Variation in organisational factors across high- and low-performing hospitals with regard to spontaneous vaginal birth for Black women in four states: a cross-sectional descriptive study.

Abstract

To describe variation in hospital organisational factors across high- and low-performing hospitals with regard to spontaneous vaginal birth (SVB) for Black women. Cross-sectional descriptive. We conducted a cross-sectional study using three datasets in four states from 2016, including the American Hospital Association Annual Survey, administrative discharge abstracts and a survey in which nurses served as informants about the organisational factors in their hospitals. Hospitals were categorised based on whether they achieved (1) the SVB rate target for Black women at low risk for caesarean birth, (2) the SVB rate target for Black women at low risk for caesarean birth and equivalent SVB rates between Black and White women at low risk for caesarean birth, or (3) neither of these metrics. The first two categories above were considered 'high performing' and the third 'low performing'. Analysis of variances were used to compare organisational factors between hospital categories. There were 257 hospitals in the sample. Outcomes were meeting the SVB rate targets for Black women at low risk for caesarean birth and SVB rate equivalence between Blacks and White patients. High-performing hospitals had better nurse work environments (2.84 vs 2.695, p =0.04), including better nurse-physician relationships (2.77 vs 2.695, p =0.02). There were statistically significantly more advanced practice nurses (APNs) on average in maternity units in high-performing hospitals compared with low performing (3.51 to 2.76; p=0.003). Better rated nurse work environments and the presence of APNs were distinguishing characteristics of high-performing hospitals. These organisational factors may be system-level targets for hospital-level interventions to improve SVB rates and equity therein.