lnvestigating Racial and Ethnic Disparities in Maternal Care at the System Level UsingPatient Safety incident Reports

Maternal mortality in the United States is high, and women and birthing people of color experience higher rates of mortality and severe maternal morbidity (SMM). More than half of maternal deaths and cases of SMM are considered preventable. Our research investigated systems issues contributing to adverse outcomes and racial/ethnic disparities in maternal care using patient safety incident reports. We reviewed incidents reported in the labor and delivery unit (L&D) and the antepartum and postpartum unit (A&P) of a large academic hospital in 2019 and 2020. Deliveries associated with a reported incident were described by race/ethnicity, age group, method of delivery, and several other process variables. Differences across racial/ethnic group were statistically evaluated. Almost two-thirds (64.8%) of the 528 reports analyzed were reported in L&D, and 35.2% were reported in A&P. Non-Hispanic white (NHW) patients accounted for 43.9% of reported incidents, non-Hispanic Black (NHB) patients accounted for 43.2%, Hispanic patients accounted for 8.9%, and patients categorized as “other” accounted for 4.0%. NHB patients were disproportionally represented in the incident reports as they only accounted for 36.5% of the underlying birthing population. The odds ratio (OR) demonstrated a higher risk of a reported adverse incident for NHB patients; however, adjustment for cesarean section attenuated the association (OR = 1.25; 95% confidence interval = 1.01–1.54). Greater integration of patient safety and health equity efforts in hospitals are needed to promptly identify and alleviate racial and ethnic disparities in maternal health outcomes. While additional systems analysis is necessary, we offer recommendations to support safer, more equitable maternal care.