Quality initiatives for decreasing racial disparities in maternal morbidity

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Implementing quality and patient safety initiatives and stratifying data by race and ethnicity significantly reduced racial disparities for severe maternal morbidity (SMM) at a Texas Medical Center hospital, according to a study presented virtually at the 41st Annual Pregnancy meeting of the Society for Maternal-Fetal Medicine (SMFM).

The study found that prior to intervention, the overall rate of SMM in Black women was 7.11%, which decreased to 5.09% post-intervention.

Similarly, for SMM from hemorrhage (SMM-H), the baseline rate for Black women was 45.45%, which decreased to 31.58% post-intervention.

“The baseline results did not surprise me because that is what is reported nationally; however, it was difficult to accept that disparate outcomes were happening in my own hospital,” said principal investigator Christina Davidson, MD, vice chair of Quality, Patient Safety and Equity for the Department of Obstetrics and Gynecology at Baylor College of Medicine in Houston.

Christina Davidson, MD

“What did surprise me was that we started to see a precipitous drop in morbidity in Black women immediately after presenting stratified data at department meetings and discussing potential root causes, such as implicit or unconscious bias, even before implementing targeted efforts,” Davidson said. “The department was highly receptive to these discussions and committed to identifying opportunities to reduce morbidity in our Black patients and eliminate the disparities.”

The study, which was conducted at Texas Children’s Pavilion for Women in The Texas Medical Center, in Houston, compared SMM and SMM-H data pre-intervention (June 2018 to February 2019) to the same data post-intervention (March 2019 to June 2020).

During the study period there were 13,659 deliveries at the hospital: 37.6% Hispanic, 34.4% Non-Hispanic (NH) White, 20% NH-Black and 8% Asian/Other.

Pre-intervention, there was a statistically significant difference in the Black and White rates of SMM and SMM-H: P< 0.001 for both groups.

Before intervention, the overall rate of SMM in White women was 3.61% and for SMM-H it was 28.14%.

This disparity between Black and White patients remained significant post-intervention for SMM (P = 0.008), but not for SMM-H (P = 0.138).

Post-intervention, the overall rate of SMM in White women was 3.48% and for SMM-H it was 25.72%.

“Unlike Black women, White women did not show a significant change in their overall SMM and SMM-H rates from baseline to post-intervention, however their rates were the lowest at baseline,” Davidson told Contemporary OB/GYN.

Davidson believes all quality and patient safety initiatives should incorporate health equity goals into the project design and data analysis.

The Alliance for Innovation on Maternal Health (AIM) has a patient safety bundle on Reduction of Peripartum Racial/Ethnic Disparities. “Elements from this bundle should be incorporated into all quality improvement initiatives,” Davidson said.

Ensuring that a healthcare system collects self-identified race and ethnicity data is the first step in stratifying data. “Whatever data metric you are trying to impact through your efforts should be stratified by race, ethnicity and preferred language to determine if/where disparities exist, so that improvement efforts can specifically target the disparity,”Davison said. “This prospective approach to stratify baseline data can help inform your efforts as you are designing your project.”

Texas Children’s Pavilion for Women is one of over 200 hospitals in Texas that has enrolled and participated in the AIM Obstetric Hemorrhage patient safety bundle. “The state’s goal is to reduce the rate of SMM-H by 25%,” Davidson said.

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Davidson reports no relevant financial disclosures.