(12) Improving caregiver-reported infant demographics across a regional neonatal network: the first step towards ensuring equitable outcomes

Background: Infant mortality disparities persist nationally. Because prematurity is the leading cause of statewide infant death, neonatal intensive care units (NICUs) must lead their hospitals’ efforts toward health justice by identifying and correcting disparities. Internal review of our neonatal network showed the second-most common infant race was “unknown,” preventing stratified disparity analysis of clinical outcomes. With targeted efforts to obtain valid and complete data, our pilot single-site quality improvement effort yielded a 50% increase, fueling a network-wide expansion. Further analysis showed variable practices, with some adult birth-hospital systems automatically populating race without caregiver verification (Fig_1).

Objectives: To equitably improve caregiver-reported infant race documentation from 14% to 50% in a neonatal network by September 2024.

Design/Methods: Our neonatal network encompasses ten central-Ohio NICUs. Utilizing Lean Six Sigma methods, we developed a multidisciplinary core team and ten site-specific teams with completion of Gemba walks and complex process maps (Fig_2). We conducted Plan-do-study-act (PDSA) cycles with process measures tracked. Balancing measures were documentation time and family resistance. We used statistical process control methods in a time series design to assess the outcome measure of caregiver-reported infant race. The project was IRB exempt.

Results: Caregiver-reported infant race documentation occurred at project baseline in 14% of patients, with characteristics in Table 1. Following the interventions of social work inclusion and a new registration process, documentation has improved to 32% (Fig_3). Ongoing PDSAs include optimizing team roles, novel off-site registration processes, MyChart reporting, equity-focused admission questionnaires, and improved charting clarity. Reported documentation time is less than five minutes with no family resistance. Regression model analysis is ongoing to identify disparities and inform equity-focused interventions.

Conclusion: Obtaining accurate and complete infant demographic data is imperative prior to analyzing for equitable outcomes. Revising documentation processes of infant race in a regional neonatal network is complicated but feasible. For systematic, reliable, and sustainable changes, we continue to collaborate across multiple hospital divisions. We believe that our work can be adopted or adapted by other institutions as a prequel to improving infant health disparities nationally.