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Stanford University School of Medicine

Gaps exist in California hospital care for babies from different ethnicities

Across California, the racial and ethnic backgrounds of tiny infants are influencing the quality of medical care they receive in hospitals' neonatal intensive care units, a new Stanford-led study has found.

The research, which appears today in Pediatrics, focused on babies who weighed less than 3.3 pounds at birth, a category known as "very low birth weight." The scientists analyzed medical records for more than 18,000 such infants born in 134 California NICUs between the beginning of 2010 and the end of 2014. California has one of the most comprehensive efforts anywhere to track and improve newborn care, thanks to the California Perinatal Quality Care Collaborative, which provided the data for this study.

The findings show a mixed picture, with better care for white infants at some hospitals and better care for babies from vulnerable populations at others. In general, however, hospitals that did the best job of caring for their patients also tended to have better outcomes for white infants than for black or Hispanic infants, and babies from vulnerable populations were more likely to be treated at lower-performing hospitals. From our press release:

'There's a long history of disparity in health care delivery, and our study shows that the NICU is really no different,' said the study's senior author, Jochen Profit, MD, associate professor of pediatrics. 'Unconscious social biases that we all have can make their way into the NICU. We would like to encourage NICU caregivers to think about how these disparities play out in their own units and how they can be reduced.'

The study used an index to measure NICU performance that Profit's team had previously developed and validated. Called Baby-MONITOR, the index measures nine different aspects of hospital care and health outcomes, and aims to give an overall picture of how well the baby's hospital stay went. The Baby-MONITOR scores in the new study were adjusted for several factors, such as how sick the babies were to begin with, since some hospitals specialize in caring for the sickest infants and the scientists did not want that fact to skew their results.

The biggest takeaway, Profit said, was that there was a lot of variation between hospitals. Although he believes all caregivers want to give the best possible care to every one of their patients, the data reveals that some hospitals are doing quite well at treating infants from all groups equitably, but others are struggling. Again, from the press release:

'It's really important for NICUs to individualize care to the patient population they see,' [Profit] said.

For instance, Hispanic families who are primarily Spanish-speaking may be experiencing language barriers that make it harder for parents to ask questions and act as advocates for their infants. 'For them, having access to translation and personnel who speak Spanish is really critical,' he said.

Hospitals serving a larger proportion of African-American infants may have different issues they need to address.

Profit and his collaborators are now planning how they can give each participating hospital regular updates on their performance. They intend to ask hospitals that are doing the best job of treating high-risk infants to share their successful strategies with others.

Previously: Feeding practices and activity patterns for babies vary with families' race and ethnicity, study shows, Study identifies socioeconomic and ethnic disparities for gallstone surgery and Helping families navigate the NICU
Photo by Carlo Navarro

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