Parental Trust and Racial Disparities in the Care of Discharged Premature Infants

出院早产儿护理中的父母信任和种族差异

• 批准号: 7770876
• 负责人: Scott A Lorch
• 金额: $ 72.56万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-02-15 至 2014-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7770876
• 关键词: Accident and Emergency department; Accounting; Admission activity; Adult; Aftercare; Ambulatory Care; Antibiotics; Asthma; Birth Weight; Black race; Caring; Caucasoid Race; Child; Childhood; Chronic; Collection; Communication; Computerized Medical Record; Counseling; Data; Decision Making; Delaware; Development; Educational Status; Ensure; Family; Frequencies; Gestational Age; Goals; Guidelines; Health Personnel; Healthcare; Healthcare Systems; Hispanics; Hospitals; Household; Immunization; Income; Infant; Inpatients; Institute of Medicine (U.S.); Intervention; Laboratories; Link; Managed Care; Measurement; Measures; Medical; Minority; Monitor; Neonatal; Neonatal Intensive Care Units; Outcome; Outcome Measure; Outpatients; Parents; Patients; Pattern; Pediatric Hospitals; Pediatrics; Pharmaceutical Preparations; Philadelphia; Physicians; Plant Roots; Play; Policies; Population; Population Heterogeneity; Premature Infant; Preventive; Process; Provider; Public Health; Quality of Care; Race; Records; Relative (related person); Reporting; Research; Robin bird; Role; Rural; Sample Size; Services; Site; Socioeconomic Status; Structural Models; Surveys; Symptoms; System; Test Result; Time; Trust; United States; Variant; Visit; cohort; expectation; health care quality; high risk; improved; insight; population based; public health relevance; racial difference; respiratory; therapy development

DESCRIPTION (provided by applicant): With over 57,000 infants born every year in the United States with a birth weight under 1500 grams, their care is a rapidly growing public health concern. Ensuring that this high-risk group of patients receives appropriate care after discharge has become an important goal in pediatrics. Recent data, though, suggest the presence of racial disparities in the care provided to premature infants. One of the potential explanations for these differences is the degree of parental trust in the health care system and health care providers. Studies in adult populations suggest that patient trust plays a key role in observed racial disparities in health care; improving trust may thus provide a feasible mechanism to reduce these disparities. Given the current lack of insight into racial disparities in the quality of care delivered to premature infants after discharge from the neonatal intensive care unit, this project proposes (1) to identify the relative contribution of race to variations in process and outcome measures of post-discharge care for the premature infant, and (2) to examine the contribution of health care-related distrust to racial disparities in care, placing health care distrust within the broader context of other patient, provider and system factors that may contribute to such disparities. To answer these questions, this project will examine a large cohort of discharged premature infants receiving care at one of 32 outpatient pediatric sites affiliated with The Children's Hospital of Philadelphia, where over 180,000 children and 500 to 1000 new premature infants are seen each year in urban and rural settings. These sites are linked by an electronic medical record system provided by EpicCare(R), which allows for unified collection and abstraction of data across the entire network of centers. Families will then be surveyed three times during the first two years after discharge from the neonatal intensive care unit to determine the relative contribution of parental trust, communication styles, and expectations from the health care system on racial differences in care. The marginal structural model approach of Robins et al will be used to control for potential confounders that occur either once during the time frame of the study, such as neonatal complications, or vary over the time frame of the study, such as hospital admissions and changes in a family's expectations from the health care system. With the large sample size, this study will be powered to find small differences in outcomes. Results from this study will allow for the development and implementation of specific policies to reduce racial disparities in outpatient pediatric care. Reducing these disparities, then, will result in higher quality care to all high-risk, discharged premature infants. PUBLIC HEALTH RELEVANCE: Racial disparities continue to be a major impediment to the delivery of high quality health care to all patients. This study will examine various underlying explanations for such disparities in the outcomes of care provided to premature infants in the first two years after discharge from the neonatal intensive care unit. By understanding these underlying explanations for the racial disparities in these outcomes, particularly families' trust in the health care system, we can aid in the development of interventions to reduce these differences in care.

描述（由申请人提供）：美国每年出生的57,000多名婴儿出生体重低于1500克，他们的护理是一个快速增长的公共卫生问题。确保这一高风险患者在出院后接受适当的护理已成为儿科的重要目标。但是，最近的数据表明，在提供给早产儿的护理中存在种族差异。这些差异的潜在解释之一是医疗保健系统和医疗保健提供者的父母信任程度。在成年人口的研究表明，患者信任在观察到的卫生保健中的种族差异中起着关键作用。因此，改善信任可能会提供可行的机制来减少这些差异。鉴于目前缺乏从新生儿重症监护病房出院后交付给早产儿的种族差异的洞察力，该项目提议（1）确定种族对过程中的变化的相对贡献，以及在卫生保健疾病中，在卫生保健中疾病的贡献中，分院后护理的结果和结果后的结果措施，在卫生保健中的贡献，以置于医疗保健的贡献中，以置于卫生保健的贡献中，并患者，提供者和系统因素可能导致这种差异。为了回答这些问题，该项目将检查与费城儿童医院相关的32个门诊儿科现场之一，在费城儿童医院附属的32名门诊儿童和500至1000名新的早期婴儿中，在城市和农村环境中每年都有500至1000名新的早产儿。这些站点由Epiccare（R）提供的电子病历系统链接，该系统允许在整个中心网络中统一收集和抽象数据。然后，在从新生儿重症监护室出院后的头两年中，将对家庭进行三次调查，以确定父母信任，沟通方式以及医疗保健系统对种族护理种族差异的相对贡献。 Robins等人的边际结构模型方法将用于控制研究时间范围内发生一次的潜在混杂因素，例如新生儿并发症，或在研究的时间范围内有所不同，例如医院的住院和家庭对医疗保健系统的期望发生变化。随着样本量的较大，这项研究将有能力找到结果的微小差异。这项研究的结果将允许制定和实施特定政策，以减少门诊儿科护理中的种族差异。因此，减少这些差异将为所有高风险，出院的早产儿提供更高质量的护理。公共卫生相关性：种族差异仍然是对所有患者提供高质量医疗保健的主要障碍。这项研究将研究对新生儿重症监护病房出院后的头两年中对早产儿提供的护理结果的各种基本解释。通过了解这些结果中种族差异的这些基本解释，尤其是家庭对医疗保健系统的信任，我们可以帮助制定干预措施，以减少这些护理中的差异。