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Racial/Ethnic Disparity in NICU Quality of Care Delivery.

CPQCC Publication
TitleRacial/Ethnic Disparity in NICU Quality of Care Delivery.
Publication TypeJournal Article
Year of Publication2017
AuthorsProfit J, Gould JB, Bennett M, Goldstein BA, Draper D, Phibbs CS, Lee HC
Date Published2017 Sep
KeywordsAfrican Americans, California, European Continental Ancestry Group, Healthcare Disparities, Hispanic Americans, Humans, Infant, Very Low Birth Weight, Intensive Care Units, Neonatal, Outcome and Process Assessment (Health Care), Prospective Studies

BACKGROUND: Differences in NICU quality of care provided to very low birth weight (<1500 g) infants may contribute to the persistence of racial and/or ethnic disparity. An examination of such disparities in a population-based sample across multiple dimensions of care and outcomes is lacking.

METHODS: Prospective observational analysis of 18 616 very low birth weight infants in 134 California NICUs between January 1, 2010, and December 31, 2014. We assessed quality of care via the Baby-MONITOR, a composite indicator consisting of 9 process and outcome measures of quality. For each NICU, we calculated a risk-adjusted composite and individual component quality score for each race and/or ethnicity. We standardized each score to the overall population to compare quality of care between and within NICUs.

RESULTS: We found clinically and statistically significant racial and/or ethnic variation in quality of care between NICUs as well as within NICUs. Composite quality scores ranged by 5.26 standard units (range: -2.30 to 2.96). Adjustment of Baby-MONITOR scores by race and/or ethnicity had only minimal effect on comparative assessments of NICU performance. Among subcomponents of the Baby-MONITOR, non-Hispanic white infants scored higher on measures of process compared with African Americans and Hispanics. Compared with whites, African Americans scored higher on measures of outcome; Hispanics scored lower on 7 of the 9 Baby-MONITOR subcomponents.

CONCLUSIONS: Significant racial and/or ethnic variation in quality of care exists between and within NICUs. Providing feedback of disparity scores to NICUs could serve as an important starting point for promoting improvement and reducing disparities.

Alternate JournalPediatrics
PubMed ID28847984
PubMed Central IDPMC5574732
Grant ListR01 HD083368 / HD / NICHD NIH HHS / United States
R01 HD084667 / HD / NICHD NIH HHS / United States