文化的异质性。其次，社会人口统计和邻里因素很少可用于医院分娩质量的研究。第三，缺乏多层次的调整会惩罚质量比较评估的有效性。照顾弱势群体的医院。为了了解 AAPI 母亲/婴儿护理流程和结果的差异，我们将开展一项全面的调查，对与分娩住院期间护理质量相关的多层次因素进行深入评估，促进通过明确社会人口统计和邻里影响来进行更公平的比较，并评估关键领域；使用关键绩效指标为母亲、低风险新生儿和出生的婴儿提供护理的质量低出生体重（VLBW；<1500g）。创新方法包括利用我们独特的多级数据源来提供全面的评估- 以前所未有的粒度评估 AAPI 人群的医院质量，通过关键指标评估质量视觉和综合测量，并使用混合方法来提供对社会文化和邻里因素优化或降低质量的机制具体目标： 1) 测试 AAPI 母亲和婴儿之间护理过程和结果的差异并确定关联患者和社区层面的社会风险因素； 2) 评估医院绩效对 AAPI 母婴人群护理流程和结果的影响系统蒸发散；和 3) 了解 AAPI 人群的出生和出生住院经历以及差异的驱动因素护理过程和结果。我们提案的一个突出优势是我们能够利用加州周边地区独特的基础设施产妇质量护理合作机构以我们之前在链接免费高质量护理方面的工作为基础。包含多层次因素的临床、管理和基于调查的数据集，我们将研究大量人群 238 名产妇中 160 万名母亲和新生儿（包括约 8,000 名极低出生体重儿）的大规模 AAPI 样本 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。预计会产生立竿见影的积极影响，因为在利用我们的专业知识进行积极的质量改进时它们旨在确定医院和社区可以改进的务实领域。