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Kheyfets A, Vitek K, Conklin C, Tu C, Larson E, Zera C, Iverson R, Reiff E, Healy A, Lauring J, Schoen C, Manganaro K, Pomerleau M, Glass B, Amutah-Onukagha N, Diop H, Meadows AR. Development of a Maternal Equity Safety Bundle to Eliminate Racial Inequities in Massachusetts. Obstet Gynecol 2023; 142:831-839. [PMID: 37734090 PMCID: PMC10510776 DOI: 10.1097/aog.0000000000005322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/10/2023] [Accepted: 04/20/2023] [Indexed: 09/23/2023]
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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Affiliation(s)
- Anna Kheyfets
- Perinatal-Neonatal Quality Improvement Network of Massachusetts, Tufts University School of Medicine, the Department of Obstetrics & Gynecology, Boston Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Brigham and Women's Hospital
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Health, Boston, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School-Baystate, Springfield, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School/UMass Memorial Health, Worcester, and the College of Nursing & Health Sciences, UMass Dartmouth, Dartmouth, Massachusetts; the Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics & Gynecology, University of California San Diego Medical Center, San Diego, California
| | - Kali Vitek
- Perinatal-Neonatal Quality Improvement Network of Massachusetts, Tufts University School of Medicine, the Department of Obstetrics & Gynecology, Boston Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Brigham and Women's Hospital
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Health, Boston, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School-Baystate, Springfield, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School/UMass Memorial Health, Worcester, and the College of Nursing & Health Sciences, UMass Dartmouth, Dartmouth, Massachusetts; the Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics & Gynecology, University of California San Diego Medical Center, San Diego, California
| | - Claire Conklin
- Perinatal-Neonatal Quality Improvement Network of Massachusetts, Tufts University School of Medicine, the Department of Obstetrics & Gynecology, Boston Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Brigham and Women's Hospital
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Health, Boston, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School-Baystate, Springfield, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School/UMass Memorial Health, Worcester, and the College of Nursing & Health Sciences, UMass Dartmouth, Dartmouth, Massachusetts; the Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics & Gynecology, University of California San Diego Medical Center, San Diego, California
| | - Christianna Tu
- Perinatal-Neonatal Quality Improvement Network of Massachusetts, Tufts University School of Medicine, the Department of Obstetrics & Gynecology, Boston Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Brigham and Women's Hospital
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Health, Boston, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School-Baystate, Springfield, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School/UMass Memorial Health, Worcester, and the College of Nursing & Health Sciences, UMass Dartmouth, Dartmouth, Massachusetts; the Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics & Gynecology, University of California San Diego Medical Center, San Diego, California
| | - Elysia Larson
- Perinatal-Neonatal Quality Improvement Network of Massachusetts, Tufts University School of Medicine, the Department of Obstetrics & Gynecology, Boston Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Brigham and Women's Hospital
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Health, Boston, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School-Baystate, Springfield, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School/UMass Memorial Health, Worcester, and the College of Nursing & Health Sciences, UMass Dartmouth, Dartmouth, Massachusetts; the Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics & Gynecology, University of California San Diego Medical Center, San Diego, California
| | - Chloe Zera
- Perinatal-Neonatal Quality Improvement Network of Massachusetts, Tufts University School of Medicine, the Department of Obstetrics & Gynecology, Boston Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Brigham and Women's Hospital
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Health, Boston, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School-Baystate, Springfield, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School/UMass Memorial Health, Worcester, and the College of Nursing & Health Sciences, UMass Dartmouth, Dartmouth, Massachusetts; the Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics & Gynecology, University of California San Diego Medical Center, San Diego, California
| | - Ronald Iverson
- Perinatal-Neonatal Quality Improvement Network of Massachusetts, Tufts University School of Medicine, the Department of Obstetrics & Gynecology, Boston Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Brigham and Women's Hospital
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Health, Boston, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School-Baystate, Springfield, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School/UMass Memorial Health, Worcester, and the College of Nursing & Health Sciences, UMass Dartmouth, Dartmouth, Massachusetts; the Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics & Gynecology, University of California San Diego Medical Center, San Diego, California
| | - Emily Reiff
- Perinatal-Neonatal Quality Improvement Network of Massachusetts, Tufts University School of Medicine, the Department of Obstetrics & Gynecology, Boston Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Brigham and Women's Hospital
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Health, Boston, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School-Baystate, Springfield, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School/UMass Memorial Health, Worcester, and the College of Nursing & Health Sciences, UMass Dartmouth, Dartmouth, Massachusetts; the Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics & Gynecology, University of California San Diego Medical Center, San Diego, California
