Elizabeth A. Howell, MD, MPP Director of The Blavatnik Family Women’s Health Research Institute Mount Sinai Health System Vice Chair for Research Professor in the Department of Obstetrics, Gynecology, and Reproductive Science Associate Dean for Academic Development Professor Department of Population Health Science and Policy Icahn Mount Sinai, New York

Within-Hospital Racial Disparities in Maternal Complications Persist

MedicalResearch.com Interview with:

Elizabeth A. Howell, MD, MPP Director of The Blavatnik Family Women’s Health Research Institute Mount Sinai Health System Vice Chair for Research Professor in the Department of Obstetrics, Gynecology, and Reproductive Science Associate Dean for Academic Development Professor Department of Population Health Science and Policy Icahn Mount Sinai, New York

Dr. Howell

Elizabeth A. Howell, MD, MPP
Director of The Blavatnik Family Women’s Health Research Institute
Mount Sinai Health System Vice Chair for Research
Professor in the Department of Obstetrics, Gynecology, and Reproductive Science
Associate Dean for Academic Development
Professor Department of Population Health Science and Policy
Icahn Mount Sinai, New York

MedicalResearch.com: What is the background for this study?

Response: Previous research has demonstrated racial and ethnic disparities in severe maternal morbidity rates in hospitals and that between-hospital differences — i.e., Black and Latina mothers receiving care at hospitals with worse outcomes — explain a sizable portion of these disparities.  However, less attention has been paid to within-hospital disparities — whether Black and Latina mothers have worse outcomes than White mothers who deliver in the SAME hospital.

In this paper, we set out to measure within-hospital racial and ethnic disparities and to evaluate the potential contribution of insurance type to these disparities. 

Our study question was based on the observation that women with Medicaid can follow different care pathways than women with private insurance. Pregnant women insured by Medicaid are often seen by resident physicians with attending coverage that may differ from attending physicians caring for commercially insured women. In addition, Medicaid reimbursement for delivery hospitalization is far less than that for commercially insured. 

MedicalResearch.com: What are the main findings?

Response: Our data demonstrated that Black and Latina women were more likely than white women to experience a severe maternal morbidity within the same hospital after accounting for patient sociodemographic and clinical characteristics, but insurance type did not explain these disparities. 

MedicalResearch.com: What should readers take away from your report?

Response: Our findings are important for women, healthcare professionals, hospitals, and healthcare systems because they raise the hypothesis that other factors such as implicit or explicit bias, structural racism, communication skills, and different care patterns may contribute to racial and ethnic disparities within hospitals.  Our findings remind us that optimizing quality of care at delivery hospitals includes more than standardizing care practices and maximizing quality and safety on the labor and delivery unit. It also should include efforts to: enhance communication between patients and clinicians; implement bias trainings; improve translation services; use disparities dashboards that stratify quality metrics by race and ethnicity; implement quality improvement activities targeting gaps identified in care, and strengthen community partnerships.

I think the take home message is that a complex web of factors contributes to racial and ethnic disparities in maternal health outcomes and solutions on multiple levels are needed to eliminate their occurrence .Our findings remind us that optimizing quality of care at delivery hospitals includes more than standardizing care practices and maximizing quality and safety on the labor and delivery unit. It also should include efforts to: enhance communication between patients and clinicians; implement bias trainings; improve translation services; use disparities dashboards that stratify quality metrics by race and ethnicity; implement quality improvement activities targeting gaps identified in care, and strengthen community partnerships. 

MedicalResearch.com: How can women try to minimize their risk for maternal health complications?

Response: There are a number of steps women can take to try to minimize their risk for a severe maternal health complication. It is important for women to get preconception care to optimize their health before they become pregnant. Risks of serious maternal health complications are higher for women with chronic illness, older age, obesity, and other factors.

If women seek care prior to becoming pregnant their healthcare provider can help them to optimize their health and hopefully lower their risk of a severe complication. Early prenatal care, good nutrition, and exercise are all important steps women can take to help to lower their risk. 

MedicalResearch.com: Is there anything else you would like to add?

Response: We used administrative data (birth certificate data linked with state discharge abstract data) and therefore were unable to assess a number of factors that may contribute to racial and ethnic disparities within hospitals. Administrative data do not contain information on management of existing preexisting health conditions, prenatal factors, or unmeasured community and social factors all of which may contribute to racial and ethnic disparities within hospitals. 

Citation:


Race and Ethnicity, Medical Insurance, and Within-Hospital Severe Maternal Morbidity Disparities

Howell, Elizabeth A.; Egorova, Natalia N.; Janevic, Teresa; More

Obstetrics & Gynecology January 09, 2020

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Last Modified: Jan 16, 2020 @ 5:22 pm

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