7 - Examining Measures of Family Centered Care

Poster Number: 7
Publication Number: 7.337

Jochen Profit, Stanford University, Palo Alto, CA, United States; Beate Danielsen, Health Information Solutions, Rocklin, CA, United States; Malathi Balasundaram, Stanford University School of Medicine, Mountain View, CA, United States; Kimber Padua, Stanford University School of Medicine, San Mateo, CA, United States; Linda S. Franck, University of California, School of Nursing, San Francisco, CA, United States; Jessica Liu, Stanford University School of Medicine, Palo Alto, CA, United States

Background: Family centered care (FCC) has been identified as a principal pathway for mitigating health disparities in NICUs. In a prior Delphi experiment, a panel of experts selected three measures as potential proxies for FCC. Whether sufficient variation across NICUs exist to allow for discrimination of performance is unknown.

Objective: To examine NICU variation in three novel measures of FCC

Design/Methods: We utilized the California Perinatal Quality Care Collaborative (CPQCC) database to examine trends in the three FCC measures among 604 very low birth from 21 NICUs from January 1 to October 30, 2021. These measures included days from NICU admission to first skin-to-skin care, days from NICU admission to first social worker contact, and hours from birth to administering oral colostrum.  Restrictions were applied to minimize the effect of outliers and outborn birth. We examined means and medians of each measure across all participating hospitals, among safety net versus non-safety net hospitals, and among white versus non-white infants. We also examined correlations between measures using Spearman rho coefficients.

Results: : Among the 21 participating NICUs, 17 (81%) were AAP level 3, 6 (29) were teaching hospitals, and 10 (48%) were safety net hospitals. Across the 21 NICUs, the median (IQR) days from admission to first skin-to-skin care was 3 (2-6), with a range of 0 to 67 days [Figure 1a].  The median (IQR) days from admission to first social worker contact was 2 (1-2) with a range of 0 to 60 days [Figure 1b]. The median (IQR) hours from birth to first oral colostrum was 32 (14-65.5) with a range of 0 to 289 hours [Figure 1c]. Safety net NICUs had a median (IQR) hours to first oral colostrum of 42.5 (26-76) versus 21 (10-53) in non-safety net NICUs (p < .001). We found no significant difference between safety net NICUs and non-safety net NICUs for the other two measures. We also found no significant differences in any of the measures across different race/ethnicities. At the NICU level, there was a nonsignificant correlation between time to first skin-to-skin and first oral colostrum (spearman Rho = 0.257, p=0.27). Conclusion(s): In this sample, we found clinically significant variation across NICUs in days to first skin-to-skin care and hours to first oral colostrum, allowing us to discriminate performance in these important potential proxy indicators of quality FCC. High performance in one measure doesn’t equal high performance in another.
Figure 1aDays to first skin to skin care across NICUs
Figure 1bDays to first social worker contact across NICUs