Presentation
PART 2: Adverse events in maternal care – investigating racial/ethnic disparities at the system level
Event Type
Oral Presentations
TimeThursday, June 9th3:00pm - 3:30pm EDT
Location
DescriptionIn the Unequal Treatment Report (2003), the Institute of Medicine suggested failure to identify the processes and structures that vary by race or ethnicity represented a significant gap in health disparities research. This gap is perhaps most evident in the research examining racial/ethnic maternal health disparities. Pregnancy related deaths are elevated among women of color, and Black women are 3 to 4 times more likely to die from pregnancy-related causes than white women. Women of color also experience higher rates of severe maternal morbidity (SMM), resulting in significant short or long-term consequences to their health. Half of all maternal deaths and SMM cases are considered preventable with timely and appropriate care and deaths from conditions such as hemorrhage have been deemed preventable in high as 93% of cases.
Poor maternal health outcomes and racial/ethnic disparities are the result of multilevel variables impacting women’s preconception health, access to nutritious food and safe spaces to exercise, and ability to secure safe, respectful care. While population level research has highlighted trends and disparities, research at the health system level is essential for identifying opportunities to improve care. Maternal mortality review committees also noted smaller scale, complementary efforts are needed to identify specific opportunities to improve maternal care within clinical systems. Despite notable contributions of systems research to patient safety, few studies have investigated the underlying mechanisms within the clinical system that undermine safety for women of color. Prior human factors investigation in maternal care have identified systems risks – such as physical environments that impede workflow, lack of clear roles for team members during emergency cesarean deliveries, inconsistent ordering and receiving processes for blood products and critical laboratory results. However, these efforts have been mostly limited to obstetric emergencies with little or no focus on potential disparate impacts. My research applies sociotechnical systems analyses to investigate the manner by which the configuration of clinical systems unintentionally fail women of color and result in adverse outcomes. This work will be conducted by a multidisciplinary team in partnership with healthcare providers and patients.
My presentation reviews our initial assessment of systems issues contributing to adverse outcomes in maternal care and disparities based on the examination of 680 patient safety incidents (PSIs) reported in maternal care units (labor and delivery and mother-baby) at a large, academic health system in 2019 and 2020. Trends in incidents across the labor and delivery and mother-baby unit (antepartum and postpartum) regarding event type and severity will be examined. PSIs will also be disaggregated by race/ethnicity and cross tabulated with unit, event type, and severity to examine disparities in adverse events. As the event type selections in the event reporting system are often limited to a single cause selected by the reporter, the narratives from PSIs will be reviewed, summarized, and coded for contributing systems factors using a SEIPS-based taxonomy: person (training, behavior), task (coordination, teamwork), equipment (usability issues, malfunction), environment (space, noise), and organization (resource allocation). While PSI data has many limitations, these reports have been commonly used to explore a vast array of systems-related safety problems in terms of outcomes, near-misses, and general underlying systems states, and prior research suggests that adverse events are reported more frequently for patients of color, specifically African-Americans, at urban teaching hospitals.
The findings from this research will elucidate a range of systems risks in maternal care which can be prioritized with stakeholders to adapt existing processes, tools, and resources and to improve the quality of maternal care. This analysis also provides an equity lens to the system investigation supporting the development of targeted efforts to address the clinical systems risks factors disparately impacting women of color.
Poor maternal health outcomes and racial/ethnic disparities are the result of multilevel variables impacting women’s preconception health, access to nutritious food and safe spaces to exercise, and ability to secure safe, respectful care. While population level research has highlighted trends and disparities, research at the health system level is essential for identifying opportunities to improve care. Maternal mortality review committees also noted smaller scale, complementary efforts are needed to identify specific opportunities to improve maternal care within clinical systems. Despite notable contributions of systems research to patient safety, few studies have investigated the underlying mechanisms within the clinical system that undermine safety for women of color. Prior human factors investigation in maternal care have identified systems risks – such as physical environments that impede workflow, lack of clear roles for team members during emergency cesarean deliveries, inconsistent ordering and receiving processes for blood products and critical laboratory results. However, these efforts have been mostly limited to obstetric emergencies with little or no focus on potential disparate impacts. My research applies sociotechnical systems analyses to investigate the manner by which the configuration of clinical systems unintentionally fail women of color and result in adverse outcomes. This work will be conducted by a multidisciplinary team in partnership with healthcare providers and patients.
My presentation reviews our initial assessment of systems issues contributing to adverse outcomes in maternal care and disparities based on the examination of 680 patient safety incidents (PSIs) reported in maternal care units (labor and delivery and mother-baby) at a large, academic health system in 2019 and 2020. Trends in incidents across the labor and delivery and mother-baby unit (antepartum and postpartum) regarding event type and severity will be examined. PSIs will also be disaggregated by race/ethnicity and cross tabulated with unit, event type, and severity to examine disparities in adverse events. As the event type selections in the event reporting system are often limited to a single cause selected by the reporter, the narratives from PSIs will be reviewed, summarized, and coded for contributing systems factors using a SEIPS-based taxonomy: person (training, behavior), task (coordination, teamwork), equipment (usability issues, malfunction), environment (space, noise), and organization (resource allocation). While PSI data has many limitations, these reports have been commonly used to explore a vast array of systems-related safety problems in terms of outcomes, near-misses, and general underlying systems states, and prior research suggests that adverse events are reported more frequently for patients of color, specifically African-Americans, at urban teaching hospitals.
The findings from this research will elucidate a range of systems risks in maternal care which can be prioritized with stakeholders to adapt existing processes, tools, and resources and to improve the quality of maternal care. This analysis also provides an equity lens to the system investigation supporting the development of targeted efforts to address the clinical systems risks factors disparately impacting women of color.