First name
Henry
Middle name
C
Last name
Lee

Title

Addressing bias and knowledge gaps regarding race and ethnicity in neonatology manuscript review.

Year of Publication

2022

Date Published

06/2022

ISSN Number

1476-5543

Abstract

A recent shift in public attention to racism, racial disparities, and health equity have resulted in an abundance of calls for relevant papers and publications in academic journals. Peer-review for such articles may be susceptible to bias, as subject matter expertise in the evaluation of social constructs, like race, is variable. From the perspective of researchers focused on neonatal health equity, we share our positive and negative experiences in peer-review, provide relevant publicly available data regarding addressing bias in peer-review from 12 neonatology-focused journals, and give recommendations to address bias and knowledge gaps in the peer review process of health equity research.

DOI

10.1038/s41372-022-01420-7

Alternate Title

J Perinatol

PMID

35668123

Title

Prioritization framework for improving the value of care for very low birth weight and very preterm infants.

Year of Publication

2021

Date Published

2021 Jun 01

ISSN Number

1476-5543

Abstract

<p><strong>OBJECTIVE: </strong>Create a prioritization framework for value-based improvement in neonatal care.</p>

<p><strong>STUDY DESIGN: </strong>A retrospective cohort study of very low birth weight (&lt;1500 g) and/or very preterm (&lt;32 weeks) infants discharged between 2012 and 2019 using the Pediatric Health Information System Database. Resource use was compared across hospitals and adjusted for patient-level differences. A prioritization score was created combining cost, patient exposure, and inter-hospital variability to rank resource categories.</p>

<p><strong>RESULTS: </strong>Resource categories with the greatest cost, patient exposure, and inter-hospital variability were parenteral nutrition, hematology (lab testing), and anticoagulation (for central venous access and therapy), respectively. Based on our prioritization score, parenteral nutrition was identified as the highest priority overall.</p>

<p><strong>CONCLUSIONS: </strong>We report the development of a prioritization score for potential value-based improvement in neonatal care. Our findings suggest that parenteral nutrition, central venous access, and high-volume laboratory and imaging modalities should be priorities for future comparative effectiveness and quality improvement efforts.</p>

DOI

10.1038/s41372-021-01114-6

Alternate Title

J Perinatol

PMID

34075201

Title

Cost of clinician-driven tests and treatments in very low birth weight and/or very preterm infants.

Year of Publication

2020

Date Published

2020 Dec 02

ISSN Number

1476-5543

Abstract

<p><strong>OBJECTIVE: </strong>To rank clinician-driven tests and treatments (CTTs) by their total cost during the birth hospitalization for preterm infants.</p>

<p><strong>STUDY DESIGN: </strong>Retrospective cohort of very low birth weight (&lt;1500 g) and/or very preterm (&lt;32 weeks) subjects admitted to US children's hospital Neonatal Intensive Care Units (2012-2018). CTTs were defined as pharmaceutical, laboratory and imaging services and ranked by total cost.</p>

<p><strong>RESULTS: </strong>24,099 infants from 51 hospitals were included. Parenteral nutrition ($85M, 32% of pharmacy costs), blood gas analysis ($34M, 29% of laboratory costs), and chest radiographs ($18M, 31% of imaging costs) were the costliest CTTs overall. More than half of CTT-related costs occurred during 10% of hospital days.</p>

<p><strong>CONCLUSIONS: </strong>The majority of CTT-related costs were from commonly used tests and treatments. Targeted efforts to improve value in neonatal care may benefit most from focusing on reducing unnecessary utilization of common tests and treatments, rather than infrequently used ones.</p>

DOI

10.1038/s41372-020-00879-6

Alternate Title

J Perinatol

PMID

33268831

Title

Survey of preterm neuro-centric care practices in California neonatal intensive care units.

