Lauren Arrington DNP CNM Assistant Professor Georgetown University School of Nursing and Health Studies NurseMidwife University of Maryland St Joseph Medical Center Allison Bryant MD MPH ID: 1031974
Download Presentation The PPT/PDF document "Health Equity as Foundational to Perinat..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1.
2. Health Equity as Foundational to Perinatal Quality Improvement: How to be Intentional about Your Project DesignLauren Arrington, DNP, CNMAssistant Professor, Georgetown University, School of Nursing and Health StudiesNurse-Midwife, University of Maryland St. Joseph Medical CenterAllison Bryant, MD, MPHSenior Medical Director of Health Equity, Mass General Brigham Health SystemAssociate Professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical SchoolChristina Davidson, MDAssociate Professor, Division of Maternal Fetal Medicine, Baylor College of Medicine Vice Chair of Quality, Patient Safety & Equity, Department of Obstetrics & Gynecology, Baylor College of MedicineChair, Society for Maternal-Fetal Medicine Patient Safety and Quality Committee
3.
4. What outcomes to follow and improve? What is of importance to your organization? To your community?
5. What outcomes to follow and improve? AND
6. -PC-01/MAT-3: Elective Delivery -PC-02/MAT-4: NTSV C-Section -PC-05/NEWB-1: Exclusive Breast Milk Feeding -PC-03: Antenatal Steroids -PC-04: Healthcare Associated Bloodstream Infection in Newborns-MAT-5: Appropriate DVT Prophylaxis-NEWB-2: Newborn Bilirubin Screening -PC-01/MAT-3: Elective Delivery -PC-02/MAT-4: NTSV C-Section -PC-05/NEWB-1: Exclusive Breast Milk Feeding -High Risk Deliveries -Episiotomy Rate-Maternity Care Processes:MAT-5: Appropriate DVT ProphylaxisNEWB-2: Newborn Bilirubin Screening -PC-01/MAT-3: Elective Delivery -PC-02/MAT-4: NTSV C-Section Leapfrog2 -PSI-18: OB Trauma – Vaginal with Instrument -PSI-19: OB Trauma – Vaginal without Instrument BCBS AQC -PPC: Prenatal and Postpartum Care -FPC: Frequency of Ongoing Prenatal CareHEDISMass Health-PC-01/MAT-3:Elective Delivery-PC-02/MAT-4: NTSV C-Section-PC-01/MAT-3: Elective Delivery HospCompJoint Commission1 VBP HACCHIA -PC-02/MAT-4: NTSV C-Section Cons.Rep.-Abdominal Hysterectomy Surgical Site Infection-PC-01/MAT-3: Elective Delivery
7. www.mghdisparitiessolutions.org/
8. www.mghdisparitiessolutions.org/
9. www.mghdisparitiessolutions.org/
10. www.mghdisparitiessolutions.org/
11. www.mghdisparitiessolutions.org/
12. Once the inequity is identified, how do we design an intervention?Kilbourne et al, AJPH 2006
13. Once the inequity is identified, how do we design an intervention?Universal efforts aimed at all?Targeted efforts aimed at populations in need?
14. How do general quality improvement efforts affect equity?…or does it?
15. “A Leaky Boat Sinks Lower”Orsi et al, AJPH 2010
16. Possible outcomes of QI initiatives vis-à-vis equityhttp://www.solvingdisparities.org/tools/roadmap
17. SMARTIE AimsInclusive – It brings traditionally marginalized people, particularly those most impacted, into processes, activities and decision and policy making in a way that shares power Equitable – It includes an element of fairness or justice that seeks to address systemic injustice, inequity, or oppressionExample – By 12/31/22 We will increase the postpartum visit rate for our Latinx/Hispanic patients by 10% so that services are distributed more equitably across races and ethnicities.(Massachusetts Department of Health, 2021)
18. Equity Adapted Model for ImprovementIn which populations? Experiencing which barriers?For whom? Under what circumstances? Who might we miss?Are there unintended consequences? Do all receive the benefits of the change equitably? Will the change worsen inequities?(Langley et al, 2009; Massachusetts Department of Health, 2021)
19. Center the Needs of the Most OppressedRetrofitDuring implementation meet with patients and community members from oppressed groups. How do they experience your intervention? What are their recommendations? Make adjustments as feasible.ReformOversight committee with patient and community representatives whose input is required for approval process.ReimagineCo-create QI projects with equitable leadership from patients and community members from oppressed groups.(McLemore, 2021)
20. Validated Measure of Obstetric Racism
21.
