NPIC’s Race & Ethnicity Dashboard
For years, clinicians, researchers, and community members have been describing the disparities in perinatal and obstetric outcomes, particularly within race and ethnicity. In 2020 NPIC set forth an initiative to bring to life, a Race & Ethnicity Dashboard.
In 2017, National Public Radio (NPR) and ProPublica launched the Lost Mothers series, which sought to put the names and faces to those who died of pregnancy complications, such as stroke, hemorrhage, heart failure, among other causes.
In 2019, Dr. Elizabeth Howell and colleagues recommended the use and implementation of race and ethnicity quality dashboards as “one of eight steps for narrowing gaps in maternal outcome disparities.”
And in 2020, NPIC set forth an initiative to bring this race and ethnic disparity dashboard to life. During 2020, NPIC worked with a diverse team comprised of representatives of member hospitals to establish the framework and initial metrics that would best serve healthcare teams in identifying and acting upon obstetric and neonatal outcome disparities.
So, what were the initial metrics that were chosen by this group? The metrics that were selected include:
- Cesarean Section
- Postpartum Hemorrhage
- Severe Maternal Morbidity Overall (including and excluding blood transfusion)
- Severe Maternal Morbidity, Hemorrhage (including and excluding blood transfusion)
- Severe Maternal Morbidity, Hypertension (including and excluding blood transfusion)
- Severe Complications in Term Newborns (Overall, Severe, Moderate)
- Neonatal Bloodstream Infection
- Birth Trauma
- NICU/Special Care Discharges
One year ago this month, NPIC published an overview of the development of the Race and Ethnicity Dashboard, including initial findings from a cohort of 335,412 maternal discharges, and 322,592 neonatal discharges. Here are some of those key findings, which continue to support the literature and other studies:
1) Cesarean Section rates are highest in Black women.
2) Rates of Medicaid utilization, the average length of stay, and case mix index are the highest in Black and Native American populations.
3) Rates of Postpartum Hemorrhage and Severe Maternal Morbidity (overall) are highest in Black and Native American populations.
In response to the work that was conducted, NPIC also created the NPIC Perinatal Quality and Equity Framework that can be utilized in a multitude of settings, including inpatient obstetric care areas. This framework includes areas such as:
1) Including Voices of the Community when creating dashboards and analytics that reflect community outcomes.
2) Recognition of the data, and conducting a routine multidisciplinary review.
3) Patient safety operations and the sustainability of a Patient Safety Nurse/Obstetric Safety Nurse within obstetric leadership teams.
4) Accuracy of race and ethnicity data, including data transparency and cultural competency when handling demographic data.
5) Hospital-sensitive equity indicators that are co-created by multidisciplinary teams, including community voices.
6) Patient reported outcome metrics (PROM) that explore experiences in care, including respectful care, racism, marginalization, mistreatment, or other key patient-reported outcomes.
7) Social Determinants of Health (SDOH) data collection that is purposeful, sustainable, and creates a community-needs assessment and action plan. There should NEVER be a “blame and shame” culture for circumstances that are shared with healthcare teams.
Last week, Vice President Kamala Harris and her team published the White House Blueprint for Addressing the Maternal Health Crisis. NPIC fully supports this blueprint and the actions required to elevate and transform maternal health in the United States.
Goal 3 of the Blueprint is to Advance Data Collection, Standardization, Transparency, Research, and Analysis. This is an outstanding goal and one that NPIC fully supports. In fact, NPIC has years of data that can provide additional substance to this goal:
* NPIC has over two (2) years of stratified race and ethnicity data providing hospitals with data that can be a critical component of community action plans for reducing and eliminating outcome disparities.
* Over 20 years of linked mother/baby data that can offer insights into what impacts the health of the mother has on newborn outcomes.
NPIC partners with hospitals, research organizations, payers, and other companies to provide data that can inform real solutions. Our hope is that hospitals across the United States will embark on their own journey to reduce and eliminate outcome disparities. With the standardization of care, respectful care models, patient activation, shared decision-making, and patient-team-based communication, care equity within obstetric and neonatal populations can be realized.
Where are you on your obstetric care equity journey?