Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1070, New York, NY, 10029, USA.
Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
Matern Child Health J. 2020 Jun;24(6):687-693. doi: 10.1007/s10995-020-02911-9.
To determine whether delivery hospitals that perform poorly for women also perform poorly for high-risk infants and to what extent Black and Hispanic women receive care at hospitals that perform poorly for both women and infants.
We examined the correlation between hospital rankings for severe maternal morbidity and very preterm morbidity and mortality in New York City Hospitals using linked birth certificate and state discharge data for 2010-2014. We used mixed-effects logistic regression with a random hospital-specific intercept to generate risk standardized severe maternal morbidity rates and very preterm birth neonatal morbidity and mortality rates for each hospital. We ranked hospitals separately by these risk-standardized rates. We used k-means cluster analysis to categorize hospitals based on their performance on both metrics and risk-adjusted multinomial logistic regression to estimate adjusted probabilities of delivering in each hospital-quality cluster by race/ethnicity.
Hospital rankings for severe maternal morbidity and very preterm neonatal morbidity-mortality were moderately correlated (r = .32; p = .05). A 5-cluster solution best fit the data and yielded the categories for hospital performance for women and infants: excellent, good, fair, fair to poor, poor. Black and Hispanic versus White women were less likely to deliver in an excellent quality cluster (adjusted percent of 11%, 18% vs 28%, respectively, p < .001) and more likely to deliver in a poor quality cluster (adjusted percent of 28%, 20%, vs. 4%, respectively, p < .001).
Hospital performance for maternal and high-risk infant outcomes is only moderately correlated but Black and Hispanic women deliver at hospitals with worse outcomes for both women and very preterm infants.
确定表现不佳的产妇分娩医院是否也会对高危婴儿表现不佳，以及黑人和西班牙裔妇女在多大程度上会在对妇女和婴儿表现不佳的医院接受治疗。
我们使用 2010-2014 年纽约市医院的链接出生证明和州出院数据，检查了严重产妇发病率和极早产儿发病率和死亡率的医院排名之间的相关性。我们使用具有随机医院特定截距的混合效应逻辑回归生成每个医院的风险标准化严重产妇发病率和极早产儿出生新生儿发病率和死亡率。我们分别根据这些风险标准化比率对医院进行排名。我们使用 k-均值聚类分析根据这两个指标的表现对医院进行分类，并使用风险调整的多项逻辑回归估计按种族/族裔在每个医院质量聚类中分娩的调整概率。
严重产妇发病率和极早产儿新生儿发病率-死亡率的医院排名呈中度相关（r=.32；p=.05）。5 聚类解决方案最适合数据，并产生了妇女和婴儿医院表现的类别：优秀、良好、中等、中等至差、差。与白人妇女相比，黑人妇女和西班牙裔妇女不太可能在优质集群中分娩（调整后的百分比为 11%，分别为 18%和 28%，p<0.001），而更有可能在低质量集群中分娩（调整后的百分比为 28%、20%，分别为 4%，p<0.001）。
产妇和高危婴儿结局的医院表现仅呈中度相关，但黑人和西班牙裔妇女在对妇女和极早产儿结局都较差的医院分娩。
