Persistent Black/White disparities in neonatal and maternal mortality rates are a major public health concern and the United States continues to rank poorly on these measures when compared to other nations. Despite billions of dollars spent in health care annually and nearly half of all births occurring to minority women, performance and quality measures in obstetrical care have yet to be thoroughly examined. Although hospital quality has been associated with neonatal very low birth weight (VLBW) mortality and obstetrical outcomes, little research has addressed the role of current obstetrical quality measures in explaining racial/ethnic disparities in neonatal mortality and other maternal health outcomes, specifically maternal mortality. We propose a study to investigate variability of 35 recommended obstetrical quality measures across hospitals and to conduct analyses using these measures to investigate racial/ethnic disparities in neonatal and maternal mortality rates. Our objectives are to: 1) Pilot the use of current obstetrical quality indicators in routine data sources to measure variability across hospitals;2) determine whether obstetrical quality measures differ by race/ethnicity and 3) examine whether racial/ethnic differences explain variation in racial/ethnic disparities in maternal and neonatal mortality rates. Methods: We will use the National Inpatient Sample (NIS), New York State Discharge Abstract Data (SPARCS), and the Mount Sinai Warehouse (electronic medical records) to investigate variation in obstetrical quality indicators among designated hospitals. We will also use Census Bureau data for community socio-economic status variables and AMA data for hospital characteristics. We will use the specific data elements required for measurement of these quality indicators as defined by the Joint Commission and other national quality leaders. The relationship between quality indicators and socio-economic status and clinical risk factors will also be assessed in order to identify those indicators most susceptible to bias. Lastly, we will conduct analyses to examine whether obstetrical quality differs by race/ethnicity, and whether such differences explain racial/ethnic disparities in maternal and VLBW neonatal mortality rates. Information from this study will provide a better understanding of quality in neonatal and maternity care in hospitals and reveal specific processes of care that could be improved upon to reduce racial/ethnic disparities in obstetrical-related outcomes in the future.

Public Health Relevance

Black/White disparities in neonatal and maternal mortality rates are a major public health concern in the United States yet the little research has addressed the role of current obstetrical quality measures in explaining these racial/ethnic disparities. Data from the proposed study will describe the variability of current obstetrical quality indicators across hospitals, determine differences in obstetrical quality measures by race/ethnicity and identify the role of obstetrical quality measures in explaining disparities in neonatal and maternal mortality. Findings could inform recommendations regarding the feasibility of using routine data sources to construct obstetrical quality measures, increase our understanding of the quality of obstetrical care in hospitals and ultimately, identify opportunities for reducing persistent racial/ethnic disparities in maternal and neonatal mortality.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21HD068765-02
Application #
8410551
Study Section
Health Disparities and Equity Promotion Study Section (HDEP)
Program Officer
Willinger, Marian
Project Start
2012-01-10
Project End
2014-12-31
Budget Start
2013-01-01
Budget End
2014-12-31
Support Year
2
Fiscal Year
2013
Total Cost
$201,069
Indirect Cost
$82,444
Name
Icahn School of Medicine at Mount Sinai
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
078861598
City
New York
State
NY
Country
United States
Zip Code
10029
Howell, Elizabeth A; Zeitlin, Jennifer; Hebert, Paul L et al. (2014) Association between hospital-level obstetric quality indicators and maternal and neonatal morbidity. JAMA 312:1531-41
Howell, Elizabeth A; Zeitlin, Jennifer; Hebert, Paul et al. (2013) Paradoxical trends and racial differences in obstetric quality and neonatal and maternal mortality. Obstet Gynecol 121:1201-8