Peer-reviewed article
Impact on Health Disparities: Secondary Analysis of an Unplanned Extubation Quality Improvement Study.
Sreenivasan G, Krishnan P, Parton LA, Singh M ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined whether a quality improvement program to reduce unplanned extubation (accidental removal of breathing tubes) in newborn intensive care units benefited all infants equally. Researchers found that at the start, Black infants, English-speaking families, and lower-income patients had higher rates of this complication. After implementing a standardized best-practice bundle, unplanned extubation rates fell across all groups, and the gaps between racial and socioeconomic groups narrowed.
Key points
- At baseline, non-Hispanic Black infants had higher unplanned extubation rates than other racial/ethnic groups
- Medicaid-insured patients and English-speaking families experienced higher baseline unplanned extubation rates
- Following implementation of the standardized best-practice bundle, unplanned extubation rates decreased across all demographic subgroups
- Health disparities in unplanned extubation rates narrowed after the quality improvement intervention
- Special-cause variation in improvement was detected beginning in December 2022
Limitations
This is a secondary analysis of a single neonatal intensive care unit, so findings may not generalize to other hospitals or settings. The study does not explain the mechanisms by which disparities existed at baseline or how the bundle addressed them.
Abstract
Introduction Quality improvement (QI) initiatives have reduced unplanned extubation (UE) rates in neonatal intensive care units, but few studies have examined the equity of these improvements. An explicit equity focus in QI can reveal disparities that may otherwise remain unrecognized. This secondary analysis of a previously published UE prevention QI initiative aimed to identify baseline disparities in UE rates and determine whether these disparities narrowed following the implementation of a standardized best-practice bundle (BPB). Methods We reviewed 6 months of preintervention medical record data and stratified UE rates by race/ethnicity, preferred primary language, and socioeconomic status (insurance as a proxy). Using the Model for Improvement, the QI team implemented the BPB components sequentially and uniformly across the neonatal intensive care unit. Data collection continued throughout implementation. Statistical process control (U) charts were used to examine baseline disparities and assess changes over time. Results At baseline, non-Hispanic Black infants, patients from English-speaking families, and Medicaid-insured patients had higher UE rates. Following the implementation of the BPB, UE rates decreased across all subgroups. Control charts showed special-cause variation beginning in December 2022. Differences in UE rates across racial/ethnic, language, and socioeconomic groups narrowed. Conclusions UE rates were higher among racial minority and lower socioeconomic status populations at baseline. A standardized QI approach was associated with lower UE rates across all subgroups and reduced baseline disparities.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Standardized best-practice bundle (BPB) for unplanned extubation prevention, implemented sequentially and uniformly across the neonatal intensive care unit
- Population
- Neonates in a neonatal intensive care unit, stratified by race/ethnicity (including non-Hispanic Black infants), preferred primary language, and insurance status (Medicaid vs. other)
Key finding
Non-Hispanic Black infants had higher baseline unplanned extubation rates compared to other racial/ethnic groups