Racial and ethnic differences in NICU care delivery

1. Differences in scores for quality of care in neonatal intensive care units (NICU) were most pronounced when stratifying for race and/or ethnicity, as opposed to adjusting scores for race and ethnicity.

2. When stratifying for race and/or ethnicity, white infants had higher quality of care scores than Hispanic and African American babies in high-performing NICUs. 

Evidence Rating: 2 (Good)

Study Rundown: Racial and/or ethnic disparities in quality of care delivery and outcomes in neonatology persist. In this population-based study, researchers evaluated racial and/or ethnic differences in the quality of NICU care through the baby-Measure of Neonatal Intensive Care Outcomes Research (Baby-MONITOR) score for very low birth weight (VLBW;<1500g) infants in NICUs across California. The score is a composite of binary variables including any antenatal steroid administration, moderate hypothermia on admission, non-surgically induced pneumothorax, health care-associate bacterial or fungal infections, chronic lung disease, timely eye examination, any human breast milk at discharge from hospital, mortality during the birth hospitalization and slowed growth velocity – with a higher score indicating better outcomes. In adjusting Baby-MONITOR scores by race and/or ethnicity, minimal differences were found on comparative assessments of overall NICU performance. In stratifying Baby-MONITOR scores by race/ethnicity, the authors found that in NICUs with lower scores, the disparity between racial/ethnic groups was typically small, but as scores rose, white infants tended to perform better than African American infants. However, African Americans in high-performing NICUs often fared better than African Americans in low-performing NICUs. This data suggests that systems-based improvements in the context of race and ethnicity may be made to improve quality of care.

Click to read the study, published today in Pediatrics

Relevant Reading: Baby-MONITOR: A composite indicator of NICU quality

In-Depth [retrospective cohort]: This retrospective population-based analysis included 18 616 VLBW infants from 134 NICUs in California between Jan 1, 2010 and Dec 31, 2014. Data was collected from the California Perinatal Quality Care Collaborative. The primary outcome was quality of care, as measured by the Baby-MONITOR score, a composite quality indicator made up of process and outcome measures in quality. The Baby-MONITOR scores were first evaluated in the context of risk-adjusting for race as per National Quality Forum Recommendations. In this analysis, researchers found variation in NICU performance with scores ranging by 5.26 standard units (-2.30 to 2.69). Additionally, compared with whites (0.24[0.6]), Hispanics (0.09[0.7]; P < 0.023) and the category “other” races and/or ethnicities (0.09[0.4]; P < 0.36) had significantly lower quality scores. In contrast, African Americans (0.2[0.5]; P = 0.550) and Asian Americans (0.28[0.5]; P < 0.556) were not significant different compared to whites. Individual component scores showed that African American infants had higher chronic lung disease, pneumothorax, slowed growth velocity scores. Quality scores were also stratified by race to assess racial and/or ethnic disparity at the NICU level, showing that white infants tended to score higher than Hispanic and black infants (Pearson r[Hispanic]=0.89, P < 0.001; r[black]=0.70, P < 0.001).

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