47 - Trends in Severe Maternal Morbidity Following an Institutional Team Goal Strategy for Disparity Reduction

Friday, February 10, 2023

2:45 PM – 3:00 PM

Location: Room 3009, Moscone West, Level 3

Objective: A multifaceted approach to reducing racial disparities in maternal outcomes is critical. In 2020, our health system committed to reducing severe maternal morbidity (SMM) in Black patients, employing multiple strategic interventions including implicit bias training, regular reporting of a composite SMM metric stratified by race/ethnicity, standardization of best practices, focused efforts on hemorrhage risk reduction, and team building. This study investigates trends in SMM by race during a period of concentrated interventions to improve maternal outcomes for Black patients.

Study Design:

This retrospective cohort study evaluated all delivery admissions at an urban, tertiary-care hospital in Philadelphia from 2019-2021. Self-reported race was categorized as Black vs. non-Black. SMM was defined according to CDC indicators as well as additional Vizient codes for hemorrhage, infection, and embolism, and analyzed with a multivariable logistic regression model accounting for co-morbidity index (OB-CMI).

Results: 12339 deliveries were included (8012 [64.6%] Black, 4382 [35.4%] non-Black]. Median OB-CMI score was higher for Black patients [3 (IQR 1-5) v. 2 (IQR 1-4); p < 0.01] (Table). There was a significant decrease in SMM for the entire cohort (8.5% in 2019 to 6.5% in 2021, p=0.001) driven by a decreased rate specifically among Black patients (8.9% in 2019 to 6.6% in 2021, p = 0.005; Figure) with a non-significant decrease for non-Black patients (7.8% in 2019 to 6.3% in 2021, p=0.21). The adjusted model similarly demonstrated decreased risk of SMM over time for Black patients, when accounting for OB-CMI (2020 vs. 2019 OR 0.81, 95% CI 0.69-0.96; 2021 vs. 2019 OR 0.73, 95% CI 0.62-0.86).

Conclusion: Dedicated efforts to reduce SMM over a 3-year period in this hospital serving a Black patient majority were associated with a significant decline in SMM, especially among Black patients. This finding demonstrates the success of a systematic approach in reducing SMM and associated disparities and is highly consequential in light of the ongoing major epidemic of racial disparities in obstetric outcomes.

Primary & Presenting Author(s)

Adina R. Kern Goldberger, MD MPH MSCE

Assistant Professor, Maternal-Fetal Medicine
Cleveland Clinic Lerner College of Medicine
Beachwood, Ohio, United States

Coauthor(s)

AH

Adi Hirshberg, MD

Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
AJ

Abike James, MD

Hospital of the University of Pennsylvania
Philadelphia, PA, United States
Lisa D. Levine, MD, MSCE (she/her/hers)

Associate Professor
Perelman School of Medicine, University of Pennsylvania
Philadelphia, Pennsylvania, United States
Elizabeth A. Howell, MD, MPP

Chair, Obstetrics and Gynecology, Perelman School of Medicine
University of Pennsylvania Health System
Philadelphia, Pennsylvania, United States
EH

Elizabeth Harbuck, BS, RN

Hospital of the University of Pennsylvania
Philadelphia, PA, United States
MH

Michael Harhay, MPH, PhD

Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
Sindhu K. Srinivas, MD, MSCE

Professor, Vice Chair for Quality and Safety, Physician Lead, Women's Health Service Line Penn Medicine
Perelman School of Medicine, University of Pennsylvania
Philadelphia, Pennsylvania, United States