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.

Project Narrative We will conduct a mixed-methods study to explore the impact of a neonatal intensive care unit (NICU) design change from open bay to single family rooms at Cone Health. We will triangulate patient health outcome data, patient experience surveys, and in-depth interviews with NICU staff to identify disparities in health outcomes and experience of care and unearth rich details on processes and mechanisms that reproduce health disparities. In partnership with community stakeholders, we will develop a conceptual framework and disseminate lessons learned and actionable recommendations to drive change at Cone Health and other health systems to improve quality and delivery of health care, improve health outcomes, and reduce health disparities.