22. Solution Focused Disparities DataReport data in an actionable form to improve the lives of those represented in the data.Provide public access to aggregate data.Acknowledge structural racism or other harms to communities that are embedded in the data.Include stories as a complement to quantitative findings in order to better contextualize the lived experience represented by the numbers. Provide clear documentation of the data analysis process along with analytic files so that others can reproduce the results.Hawn Nelson et al, 2020)
23. Case Study: Implementation of AIM Ob Hemorrhage and Disparities Bundles
24. TexasAIMObstetric Hemorrhage AIM Patient Safety Bundle | AIM Program (Previously Council on Patient Safety) (safehealthcareforeverywoman.org)Texas Department of State Health Services (DSHS) launched statewide initiative in 2018 to implement AIM Obstetric Hemorrhage patient safety bundleGoal: reduce SMM from hemorrhage by 25% by January 1, 2020
25. Texas Children’s Hospital Pavilion for WomenLevel IV Maternal and Neonatal hospital located in Texas Medical Center~6500 deliveries/year24/7 coverage by Ob/Gyn Hospitalists, Critical Care Medicine, and BCM ResidentsPatient demographics:38% Hispanic34% Non-Hispanic White20% Non-Hispanic Black8% Asian/Other40% Medicaid10% non-English preferred language25
26. Pavilion for Women Quality Improvement Initiative
27. Data Presented at Texas Children’s Pavilion for Women Department Meeting: January 2019SMM Rates October 2015 – January 2019
28. Patient Safety Bundles - Improving Maternal Health | Council on Patient Safety (safehealthcareforeverywoman.org)
29.
30.
31. due to health disparities from unconscious bias
32. Davidson C, et al. Examining the effect of quality improvement initiatives on decreasing racial disparities in maternal morbidity. BMJ Qual Saf. 2022 Apr 15
33. Severe Maternal Morbidity from Hemorrhage (SMM-H) Rate decreased from 45.5% during the Pre-Intervention Phase to 31.6% during the Post-Intervention Phase (p=.011)Davidson C, et al. Examining the effect of quality improvement initiatives on decreasing racial disparities in maternal morbidity. BMJ Qual Saf. 2022 Apr 15
34. Severe Maternal Morbidity from Hemorrhage Rate (%)Davidson C, et al. Examining the effect of quality improvement initiatives on decreasing racial disparities in maternal morbidity. BMJ Qual Saf. 2022 Apr 15
35. Davidson C, et al. Examining the effect of quality improvement initiatives on decreasing racial disparities in maternal morbidity. BMJ Qual Saf. 2022 Apr 15
36. Equity Impact Assessment Toolhttps://www.seattlechildrens.org/clinics/diversity-health-equity
37. THANK YOU!
38. ReferencesHawn Nelson, A., Jenkins, D., Zanti, S., Katz, M., Berkowitz, E., et al. (2020). A Toolkit for Centering Racial Equity Throughout Data Integration. Actionable Intelligence for Social Policy, University of Pennsylvania. Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009.Massachusetts Department of Health. (2021). Racial Equity Roadmap. https://www.mass.gov/doc/racial-equity-data-road-map-pdf/downloadMcLemore, M. R. (2021, May 11). Retrofit, Reform, and Reimagine: A Conceptual Framework to Identify Structural Determinants of Health, Resolve Health Disparities, and Achieve Health Equity. presented at: 14th Annual Symposium Social Determinants of Health Johns Hopkins Center for Women’s Health, Sex and Gender Research. https://www.youtube.com/watch?v=0gq97JhFG48