Disparities in NICU quality of care: a qualitative study of family and clinician accounts

Abstract

ObjectiveTo identify how family advocates and clinicians describe disparities in NICU quality of care in narrative accounts.Study designQualitative analysis of a survey requesting disparity stories at the 2016 VON Quality Congress. Accounts (324) were from a sample of RNs (n = 114, 35%), MDs (n = 109, 34%), NNPs (n = 55, 17%), RN other (n = 4, 1%), clinical other (n = 25, 7%), family advocates (n = 16, 5%), and unspecified (n = 1, <1%).ResultsAccounts (324) addressed non-exclusive disparities: 151 (47%) language; 97 (30%) culture or ethnicity; 72 (22%) race; 41 (13%) SES; 28 (8%) drug use; 18 (5%) immigration status or nationality; 16 (4%) sexual orientation or family status; 14 (4%) gender; 10 (3%) disability. We identified three types of disparate care: neglectful care 85 (26%), judgmental care 85 (26%), or systemic barriers to care 139 (44%).ConclusionsNearly all accounts described differential care toward families, suggesting the lack of equitable family-centered care.

The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families

“…Principles of diversity and inclusion should be applied to this team to assure that concerns of those whose voices have long been ignored are now heard. 73,123 The third is a community resources team with a bidirectional purpose: health-care personnel can educate community partners about the health problems and needs of premature infants and their families, and community partners can engage with health-care personnel to develop a comprehensive list of resources and services in the community and to foster communication across the hospital community. Such a group might include early intervention workers, primary care physicians, child physical and occupational therapists, social services, education services, public health professionals, community leaders, and representatives from community-based agencies.…”

“…These factors can affect the health of the neonate and have the potential to incite disparities that will last beyond discharge. 73 While studies have examined the role of racism in preterm birth, few studies have examined the role of racism and bias in the NICU setting. 32 A growing body of research in maternal health acknowledges the role that structural racism plays in generating disparities.…”

“…[80][81][82] As noted above, evidence suggests that some minority families experience lower-quality interactions with NICU staff, which might reduce effectiveness in discharge planning and family readiness. 73 Deeper study of new and existing programs that support discharged preterm infants as they grow and age is also occurring.…”

Multilevel social factors and NICU quality of care in California

“…Although overall outcomes and equities have improved [4], inequities in care delivery have been demonstrated to exist. Vulnerable populations are segregated into lower quality NICUs [5][6][7][8][9] and within NICUs they tend to receive lower quality of care, particularly less family-centered care [10]. Recent studies have created multifaceted activities centered around using quality improvement (QI) strategies to address equity in care delivery.…”

To Improve the Inpatient Experience, Invest in the Human Side of Health Care

“…10,11 In addition, comfort and good communication are fundamentally rooted in caregiver respect for children and their families. Emerging evidence documenting implicit bias among nurses [12][13][14] highlights that even the most trusted group of health care professionals (and the organizations that employ them) must reckon with how larger societal forces shape care delivered within hospital walls.…”