Adverse Events in Maternal Care: Investigating Racial/Ethnic Disparities at the System Level

Abstract

Pregnancy related deaths are elevated among women of color, and Black women are 3 to 4 times more likely to die from pregnancy-related causes than white women. Women of color also experience higher rates of severe maternal morbidity (SMM). Half of all maternal deaths and SMM cases are considered preventable with timely and appropriate care. Poor maternal health outcomes and racial/ethnic disparities are the result of multilevel variables including poor quality of care. Few studies have investigated the underlying mechanisms within clinical systems that undermine safety for women of color. This research investigates systems issues contributing to adverse outcomes in maternal care and disparities based on the examination of patient safety incidents (PSIs) reported in the obstetric care units in a large, academic health system in 2019 and 2020. Trends in event type and harm score were examined and the data was disaggregated by race/ethnicity and cross tabulated with unit, event type, and harm score to examine disparities in adverse events. Of the 693 reported incidents, non-Hispanic White (NHW) and non-Hispanic Black (NHB) patients accounted for 43.8% each. Hispanic patients accounted for 7.9% of reported incidents and patients categorized as “Other” accounted for 4.3% of the reported incidents. In both 2019 and 2020, the odds ratio demonstrated a higher likelihood of a reported event for non-Hispanic Black patients (1.99, 95%CI, 1.56 -2.52 and 1.70, 95% CI 1.28-2.25, respectively) and patients categorized as “Other” (15.34, 95% CI 7.25-32.44 and 4.43, 95%CI 1.85-10.58). These findings can facilitate the identification of mechanisms within the clinical system contributing to variation in adverse outcomes for women of color and support the design of more precise interventions and sustained, effective delivery.