Health Equity and Quality of Care Assessment: A Continuing Challenge

Lorch, Scott A.

doi:10.1542/peds.2017-2213

Cited by 7 publications

(6 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…8 Although we use this framework explicitly for this review, it is important to understand that disparities in care and outcomes may overlap with biologic and socioeconomic factors that may be difficult to untangle. 3 We do not address these important issues in our review. However, there is ample evidence that racial and ethnic minorities have disadvantages across the spectrum of factors identified as representing quality of NICU care.…”

Section: Discussionmentioning

confidence: 99%

“…2 An additional component to racial and/ or ethnic inequity in infant outcomes is differences in NICU quality of care stratified by race and/or ethnicity. 3 Disparities in quality have been found in other areas of health care, including, for instance, cancer care, 4 cardiovascular care, 5 and pediatric care. 6 The advantage of addressing disparities in care delivery is that they are amenable to improvement through quality improvement (QI) methodology, with the potential for spreading solutions at scale with long-term benefit.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Racial/Ethnic Disparities in Neonatal Intensive Care: A Systematic Review

et al. 2019

View full text Add to dashboard Cite

CONTEXT: Racial and ethnic disparities in health outcomes of newborns requiring care in the NICU setting have been reported. The contribution of NICU care to disparities in outcomes is unclear. OBJECTIVE: To conduct a systematic review of the literature documenting racial/ethnic disparities in quality of care for infants in the NICU setting. DATA SOURCES: Medline/PubMed, Scopus, Cumulative Index of Nursing and Allied Health, and Web of Science were searched until March 6, 2018, by using search queries organized around the following key concepts: “neonatal intensive care units,” “racial or ethnic disparities,” and “quality of care.” STUDY SELECTION: English language articles up to March 6, 2018, that were focused on racial and/or ethnic differences in the quality of NICU care were selected. DATA EXTRACTION: Two authors independently assessed eligibility, extracted data, and cross-checked results, with disagreements resolved by consensus. Information extracted focused on racial and/or ethnic disparities in quality of care and potential mechanism(s) for disparities. RESULTS: Initial search yielded 566 records, 470 of which were unique citations. Title and abstract review resulted in 382 records. Appraisal of the full text of the remaining 88 records, along with the addition of 5 citations from expert consult or review of bibliographies, resulted in 41 articles being included. LIMITATIONS: Quantitative meta-analysis was not possible because of study heterogeneity. CONCLUSIONS: Overall, this systematic review revealed complex racial and/or ethnic disparities in structure, process, and outcome measures, most often disadvantaging infants of color, especially African American infants. There are some exceptions to this pattern and each area merits its own analysis and discussion.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Racial/Ethnic Disparities in Neonatal Intensive Care: A Systematic Review

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In a commentary, Lorch 73 noted the challenges of combining health equity goals with the measurement of health care quality in perinatal care. By monitoring indicators stratified by indicators of social determinants (race/ethnicity, insurance, urban/rural), quality improvement collaboratives have the potential to improve health care quality, address health equity, and reduce disparities with thoughtful intent in the appropriate cultural context.…”

Section: Public Health’s Role In the Prevention Of Very Preterm Birthmentioning

confidence: 99%

Public Health Implications of Very Preterm Birth

Barfield

2018

Clinics in Perinatology

160

View full text Add to dashboard Cite

With advanced perinatal care and technology, survival among infants born very preterm (<32 weeks gestation) has improved dramatically over the last several decades. However, adverse medical and neurodevelopmental outcomes for those born very preterm remains high, particularly at the lowest gestational ages. Public health plays a critical role in providing data to assess population-based risks associated with very preterm birth, addressing disparities, and identifying opportunities for prevention, including improving the health of reproductive-age women, before, during, and after pregnancy.

show abstract

“…39 Emerging research suggests that current structures and processes in place in health care may disadvantage infants of color cared for in the NICU, especially Black infants. 24,40,41 Many of the poorer outcomes noted in these populations could be mitigated by newer strategies inclusive of infrastructures and processes that support addressing racial and ethnic disparities. 23,42,43 Normalized median login results showed that there were more logins occurring earlier into the hospital stay than later into the hospital stay in the Public Insurance group as compared with the Non-Public Insurance group.…”

Section: Discussionmentioning

confidence: 99%

Effect of Health Insurance Status and Visitation Restrictions on Virtual Visitation Technology in the Neonatal Intensive Care Unit

Henderson-Sears,

Stefanescu,

Stefanescu

et al. 2023

Am J Perinatol

View full text Add to dashboard Cite

Objective: To examine the relationship between virtual technology system utilization and insurance status or type of visitation restrictions in a single center neonatal intensive care unit. Study design: Prospective cohort study with separate analyses performed based on insurance status (public versus non-public) and “in effect” unit visitation restrictions. The three study epochs based on patient visitation restrictions were epoch 1 (July to October 2019) with standard visitation restrictions, epoch 2 (November 2019 to February 2020) with RSV/Influenza visitation restrictions, and epoch 3 (March to June 2020) with COVID-19 visitation restrictions, respectively. Results: Families of 357 infants used web-based cameras through most of the infant’s hospitalization (median 86.05%, Q3 97.9%) with 165,795 total camera logins, indicating consistent utilization. There was a trend for fewer logins per infant and significantly longer time to consent (p=0.03) in the Public Insurance group. Unit visitation restrictions impacted the time to consent, the shortest being in Epoch 3 during the Covid-19 pandemic (p=0.03). Conclusion: Virtual visitation technology is well embraced by NICU families, however gaps in access and use among subgroups signals a form of social inequality that needs to be explored further.

show abstract

Health Equity and Quality of Care Assessment: A Continuing Challenge

Abstract: Opinions expressed in these commentaries are those of the author and not necessarily those of the American Academy of Pediatrics or its Committees.

Cited by 7 publications

References 8 publications

Racial/Ethnic Disparities in Neonatal Intensive Care: A Systematic Review

Racial/Ethnic Disparities in Neonatal Intensive Care: A Systematic Review

Public Health Implications of Very Preterm Birth

Effect of Health Insurance Status and Visitation Restrictions on Virtual Visitation Technology in the Neonatal Intensive Care Unit

Contact Info

Product

Resources

About