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Blog Post
A Dedicated Effort to Reduce Black Birth Complications Yields Results
LDI Fellows Find a Coordinated Systematic Intervention Improved Black Maternal Health Outcomes
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Black patients who give birth are more likely than others to experience preventable complications, and even die. The causes of this Black maternal health crisis are thought to be poor social determinants of health–including a lack of insurance, housing, and transportation– and factors within health care at the patient, provider, and system levels. Despite the resources allocated to the problem, improving pregnancy-related morbidity and mortality for Black patients remains a challenge.
One bright spot is a recent study from Penn LDI Senior Fellows Elizabeth Howell, Sindhu K. Srinivas, and colleagues. The authors demonstrate how a 2020 commitment by the University of Pennsylvania Health System to reduce major maternal morbidity and mortality among Black patients improved outcomes and reduced disparities.
A System-Wide Intervention to Improve Maternal Outcomes for Black Patients
Led by the Department Chair of Obstetrics & Gynecology and the Women’s Health Service Line Lead Physician, the health system used a multifaceted strategy that rested on instituting a system-wide, severe maternal morbidity metric coupled with targeted reduction goals across all birthing facilities and regular outcome reporting stratified by race and ethnicity. The health system also standardized practices in obstetric care delivery to reduce bias and focused on risk reduction and standardized management for postpartum hemorrhage because it accounted for 50% or more severe maternal morbidity cases across the participating hospitals. This standardized approach included implementing the system-wide use of JADA, a device that treats postpartum hemorrhage.
Maternal Outcomes at One Hospital Show how a System-Wide Approach to Disparities Had an Impact
Srinivas and colleagues retrospectively examined all deliveries at the system hospital serving the greatest proportion of Black patients between 2019 and 2021. Of the 12,339 deliveries in the analysis, 64.6% were to Black patients. As shown in Figure 1, the investigators found a reduction in severe complications for all patients over the study period, largely driven by a decrease among Black patients. Complications fell among non-Black patients, too, but the reduction was not significant.
Prioritizing Equity, Reporting Transparency, and Clinical Standardization are Key to Successful Interventions
The data from one hospital participating in a health system intervention suggests that major innovations in clinical practice might be less important than prioritizing equity as a performance target and standardizing clinical operations.
The findings indicate that improving outcomes for Black obstetric patients is possible. Hospitals can do this by evaluating their own surveillance and reporting practices regarding severe maternal morbidity and by pursuing a combination of transparent outcomes and standardization in clinical management.
According to Srinivas, one key to success is to “…continue the support of system-level infrastructure to examine and focus on equity. This includes a focus on creating a system-wide approach to regularly report stratified data and an organized infrastructure for multidisciplinary leaders at each entity to jointly examine the data and implement strategies that are data-driven.” As for the next steps in addressing the Black maternal health crisis, Srinivas says, “We need to continue to be bold in our strategies to address maternal morbidity, mortality, and disparities. This includes setting bold targets and creating infrastructure that allows hospitals to collaborate and learn from one another, and implementing evidence-based solutions to achieve optimal, equitable maternal outcomes.“
The study, “Trends in Severe Maternal Morbidity Following an Institutional Team Goal Strategy for Disparity Reduction,” was published December 2024 in the American Journal of Obstetrics & Gynecology Maternal Fetal Medicine. Authors include Adina R. Kern-Goldberger, Adi Hirshberg, Abike James, Lisa D. Levine, Elizabeth Howell, Elizabeth Harbuck, and Sindhu K. Srinivas.
Author
Christine Weeks
Director of Strategic Initiatives
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