Implementation and outcomes of a system-wide women's health 'team goal' to reduce maternal morbidity for black women: a prospective quality improvement study.
Implementation and outcomes of a system-wide women's health 'team goal' to reduce maternal morbidity for black women: a prospective quality improvement study.
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DOI：
10.1136/bmjoq-2022-002061
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发表时间：
2022-11
期刊：
影响因子：
1.4
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中科院分区：
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为了应对美国产科结果中不可接受的种族差异，我们的卫生系统建立了一个正式的目标，以减少黑人妇女的孕产妇发病率。在这里，我们描述了我们在5个住院医院不同实施气候的背景下实现这一以公平为中心的目标的过程。为了实现系统目标，我们建立了一个多学科、基于站点的协作团队。经验证的18个问题实施气候量表（ICS）在基线时分发给现场临床医生。网站关注出血，对符合发病率标准的黑人妇女进行病例审查。按地点比较病例，针对特定地点改进出血风险评估、预防和管理的方法应运而生。然后根据现场选择、定制和实施循证实践（ebp）。每月系统范围的团队会议包括(1)度量跟踪和(2)围绕EBP实施的障碍/促进因素进行讨论的现场演示。将目标制定前一年（2019年7月1日至2020年6月30日）与目标制定后一年（2020年7月1日至2021年6月30日）的黑人妇女孕产妇发病率进行了比较。产科住院单位的ICS平均评分因地区而异（p=0.005），气候更支持在城市/学术医院实施ICS。根据案例审查，站点报告实现了2到8个ebp以达到目标。尽管ICS评分不同，但这一过程与黑人妇女从发育前到发育后总体以及1、2和3位点的产妇发病率显著降低有关，而在4和5位点的发病率降低无统计学意义（总体：- 29.4%,p<0.001）。卫生系统的目标是降低黑人妇女的孕产妇发病率，这导致了一种数据驱动的合作模式，用于实施针对现场的干预措施。如果卫生系统优先考虑以公平为重点的目标，则可以支持站点实施改善护理的ebp。
In response to the unacceptable racial disparities in US obstetric outcomes, our health system established a formal goal to reduce maternal morbidity for black women. Here, we describe our process for meeting this equity-focused goal in the context of diverse implementation climates at 5 inpatient sites. To meet the system goal, we established a collaborative of multidisciplinary, site-based teams. The validated 18-question Implementation Climate Scale (ICS) was distributed to site clinicians at baseline. Sites focused on haemorrhage, performing case reviews of black women meeting morbidity criteria. Comparing cases by site, site-specific areas for improvement in haemorrhage risk assessment, prevention and management emerged. Evidence-based practices (EBPs) were then selected, tailored and implemented by site. Monthly system-wide team meetings included (1) metric tracking and (2) site presentations with discussions around barriers/facilitators to EBP implementation. Maternal morbidity rates among black women were compared the year before goal development (1 July 2019–30 June 2020) to the year after (1 July 2020–30 June 2021). Mean ICS scores for inpatient obstetric units differed by site (p=0.005), with climates more supportive of implementation at urban/academic hospitals. In response to case reviews, sites reported implementing 2 to 8 EBPs to meet the goal. Despite different ICS scores, this process was associated with significant reductions in maternal morbidity for black women from pregoal to postgoal development overall and at sites 1, 2 and 3, with non-statistically significant reductions at sites 4 and 5 (overall: −29.4% reduction, p<0.001). A health system goal of reducing maternal morbidity for black women led to a data-driven, collaborative model for implementing site-tailored interventions. If health systems prioritise equity-focused goals, sites can be supported in implementing EBPs that improve care.