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Review
. 2023 Oct 1;142(4):831-839.
doi: 10.1097/AOG.0000000000005322. Epub 2023 Sep 7.

Development of a Maternal Equity Safety Bundle to Eliminate Racial Inequities in Massachusetts

Anna Kheyfets  1   2 , Kali Vitek  1   2 , Claire Conklin  1   2 , Christianna Tu  1   2 , Elysia Larson  1   2 , Chloe Zera  1   2 , Ronald Iverson  1   2 , Emily Reiff  1   2 , Andrew Healy  1   2 , Julianne Lauring  1   2 , Corina Schoen  1   2 , Karen Manganaro  1   2 , Mary Pomerleau  1   2 , Bonnell Glass  1   2 , Ndidiamaka Amutah-Onukagha  1   2 , Hafsatou Diop  1   2 , Audra R Meadows  1   2
Affiliations
Review

Development of a Maternal Equity Safety Bundle to Eliminate Racial Inequities in Massachusetts

Anna Kheyfets et al. Obstet Gynecol. .

Abstract

Objective: The PNQIN (Perinatal-Neonatal Quality Improvement Network of Massachusetts) sought to adapt the Reduction of Peripartum Racial and Ethnic Disparities Conceptual Framework and Maternal Safety Consensus Bundle by selecting and defining measures to create a bundle to address maternal health inequities in Massachusetts. This study describes the process of developing consensus-based measures to implement the PNQIN Maternal Equity Bundle across Massachusetts hospitals participating in the Alliance for Innovation on Maternal Health Initiative.

Methods: Our team used a mixed-methods approach to create the PNQIN Maternal Equity Bundle through consensus including a literature review, expert interviews, and a modified Delphi process to compile, define, and select measures to drive maternal equity-focused action. Stakeholders were identified by purposive and snowball sampling and included obstetrician-gynecologists, midwives, nurses, epidemiologists, and racial equity scholars. Dedoose 9.0 was used to complete an inductive analysis of interview transcripts. A modified Delphi method was used to reach consensus on recommendations and measures for the PNQIN Maternal Equity Bundle.

Results: Twenty-five interviews were completed. Seven themes emerged, including the need for 1) data stratification by race, ethnicity and language; 2) performance of a readiness assessment; 3) culture shift toward equity; 4) inclusion of antiracism and bias training; 5) addressing challenges of nonacademic hospitals; 6) a life-course approach; and 7) selection of timing of implementation. Twenty initial quality measures (structure, process, and outcome) were identified through expert interviews. Group consensus supported 10 measures to be incorporated into the bundle.

Conclusion: Structure, process, and outcome quality measures were selected and defined for a maternal equity safety bundle that seeks to create an equity-focused infrastructure and equity-specific actions at birthing facilities. Implementation of an equity-focused safety bundle at birthing facilities may close racial gaps in maternal outcomes.

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Conflict of interest statement

Financial Disclosure Chloe Zera reports money was paid to her institution from Ariadne Labs/Harvard School of Public Health and the CVS Health Foundation. Julianne Lauring reports receiving payment from GSK Pharmaceutical. Andrew Healy reports Baystate Medical Center has received money for his participation in the state quality collaborative (PNQIN) (about $10,000/y). Audra R. Meadows reports receiving payment from the Institute for Healthcare Improvement, Institute for Perinatal Quality Improvement, and the March of Dimes. She has received consulting support to the California Maternal Quality Care Collaborative. The other authors did not report any potential conflicts of interest.

Figures

Fig. 1.
Fig. 1.. Driver diagram for the Massachusetts Maternal Equity Bundle. SMM, severe maternal morbidity; SMART, specific, measurable, applicable, realistic, and timely; AIM, Alliance for Innovation on Maternal Health; PREM, patient-reported experience measure.
Figure
Figure
No available caption
See this image and copyright information in PMC

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