Identifying the reasons for racial health
disparities and ways to address them is a significant, complex challenge in
health care. A new INQRI-funded study led by Eileen T. Lake, PhD, RN, FAAN and Jeannette A.
Rogowski, PhD, provides insight into the issue of very
low birth weight (VLBW) infants, who are disproportionately black, and finds
that it’s not just their race that’s a factor in their health outcomes, it’s
the quality of care at the hospitals where they’re born. The study was
published in the journal Health Services Research.
The research team examined data on 8,252 VLBW
infants in 98 Vermont Oxford Network member neonatal intensive care units
(NICUs) throughout the country and the results of a survey of 5,773 NICU
nurses. They found that nurse understaffing and practice environments were
worse at hospitals with higher concentrations of black patients, contributing
to adverse outcomes for VLBW infants born in those facilities.
Since 7 out of 10 black VLBW infants are born in
hospitals with a high concentration of black patients, researchers concluded
that improvements in nursing at such hospitals have the potential to boost the
quality of care for many black VLBW infants. The study looked at two
nurse-sensitive perinatal quality standards—hospital-acquired infection and
discharge without having started breast milk, which have long-term health
implications for VLBW infants—and found higher rates of both in
high-black-concentration hospitals. NICU nursing features ultimately accounted
for one-third to one-half of hospital-level health disparities.
“Very low birth weight infants are at a high risk
for a lifetime of health challenges,” said Lake. “The birth hospitalization is
the starting point. With a high number
of black infants born in relatively few hospitals, tackling a previously
unaddressed question—do infants cared for in hospitals with a high
concentration of black infants have poorer perinatal quality outcomes?—gives us
an opportunity to make a positive impact on population-level health
disparities.”
The study highlights dramatic differences in the
distribution of care for black infants, with nearly three-fourths of black VLBW
infants born in a third of hospitals that care for critically ill newborns.
Only 1 in 20 black infants are born in hospitals with better nursing
characteristics, and odds of adverse outcomes related to nurse-sensitive
perinatal quality standards are at least 60 percent higher for infants born in
disproportionately black hospitals.
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