Hospital Financial Health, NICU Strain, and Neonatal Outcome Variation and Subpopulation Disparities - PROJECT SUMMARY/ABSTRACT Training: This K23 proposal will equip Dr. Elizabeth (Betsy) Salazar for a career as an independent physician- scientist. Her long-term goal is to inform policies and interventions to reduce structural drivers of maternal and infant outcome variation and associated disparities in NIH-prioritized subpopulations at the hospital level. She will perform rigorous retrospective studies with advanced econometric methods to elucidate how two policy- relevant hospital characteristics, hospital financial health and neonatal intensive care unit (NICU) strain, influence outcome variation and associated subpopulation disparities. Dr. Salazar and her mentorship team have created a career development plan incorporating: 1) comprehensive, collaborative mentorship from successful investigators with diverse experience in perinatal care, health economics and finances, biostatistics, and health disparities, in an exceptional research environment for this topic; 2) advanced training in hospital finances and operations, econometric analyses, and disparities analyses; and 3) innovative research examining the role of 2 hospital factors in neonatal outcome variation and subpopulation disparity. Research: One tenth of infants in the United States require care in the neonatal intensive care unit (NICU) with extensive associated costs. Hospitals demonstrated over 100-fold variation in neonatal morbidity and mortality, as well as significant outcome disparities in NIH-prioritized subpopulations of infants born extremely prematurely at high risk of disability, as well as infants born to birthing parents residing in rural environments, facing lower socioeconomic status as indicated by public insurance, or experiencing structural racism based on race and ethnicity. Hospital factors contribute significantly to this observed variation and disparity. Two hospital factors, hospital financial health, and NICU strain, or the availability to meet the daily demand for high-quality care to optimize outcomes, are associated with adult outcomes and disparities, but have not been studied in neonates despite their relevance for hospital-staffing and disproportionate share payment legislation. Dr. Salazar’s mentored research will address this gap. By creating an enhanced administrative cohort, she will: 1) define the relationship between hospital financial health and neonatal morbidity and mortality considering hospital differences in case-mix, 2) examine the association of NICU strain with neonatal morbidity and mortality considering effect of the hospitalization and whether strain serves as mediator for the effects of hospital financial health, and 3) assess whether hospital financial health and NICU strain have differential effects in NIH-prioritized subpopulations. This study will directly address top NICHD research priorities “understanding of the contribution of social, economic, structural, and regional factors” in neonatal health. Summary: Findings will inform future R01 proposals to examine the role of hospital financial health and NICU strain on neonatal quality of care and maternal outcomes. Through this award, Dr. Salazar will become a national expert on the role of hospital finances and operations in neonatal care and their policy implications.
