Research Project
10218800
PROJECT SUMMARY Despite having the most expensive maternity care in the world, the maternal mortality rate (MMR) in the US increased to 16.9 deaths per 100,000 live births in 2017, with estimates as high as 26.4 in 2015. For every maternal death there are 50 - 100 cases of severe maternal morbidity (SMM) and this rate has also increased sharply ? rising 45% between 2006 and 2015. Women of color are more likely to suffer mortality and SMM; Black women are 3 to 4 times more likely to die from pregnancy-related causes than white women. Maternal mortality and SMM cost billions of dollars each year. However, 45 ? 60% of all maternal deaths and SMM are preventable with timely and appropriate care. Thus, disparities in mortality and SMM are not only related to individual-level variables but also to multilevel contributors, which suggests that there are opportunities to improve health service quality. Examination of the structures and processes of care would help uncover challenges in the clinical systems that contribute to poor maternal care and disparities and identify also features of the system of care that are amenable to interventions. Despite 20 years of systems research in healthcare, few studies have examined the contribution of clinical systems to adverse outcomes and disparities in maternal care. Initial observations in the maternal care units - antepartum, labor and delivery (L&D), and postpartum - and review of patient safety incidences identified a range of systems issues such as understaffing, extensive use of inexperienced contract nurses, missing equipment and supplies, and malfunctioning equipment, that impacted patient care. Preliminary analysis of 19 months of administrative data found that the hospital?s L&D unit delivered 4,057 patients, an average of 225.39 patients each month, and the cesarean delivery rate was 38%. There were 45 readmissions during this period, 15 recorded cases of SMM (hemorrhage, hysterectomy, and abscess) and one maternal death. This data was not disaggregated by race. This research proposes a mixed methods approach to investigate systems safety and equity by conducting a prognostic risk assessment and examining distributions of incidents as a preliminary assessment of disparate care. This research will describe, in more detail than has ever been available before, how the clinicians delivering maternal care are predisposed to success or failure by the design of the work system and offer a reasonable approximations of disparate quality of care in the health system. Specifically, the following three aims will be conducted: AIM 1: Develop a sociotechnical systems model of maternal care using a work systems analysis; AIM 2: Examine risks in maternal care units using patient safety incident reports; and AIM 3: Identify sociotechnical factors contributing to disparities in adverse events in maternal care. This research coalesce patient safety and disparities efforts to generate and test hypotheses that will ultimately lead to multi- level interventions that can be tailored for local implementation and scaled for widespread adoption.
