RP1 _NBEC

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Clinical evidence of persistent, large, and increasing mortality gaps between Non-Hispanic Black and other women in the United States, along with patient surveys and personal stories leave no doubt that implicit bias and racism in the health care system contribute significantly to disparate maternal outcomes. Central to identifying the factors to reduce maternal mortality are interventions for healthcare providers and institutions to recognize the root causes of racism and bias. Our long-term goal is to make respectful care practices the standard across the care continuum—pre-conception to 1-year postpartum—to reduce disparities in maternal outcomes. The overall objective for this application, which is the next step toward attainment in our long-term goal, is to demonstrate a multifaceted, evidence-based intervention will reduce hospital disparities in maternal outcomes. Our central hypothesis is that hospitals that implement the multifaceted intervention of training, incorporating equity in all quality improvement efforts, and partnership building with community-based organizations will have better maternal health outcomes than hospitals who have implemented remote asynchronous implicit bias training alone. Our previous studies connect mistreatment, discrimination, and racism across the care continuum to physical and emotional harm to Black mothers. The rationale that underlies the proposed research is that reducing inequitable and disrespectful treatment is likely to offer strong scientific rationale for taking a multifaceted approach to equity work to reduce disparities. Our research strategy will be to conduct a multi-hospital cluster-randomized controlled trial within 9 Ochsner hospitals (~1900 staff and 14000 deliveries per year) to compare an interactive multifaceted intervention—implicit bias training, incorporating equity in all quality improvement, and community partnership building— to a remote asynchronous training alone intervention. Maternal health will be measured by a composite outcome matched to ACOG patient safety bundle recommendations, collected centrally through electronic health records, and patient satisfaction by Hospital Consumer Assessment of Healthcare Providers and Systems routinely collected data. This will enable us to achieve the following Aims: 1) Determine the effect of a multifaceted respectful maternity care intervention on hospital maternal outcome and patient satisfaction disparities; 2) Determine the effect of a multifaceted respectful maternity care intervention on provider bias; 3) Examine how a respectful maternity care and implicit bias intervention among impacts patient and hospital staff satisfaction. These results are expected to have an important positive impact because they will provide strong evidence- based proof of principle that, by bringing together existing approaches for addressing biased treatment and care, maternal outcome disparities are reduced.