Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
School of Journalism, Writing, and Media, University of British Columbia, Kelowna, BC, Canada.
J Perinatol. 2024 May;44(5):659-664. doi: 10.1038/s41372-023-01856-5. Epub 2023 Dec 28.
Racial/ethnic disparities are well-described in the neonatal intensive care unit (NICU). We explored expert opinion on their etiology, potential solutions, and the ability of health equity dashboards to meaningfully capture NICU disparities.
We conducted 12 qualitative semi-structured interviews, purposively selecting a diverse group of neonatal experts. We used grounded theory to develop codes, shape interviews, and conduct analysis.
We identified three sources of disparity: interpersonal bias, care process and institutional barriers, and social determinants of health, particularly as they affect parental engagement in the NICU. Proposed solutions included racial/cultural concordance, bolstering hospital-based resources, and policy interventions. Health equity dashboards were viewed as useful but limited, because clinical metrics do not account for many of the aforementioned sources of disparities.
Equity dashboards serve as a motivational starting point for quality improvement; future iterations may require novel, qualitative data sources to identify underlying etiologies of NICU disparities.
新生儿重症监护病房(NICU)中存在明显的种族/民族差异。我们探讨了这些差异的病因、潜在解决方案,以及健康公平仪表板是否能够有效地捕捉到 NICU 中的差异。
我们进行了 12 次定性半结构化访谈,有目的地选择了一组多样化的新生儿专家。我们使用扎根理论来开发代码、塑造访谈和进行分析。
我们确定了三种差异来源:人际偏见、护理过程和机构障碍,以及健康的社会决定因素,特别是它们如何影响父母在 NICU 中的参与度。提出的解决方案包括种族/文化一致性、加强医院的资源,以及政策干预。健康公平仪表板被认为是有用的,但也有局限性,因为临床指标并没有考虑到许多上述差异的来源。
公平仪表板是质量改进的一个激励起点;未来的迭代可能需要新的、定性的数据来源,以确定 NICU 差异的潜在病因。