Developing research led by Myrtede Alfred (MIE) offers new insight to address racial and ethnic maternal care disparities in the United States.
Evaluating clinical systems issues using 528 incident reports in 476 deliveries, Alfred found that Non-Hispanic Black (NHB) patients are represented disproportionately in incident reports from a large academic hospital in the southeastern United States.
The study, published in a special issue of the Joint Commission Journal on Quality and Patient Safety, analyzed incident reports documented in 2019 and 2020 from the labour and delivery unit (L&D) and the antepartum and postpartum unit (A&P) of the hospital.
The investigation is among a few that use incident reports to explore differences in adverse outcomes for birthing in racialized groups. Supported by the 2023 BRN IGNITE grant and the Agency for Healthcare Research and Quality (AHRQ), the project is part of Alfred’s work to ensure equitable maternal care.
“The emphasis of this work was to disaggregate commonly used patient-safety data by race to understand whether there were certain outcomes where we saw marginalized women, mostly Black women, being disproportionally represented,” says Alfred.
The paper notes that while NHB and Non-Hispanic white (NHW) patients saw similar rates of reported incidents (ranging at about 43% for both), NHB patients account for 36.5% of the hospital’s birthing population, making them disproportionally represented in reports.
Incident reports drive patient safety and quality improvement initiatives. Some of the top five reported incidents included communication, medication-related incidents and omission/errors in assessment, diagnosis or monitoring.
NHB patients accounted for 54% of omission/error events — the only incident category that had a clear correlation to race and ethnicity, compared to other incidents. More than half of NHB patients reported events that include infrastructure failures, complications of care, and falls, to name a few.
Alfred explains that the population within the southeastern United States has higher rates of comorbidities, like diabetes and hypertension, which leaves them at a higher risk for harm, especially with delayed lab tests and blood glucose level readings.
“When those things are not happening, what that is doing is putting patients at a level where they are potentially declining in health, and it’s not captured quickly enough to support interventions,” she says.
The report also found that NHB patients experienced a longer length of stay compared to NHW patients. This may be due to the higher rates of caesarean deliveries, which increases likeness of harm and the chance of repeating the procedure in a future delivery.
“We know NHB patients are getting more caesarean deliveries, which are associated with more time in a hospital and exposes them to harm, particularly if they are monitored less,” Alfred says.
“What we’re trying to do is build that connection between what is causing the higher levels of harm that we are seeing for Black women. We are moving away from outcomes to understand the reason behind them.”
Since incident reports are voluntary, this leaves a question of incident frequency, which is likely under-reported, Alfred says.
Unlike in Canada, U.S. health-care systems collect race-based data. While maternal health disparities are recognized at the national or state level, local hospitals and health systems need more data to provide responsive care for NHB patients.
Such data could be used in the development of an equity dashboard that could support shared understandings of issues and establish precise interventions to reduce disparities. Part of the accountability in reaching health equity goals includes acknowledgment of the historic harm in the United States in denying care and rebuilding patient trust, Alfred says.
“We largely think about harm in terms of physical harm, but there is an emotional side to harm that we could be incorporating. There is a big push for implicit bias training, which will be part of the solution.”