Year of Publication

2019

Number of Pages

256-262

Date Published

2019 02

ISSN Number

1476-5543

Abstract

<p><strong>OBJECTIVE: </strong>Examine the adoption and presence of preterm, neuro-centric care practices across neonatal intensive care units (NICUs).</p>

<p><strong>STUDY DESIGN: </strong>Statewide, cross-sectional survey of California NICUs. Data were collected surrounding the timing of adoption and presence of delivery room practices, nursing protocols, provider management practices and quality improvement initiatives.</p>

<p><strong>RESULT: </strong>Among the 95 NICUs completing the survey (65%), adoption of all surveyed practices increased between 2005 and 2016, though rates of uptake changed over time and varied by practice. Adoption of indomethacin prophylaxis increased 1.8-fold, whereas delayed cord clamping increased 78-fold. Adoption of premedication for intubation and a patent ductus arteriosus management algorithm differed by unit level. Additionally, two underlying practice domains were identified; adoption of delivery room practices and adoption of any preterm practice.</p>

<p><strong>CONCLUSION: </strong>Adoption of preterm, neuro-centric care practices across California NICUs has increased, though uptake patterns vary by practice and level.</p>

DOI

10.1038/s41372-018-0283-8

Alternate Title

J Perinatol

PMID

30518797

Title

Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants.

Year of Publication

2019

Number of Pages

455-461

Date Published

2019 05 01

ISSN Number

2168-6211

Abstract

<p><strong>Importance: </strong>Racial and ethnic minorities receive lower-quality health care than white non-Hispanic individuals in the United States. Where minority infants receive care and the role that may play in the quality of care received is unclear.</p>

<p><strong>Objective: </strong>To determine the extent of segregation and inequality of care of very low-birth-weight and very preterm infants across neonatal intensive care units (NICUs) in the United States.</p>

<p><strong>Design, Setting, and Participants: </strong>This cohort study of 743 NICUs in the Vermont Oxford Network included 117 982 black, Hispanic, Asian, and white infants born at 401 g to 1500 g or 22 to 29 weeks' gestation from January 2014 to December 2016. Analysis began January 2018.</p>

<p><strong>Main Outcomes and Measures: </strong>The NICU segregation index and NICU inequality index were calculated at the hospital level as the Gini coefficients associated with the Lorenz curves for black, Hispanic, and Asian infants compared with white infants, with NICUs ranked by proportion of white infants for the NICU segregation index and by composite Baby-MONITOR (Measure of Neonatal Intensive Care Outcomes Research) score for the NICU inequality index.</p>

<p><strong>Results: </strong>Infants (36 359 black [31%], 21 808 Hispanic [18%], 5920 Asian [5%], and 53 895 white [46%]) were segregated among the 743 NICUs by race and ethnicity (NICU segregation index: black: 0.50 [95% CI, 0.46-0.53], Hispanic: 0.58 [95% CI, 0.54-0.61], and Asian: 0.45 [95% CI, 0.40-0.50]). Compared with white infants, black infants were concentrated at NICUs with lower-quality scores, and Hispanic and Asian infants were concentrated at NICUs with higher-quality scores (NICU inequality index: black: 0.07 [95% CI, 0.02-0.13], Hispanic: -0.10 [95% CI, -0.17 to -0.04], and Asian: -0.26 [95% CI, -0.32 to -0.19]). There was marked variation among the census regions in weighted mean NICU quality scores (range: -0.69 to 0.85). Region of residence explained the observed inequality for Hispanic infants but not for black or Asian infants.</p>

<p><strong>Conclusions and Relevance: </strong>Black, Hispanic, and Asian infants were segregated across NICUs, reflecting the racial segregation of minority populations in the United States. There were large differences between geographic regions in NICU quality. After accounting for these differences, compared with white infants, Asian infants received care at higher-quality NICUs and black infants, at lower-quality NICUs. Explaining these patterns will require understanding the effects of sociodemographic factors and public policies on hospital quality, access, and choice for minority women and their infants.</p>

DOI

10.1001/jamapediatrics.2019.0241

Alternate Title

JAMA Pediatr

PMID

30907924

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