Disparities in Neonatal Abstinence Syndrome Infant Outcomes and Related Nursing System Factors
Significance: Infants with neonatal abstinence syndrome (NAS) and prenatal opioid exposure (OE) have complex care needs. Potential racial and geographic outcome disparities among NAS/OE infants are uncertain. Due to their complex care needs, these infants may be especially sensitive to variation in hospital nursing resources. Objectives: The study purpose is to examine the potential contribution of nursing to outcome disparities among NAS/OE infants by: 1) measuring the extent of racial/ethnic segregation and care inequality of nursing units for NAS/OE infants; 2) documenting potential racial and urban/rural disparities in health outcomes (i.e., length of stay, transfer, 30-day readmission) among these infants and 3) exploring hospital-level variation in nursing resources (i.e., work environment, education, and workload) associated with disparities. Procedures: This cross-sectional study will use three datasets from three large states in 2016: 1) registered nurse survey data to measure nursing resources; 2) inpatient discharge abstract data to measure maternal and infant characteristics and outcomes; and 3) American Hospital Association data to measure hospital characteristics and urban/rural status. We will use Lorenz
curves to describe racial segregation and inequality by nursing unit and estimate regression models of NAS/OE infant outcomes on minority-serving status and nursing resources as predictors.
Impact: The proposed study will reveal outcome disparities among NAS/OE infants and the association of disparities with variation in nursing resources. Evidence from this pilot will strengthen our planned NIH application, allowing our disparities specific aim to be determinative, not exploratory.