Oral Concurrent Session 2 - Health Equity and Disparities
20 - Examining the effect of quality initiatives on decreasing racial disparities in maternal morbidity
Thursday, January 28, 2021
4:30 PM – 4:45 PM EST
Objective: To evaluate the impact of QI and patient safety (QI/PS) initiatives and data disaggregation on racial disparities in severe maternal morbidity (SMM).
Study Design: Our hospital began monitoring and reporting on SMM-overall and SMM-hemorrhage (SMM-H) rates in 2018 using administrative data defined by Centers for Disease Control. In March 2019, we began stratifying data by race and ethnicity and noted a disparity in rates, with Black women having the highest rates. The data was presented at monthly department meetings and annual Grand Rounds. During this time, our hospital implemented several QI/PS initiatives around obstetric hemorrhage and used the stratified data to inform guideline development to reduce racial disparity. The initiatives included implementation of the Ob hemorrhage bundle from the Alliance for Innovation on Maternal Health and multi-/inter-disciplinary in-depth case reviews of adverse patient outcomes. We then retrospectively analyzed our data to examine whether race-specific SMM and SMM-H rates were reduced and the impact on the disparity gap. Our outcome of interest was SMM and SMM-H prior to data stratification (pre-intervention: June 2018-February 2019) as compared to after data stratification (post-intervention: March 2019-June 2020). Data was analyzed using chi-square analysis.
Results: During our study time period, there were 13,659 deliveries at our hospital: 37.6% Hispanic, 34.4% Non-Hispanic (NH) White, 20% NH-Black, 8% Asian/Other. There was a statistically significant difference in the Black/White rate of SMM and SMM-H pre-intervention (p <.001 for both). This disparity remained significant post-intervention for SMM (p=.008), but not for SMM-H (p=.138). The rate of SMM in Black women decreased from 7.11 pre-intervention to 5.09% post-intervention (p=.038) (Figure 1). The rate of SMM-H in Black women decreased from 45.45% to 31.58% (p=.011) (Figure 2).
Conclusion: QI/PS efforts that incorporate race/ethnicity data stratification to identify disparities and use the information to target interventions have the potential to reduce these disparities.