Quality of Care and Disparities in Obstetrics

Abstract

Growing attention is being paid to obstetric quality of care as patients are pressing the health care system to measure and improve quality. There is also an increasing recognition of persistent racial and ethnic disparities prevalent in obstetric outcomes. Yet few studies have linked obstetric quality of care with racial and ethnic disparities. This article reviews definitions of quality of care, health disparities, and health equity as they relate to obstetric care and outcomes; describes current efforts and challenges in obstetric quality measurement; and proposes 3 steps in an effort to develop, track, and improve quality and reduce disparities in obstetrics.

Keywords: Disparities; Equity; Obstetrics; Quality improvement; Quality of care.

Figure 1

Risk –adjusted severe maternal morbidity rates for black and white deliveries by site of care. From Howell EA, Egorova N, Balbierz A, et al. Black-white differences in severe maternal morbidity and site of care. Am J Obstet Gynecol. 2016 Jan;214(1):122.e5; with permission.

Figure 2

Three strategies to reduce disparities by focusing on quality of care.