Project Abstract
With over 400,000 preterm births in the US annually, neonatal intensive care units (NICUs) are critical to
providing high quality care and ensuring optimal health outcomes for neonates. Neonatal intensive care
units (NICUs) began as open-bays (large rooms, variable size, and multiple newborns admitted), but the
latest NICU design and a growing trend is single family rooms that typically have only one baby admitted
per room and accommodate at least one parent rooming-in. The scholarly literature provides mixed-
evidence on the impact of NICU design changes on patient health outcomes and patient experience of
care. Also, a recent community needs assessment called to reduce disparities in maternal and child
health by race and ethnicity. These lead us to conduct a mixed-methods process and outcome
evaluation examining the impact of a NICU transition from open bay to single family rooms that
occurred at Cone Health in Greensboro, NC. A theoretical benefit of single family room designs is
increased parent-neonate bonding time, yet this assumes that parents routinely room-in with neonates.
Black and low income parents may experience economic and transportation hardships that constrain
their opportunity to room-in at the frequency of white and economically privileged parents. Thus, we
hypothesize that single family rooms disproportionately benefit neonates from economically privileged
families (predominantly white) compared to neonates from families with low incomes (predominantly
Black and LatinX in our community). We will conduct a mixed-methods study that triangulates patient
health outcome data, patient experience surveys, and in-depth interviews with NICU staff to explore
whether different patient sub-populations unequally benefited from or were unintentionally harmed by
a NICU design change from open-bay to single family rooms. A secondary data analysis will help us
determine whether patient health outcomes and patient experience of care changed before vs. after the
NICU transition from open-bay to single family rooms. We will examine health disparities across patient
sub-populations, with special attention to race/ethnicity and socioeconomic status. We will then collect
and analyze qualitative data to provide rich detail on processes that reproduce health disparities; we will
explore barriers and facilitators to implementing strategies to mitigate unintended consequences,
improve care delivery, improve health outcomes, and reduce health disparities among patient sub-
populations. Using a community engaged approach with a Stakeholder Advisory Board, we will develop
a conceptual framework on the impact of NICU design changes and disseminate lessons learned and
actionable recommendations to drive systemic changes to policies and procedures at health systems to
improve patient quality of care, improve health outcomes, and reduce health disparities.
