The Quality Improvement Project
Maternal HealthCARE, a partnership between March of Dimes and the U.S. Department of Health and Human Services, is a quality improvement collaborative created to advance equity and provide safe and equitable maternity care for all.
This two-year quality improvement project will be executed in several hospitals across two states. Improvement measures will focus on best practices for patient centered, respectful, antiracist care for all, using a team-based approach to care, and stratifying data by race and ethnicity to create data transparency.
The United States is facing a crisis in maternal healthcare, where Black women are 3-4 times more likely to die from pregnancy-related causes within a year of childbirth. Black women, even those with low-risk pregnancies, are more likely to experience severe maternal morbidity (SMM) both during and after the birth hospitalization than their white counterparts.
Participating hospitals in the quality improvement project will establish a culture that addresses racial inequities and the disparity gap in outcomes for Black birthing people through implementation of all key activities by December 2023.
- Reduce institutional, individually mediated and internalized racism.
- Utilize race and ethnicity quality data to improve birth equity.
- Utilize a strategy for respectful care practices and centering the patient in decision making during the entire birth experience.
- Engage patients, support partners, and the community to create community accountability.
Quality improvement is a systematic, multidisciplinary, and data driven approach that improves efficiency, effectiveness, and reliability of processes. Evaluation is an essential part of any quality improvement project and uses improvement measures or metrics to measure change. This project’s evaluation will use structural, process, and outcome measures to determine the effectiveness of quality interventions at each participating hospital.
The Maternal HealthCARE project and evaluation were funded by United Healthcare.
We plan to begin data collection in February 2022.
Structural, process, and outcome measures were created for each Maternal HealthCARE project objective and were used to create qualitative and quantitative data collection tools. Data will be collected from the hospital project team, hospital staff, hospital providers, patients, and the community to gather a complete picture of the effectiveness of the improvement efforts.
Hospital project teams will submit quarterly data on hospital structural measures to demonstrate hospital progress towards implementation of an anti-racism workgroup, the TeamBirth shared decision-making model, and utilization of the best-practice recommendations for collecting race and ethnicity data from patients. Hospital project teams will also submit monthly data on quantitative patient outcomes data for severe maternal morbidity (SMM) and other outcomes, all stratified by race and ethnicity. These data will be compared to other project measures to determine if the implemented interventions have an effect on patient outcomes. They will also be used to inform discussions for participating hospital awareness regarding their successes or gaps in patient care.
Hospital Staff and Providers will complete a staff culture survey 3 times throughout the project to collect data around progress on the hospital racial equity measures and to provide hospital quality improvement teams with staff perceptions and attitudes about racial equity initiatives. The staff culture survey will be used to collect these data. This staff culture survey is a voluntary survey that will collect basic demographic information and Likert scale ratings of hospital, unit, and individual level racial equity beliefs and attitudes.
Patients over the age of 18 years old who receive services at the participating hospitals will be invited to complete a patient experience survey. The survey will include the validated tool Mothers Autonomy in Decision Making (MADM) and the validated tool Mothers on Respect Index (MORi).
The Community that surrounds participating hospitals will be invited to provide feedback on the implementation of the improvement measures. Community Accountability Panels (CAP) will be established in each state and will be evaluated using structural and process measures. Quantitative and qualitative data from each CAP will be collected through a pre, mid, and post survey that ask about the emotional safety of meetings and the perceived effectiveness of hospital interventions.