title: Disparities in perinatal quality outcomes for very low birth weight infants in neonatal intensive care.
abstract: OBJECTIVE
  To determine if hospital-level disparities in very low birth weight (VLBW) infant outcomes are explained by poorer hospital nursing characteristics.
  
  
  METHODS
  Nurse survey and VLBW infant registry data.
  
  
  METHODS
  Retrospective study of 8,252 VLBW infants in 98 Vermont Oxford Network hospital neonatal intensive care units (NICUs) nationally. NICUs were classified into three groups based on their percent of infants of black race. Two nurse-sensitive perinatal quality standards were studied: nosocomial infection and breast milk.
  
  
  METHODS
  Primary nurse survey (N = 5,773, 77 percent response rate).
  
  
  RESULTS
  VLBW infants born in high-black concentration hospitals had higher rates of infection and discharge without breast milk than VLBW infants born in low-black concentration hospitals. Nurse understaffing was higher and practice environments were worse in high-black as compared to low-black hospitals. NICU nursing features accounted for one-third to one-half of the hospital-level health disparities.
  
  
  CONCLUSIONS
  Poorer nursing characteristics contribute to disparities in VLBW infant outcomes in two nurse-sensitive perinatal quality standards. Improvements in nursing have potential to improve the quality of care for seven out of ten black VLBW infants who are born in high-black hospitals in this country.
authors.affiliation: Center for Health Outcomes and Policy Research, School of Nursing, Department of Sociology, Leonard Davis Institute of Health Economics, University of Pennsylvania, 302 Claire M. Fagin Hall, Philadelphia, PA 19104.
authors.forename: Eileen T
authors.initials: ET
authors.lastname: Lake
authors.forename: Douglas
authors.initials: D
authors.lastname: Staiger
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Horbar
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kenny
authors.forename: Thelma
authors.initials: T
authors.lastname: Patrick
authors.forename: Jeannette A
authors.initials: JA
authors.lastname: Rogowski
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D001942:Breast Feeding / Q000208:ethnology / Q000706:statistics & numerical data*; D002985:Clinical Protocols; D003428:Cross Infection / Q000453:epidemiology; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012189:Retrospective Studies; D014707:Vermont; D016526:Workload / Q000706:statistics & numerical data
keywords: Health disparities; VLBW infants; nurse practice environment; nurse staffing; quality standards