产前物质暴露和儿童保护系统报告的多层预测因素
Julia Reddy1, Carolyn T Halpern1, Davida M Schiff2
1Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.
The Journal of pediatrics
|March 21, 2025
概括
儿童保护系统 (CPS) 对产前物质暴露的婴儿的报告因医院而异. 在主要私人保险医院的公开保险分娩面临更高的报告率,这表明CPS报告中的潜在偏见.
科学领域:
- 围产期健康 围产期健康
- 公共卫生政策 公共卫生政策
- 儿童福利系统的儿童福利系统.
背景情况:
- 产前物质暴露是影响婴儿福祉的重大问题,需要儿童保护系统 (CPS) 的参与.
- 现有的研究突出了医疗保健获取和结果的差异,但医院级因素对暴露婴儿的CPS报告的影响不太清楚.
研究的目的:
- 描述儿童保护系统 (CPS) 在出生后报告的模式,有记录的产前物质暴露.
- 检查个人和医院层面的因素如何与CPS报告有关,在这个脆弱的婴儿群体中.
主要方法:
- 一项回顾性队列研究,利用2018年加利福尼亚州出生情况的州级行政数据.
- 对黑人,白人和美国出生的西班牙裔母亲的分娩进行分析,这些母亲有记录的产前物质暴露.
- 应用随机拦截混合模型来评估CPS报告的医院和个人预测因素,包括相互作用效应.
主要成果:
- 在260,525名出生中,有2.6%的出生前暴露于物质的记录,在物质使用模式中观察到种族差异.
- 分娩医院占CPS报告中差异的24%.
- 与私人保险分娩占多数的医院的公共保险分娩与私人保险分娩相比,CPS报告的可能性几乎翻了一番.
结论:
- 对于产前暴露物质的出生,CPS报告存在显著差异,受医院级因素的影响.
- 医院和个体特征之间的相互作用表明CPS政策实施中的潜在偏见和不一致.
- 建议改进决策工具和提供者培训,以减轻差异,增强公平的CPS参与.
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