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Data Gives Patients a Voice: Lessons Learned about Maternal Health Equity

Why It Matters

“No one intentionally wants to provide different care based on race, ethnicity, age, or language. That’s not why we went into health care.”

Data Gives Patients a Voice Lessons Learned about Maternal Health Equity

Photo by Kane Reinholdtsen | Unsplash

The aha moment came a few years ago for Carmen Morehead, MSN, RN, CNL. She was a discharge planner doing her best to help her patients. But time after time, a lack of insurance or Medicaid coverage limitations meant she could not get her patients the physical therapy, equipment, medication, or rehabilitation placement they needed.

She found these cases troubling. “I couldn't put a name to it at the time,” Morehead, Health System Performance Improvement and Equity Coordinator at USA Health (Mobile, Alabama, USA), recalled during a recent interview with the Institute for Healthcare Improvement (IHI). “But, as I learned more, I realized these were health inequities.” The systemic injustices she witnessed inspired Morehead’s drive to eliminate health disparities.

When USA Health Children & Women’s Hospital learned about the IHI Eliminating Inequities and Reducing Postpartum Morbidity and Mortality Learning Community funded by Merck for Mothers, they jumped at the chance to join with little expectation of acceptance. “We went at [the application process] as a team with nothing but heart,” recounted Kristen Noles, DNP, CNL, USA Health Performance Improvement Manager. To their surprise, IHI invited them to take part. Noles believes their sincere commitment to improving Black maternal health outcomes was the deciding factor. “Passion is what got us into the IHI Learning Community,” Noles said. “We cared and we wanted to do more.”

Revelations, Grief, and Recommitment

A turning point in USA Health’s Learning Community participation was using a software tool (AdaptX) which integrated with their electronic medical record and for the first time gave them access to recent data stratified by race and ethnicity, provider, or unit. When the team examined the data for their first PDSA cycle focused on pain management, the scores indicated that White women on average experienced moderate pain while Black women on average experienced severe pain.

The meaning of what their data revealed produced a grief response. While they expected to see disparities based on the research, “it hit us hard,” Noles recalled. “No one intentionally wants to provide different care based on race, ethnicity, age, language. That’s not why we went into health care.” The team did not convene for the rest of the week and let the glaring reality of the data sink in.

Even providers who consciously reject racism have unconscious bias and internalized cultural stereotypes that influence medical care and impact outcomes. The key is how to respond once this becomes evident. For the USA Health team, after a few days, they processed their feelings together and recommitted to what they knew would be a hard road ahead. They decided to learn from their data not with judgment or pointing fingers, but with curiosity and humility.

Wide-Ranging Impact

According to IHI Director Deborah Bamel, MPH, who led the Eliminating Inequities and Reducing Postpartum Morbidity and Mortality Learning Community, the USA Health team has accomplished much in a relatively short time by embracing the use of quality improvement (QI) methods to further their maternal health equity objectives. “This team has truly lived and embodies what it means to use QI to improve patient care,” she stated. “When you find dedicated, motivated people who are willing to learn and grow and equip them with the right tools, they can have a profound impact.”

Indeed, their list of accomplishments continues to grow as they continuously see opportunities to improve equity and word of their effort spreads. They developed, tested, and launched their Hero4MOM program in less than six months. Hero4MOM is a post-partum blood pressure monitoring program for women with (or at risk of) hypertension. The program provides blood pressure cuffs and education to patients. It leverages emailing and coordinates engagement to prompt patients to check their blood pressure daily. Said Bamel, “They are already seeing the results of their hard work in their patient’s outcomes.” The program has led to early follow-ups, telehealth visits, and timely interventions for patients potentially preventing complications and readmissions.

By demonstrating how much they can improve the lives of all their patients by focusing on Black maternal health, the USA Health team have also convinced their leaders to center health equity in their system’s strategic plan. They have established structures, processes, and cascaded knowledge and expert strategies throughout the organization and beyond it, reaching other states including Mississippi and Florida. They have created partnerships with other departments in their system and external organizations to decrease duplicated efforts and maximize their collective impact.

Key Takeaways

The USA Health team has collected multiple lessons learned since joining the Learning Community:

  • Stratified data changes everything. Morehead described getting access to recent stratified data as “revolutionary.” Stratified data has helped the team identify more cases of acute severe hypertension, recognize patterns and trends over time, and analyze data that uncovers disparities. This information put them in a better position to make informed decisions and target inventions in response to what their community is experiencing. As Noles stated, “The data gives a voice for the population that we serve and allows us to reflect on our care delivery and processes.”
  • Quality Improvement methods provide a way forward. A systematic approach to improvement set a solid foundation for achieving the equitable outcomes USA Health sought to achieve. As Morehead asserted, “When you don’t have QI, people are very quick to jump to a solution” that may not take you where you need to go. “But a QI methodology gives you a roadmap,” she said. In addition to QI training, the Learning Community provided monthly coaching and encouraged use of IHI’s Framework for Improving Health Equity as a springboard for their efforts.
  • Community-wide challenges require community-wide solutions. The USA Health team is trying to overcome multiple systemic problems and resources are scarce. “There are so many maternity care deserts in Alabama,” Morehead explained. As defined by the March of Dimes, maternity care deserts are counties in the US where there is “a lack of maternity care resources, where there are no hospitals or birth centers offering obstetric care and no obstetric providers.” She added, “It’s alarming how many women are at high risk, but I don't think people realize it until it’s impacting them.” Morehead noted that “lifting up the voices of those patients most likely to experience morbidity and mortality in the maternal space” and attracting more Black OB/GYNs, midwives, and nurse practitioners would be two keys to improvement. Noles added that building alliances with other organizations working to improve the health and well-being of their community, including MoMMA’s Voices and the USA Center for Healthy Communities, have been fortifying and necessary.

Noles and her USA Health colleagues understand they still have a long way to go in their journey to improve maternal health equity. But they are excited about using the QI skills they are building to do more. “We now have a foundation,” she stated, “so I can’t wait to see what is in store for us and our community.”

Cleola Payne, MPH, is an IH Project Manager.

You may also be interested in:

Getting Started with QI and Health Equity: “Don’t Be Intimidated. Be Inspired”

Co-Design and Building QI Capability: Overcoming Challenges in Maternal and Child Health