The Joint Commission Journal on Quality and Patient Safety (JQPS) published a special 50th anniversary issue on healthcare equity. The issue includes several original articles, review articles and other reports to help healthcare organizations take a systems-based approach to achieve equity.

The study, “Investigating Racial and Ethnic Disparities in Maternal Care at the System Level Using Patient Safety Incident Reports,” is featured in the issue and sheds light on the disproportionate rates of mortality and severe maternal morbidity (SMM) among women and birthing people of color.

Researchers reviewed incidents reported in the labor and delivery unit (L&D) and the antepartum and postpartum unit (A&P) at 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 other process variables. Differences across racial ethnic groups were statistically evaluated.

The researchers analyzed 528 incident reports that occurred among:

  • Non-Hispanic white (NHW) patients – 43.9%
  • Non-Hispanic Black (NHB) patients – 43.2%
  • Hispanic patients – 8.9%
  • Other patients – 4%

NHB patients were disproportionately represented in the incident reports, as they accounted for only 36.5% of the underlying birthing population. The odds of having a reported incident for NHB patients were attenuated when controlling for cesarean section. This indicates that cesarean delivery is a confounder for the association between race and reported incident.

“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,” conclude the study authors. “Many of these challenges identified are recognized at the national or state level, but individual hospitals and health systems may be unaware of the racial and ethnic disparities in their maternal care and health outcomes.”

Additionally, the study found that NHB patients accounted for the majority of the following event types:

  • Falls
  • Complications of care
  • Infrastructure failures
  • Medical records/patient identification
  • Transfusions

“These findings can directly inform safety and equity efforts in intrapartum care, and they show the potential value of using incident reporting system data to identify and address disparities,” notes an accompanying editorial by David W. Baker, MD, MPH, FACP, executive vice president, Healthcare Quality Evaluation and Improvement, The Joint Commission, and editor-in-chief, The Joint Commission Journal on Quality and Patient Safety.