Research from Professor Myrtede Alfred highlights racial and ethnic disparities in maternal care at U.S. hospitals in a special issue on healthcare equity just published by The Joint Commission Journal on Quality and Patient Safety (JQPS). Reviewing patient safety incident reports, Professor Alfred and her team examined the systems issues contributing to adverse outcomes and racial/ethnic disparities in maternal care. Differences across racial ethnic groups were statistically evaluated to help healthcare organizations take a systems-based approach to supportable equitable maternal care.
The study, “Investigating Racial and Ethnic Disparities in Maternal Care at the System Level Using Patient Safety Incident Reports,” gathered information in 2019 and 2020 from the labour and delivery unit (L&D) and the antepartum and postpartum unit (A&P) at a large academic hospital in the Southeastern United States. The findings showed that Non-Hispanic Black (NHB) patients were disproportionately represented in the incident reports. This included reports of falls, complications of care, infrastructure failures, medical records/patient identification and transfusions.
“This study is among few which have used incident reports specifically to investigate patient care for women and birthing people of colour and identify differences in adverse outcomes,” says lead author Alfred, an Assistant Professor in the Department of Mechanical & Industrial Engineering. “In addition to policy level interventions, creating an infrastructure at the local hospital and health system level is a strong step to promptly identify and alleviate racial and ethnic disparities in maternal health outcomes.”
Data from the incident reports outlined how NHB patients had higher representation in omission/error in assessment, diagnosis and monitoring incidents, such as missed or delayed lab tests, blood glucose level readings, medication administrations and initiation of breastfeeding/pumping. Delays in diagnosis and treatment are concerning given higher rate of comorbidities, such as diabetes and hypertension, experienced by NHB and Hispanic patients. These incidents can have significant impact on patients’ health, not just in the hospital setting but after discharge.
“Redesigning health systems to provide responsive care for NHB and birthing people of colour is critical to improving equity in outcomes,” says Alfred. “This includes better supporting the health care teams who monitor and address these concerns during and after birth, measuring outcomes and experiences in a manner that facilitates identification of disparities, and meaningfully engaging with patients and their families.”
Developing a comprehensive framework for equity analyses at the system level and integrating patient safety and health equity efforts are needed to improve racial and ethnic disparities in maternal health outcomes. The research acknowledges that many of these challenges are recognized at the national or state level, however, stronger awareness of differences in outcomes at the individual hospital and health systems level is necessary to support safe, patient-centered and equitable maternal care.
-Published January 4, 2024 by Kendra Hunter