| | - Andrew Healy
- Perinatal-Neonatal Quality Improvement Network of Massachusetts, Tufts University School of Medicine, the Department of Obstetrics & Gynecology, Boston Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Brigham and Women's Hospital
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Health, Boston, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School-Baystate, Springfield, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School/UMass Memorial Health, Worcester, and the College of Nursing & Health Sciences, UMass Dartmouth, Dartmouth, Massachusetts; the Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics & Gynecology, University of California San Diego Medical Center, San Diego, California
| | - Julianne Lauring
- Perinatal-Neonatal Quality Improvement Network of Massachusetts, Tufts University School of Medicine, the Department of Obstetrics & Gynecology, Boston Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Brigham and Women's Hospital
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Health, Boston, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School-Baystate, Springfield, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School/UMass Memorial Health, Worcester, and the College of Nursing & Health Sciences, UMass Dartmouth, Dartmouth, Massachusetts; the Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics & Gynecology, University of California San Diego Medical Center, San Diego, California
| | - Corina Schoen
- Perinatal-Neonatal Quality Improvement Network of Massachusetts, Tufts University School of Medicine, the Department of Obstetrics & Gynecology, Boston Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Brigham and Women's Hospital
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Health, Boston, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School-Baystate, Springfield, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School/UMass Memorial Health, Worcester, and the College of Nursing & Health Sciences, UMass Dartmouth, Dartmouth, Massachusetts; the Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics & Gynecology, University of California San Diego Medical Center, San Diego, California
| | - Karen Manganaro
- Perinatal-Neonatal Quality Improvement Network of Massachusetts, Tufts University School of Medicine, the Department of Obstetrics & Gynecology, Boston Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Brigham and Women's Hospital
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Health, Boston, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School-Baystate, Springfield, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School/UMass Memorial Health, Worcester, and the College of Nursing & Health Sciences, UMass Dartmouth, Dartmouth, Massachusetts; the Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics & Gynecology, University of California San Diego Medical Center, San Diego, California
| | - Mary Pomerleau
- Perinatal-Neonatal Quality Improvement Network of Massachusetts, Tufts University School of Medicine, the Department of Obstetrics & Gynecology, Boston Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Brigham and Women's Hospital
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Health, Boston, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School-Baystate, Springfield, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School/UMass Memorial Health, Worcester, and the College of Nursing & Health Sciences, UMass Dartmouth, Dartmouth, Massachusetts; the Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics & Gynecology, University of California San Diego Medical Center, San Diego, California
| | - Bonnell Glass
- Perinatal-Neonatal Quality Improvement Network of Massachusetts, Tufts University School of Medicine, the Department of Obstetrics & Gynecology, Boston Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Brigham and Women's Hospital
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Health, Boston, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School-Baystate, Springfield, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School/UMass Memorial Health, Worcester, and the College of Nursing & Health Sciences, UMass Dartmouth, Dartmouth, Massachusetts; the Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics & Gynecology, University of California San Diego Medical Center, San Diego, California
| | - Ndidiamaka Amutah-Onukagha
- Perinatal-Neonatal Quality Improvement Network of Massachusetts, Tufts University School of Medicine, the Department of Obstetrics & Gynecology, Boston Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Brigham and Women's Hospital
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Health, Boston, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School-Baystate, Springfield, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School/UMass Memorial Health, Worcester, and the College of Nursing & Health Sciences, UMass Dartmouth, Dartmouth, Massachusetts; the Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics & Gynecology, University of California San Diego Medical Center, San Diego, California
| | - Hafsatou Diop
- Perinatal-Neonatal Quality Improvement Network of Massachusetts, Tufts University School of Medicine, the Department of Obstetrics & Gynecology, Boston Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Brigham and Women's Hospital
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Health, Boston, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School-Baystate, Springfield, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School/UMass Memorial Health, Worcester, and the College of Nursing & Health Sciences, UMass Dartmouth, Dartmouth, Massachusetts; the Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics & Gynecology, University of California San Diego Medical Center, San Diego, California
| | - Audra R Meadows
- Perinatal-Neonatal Quality Improvement Network of Massachusetts, Tufts University School of Medicine, the Department of Obstetrics & Gynecology, Boston Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Brigham and Women's Hospital
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Health, Boston, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School-Baystate, Springfield, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, UMASS Chan Medical School/UMass Memorial Health, Worcester, and the College of Nursing & Health Sciences, UMass Dartmouth, Dartmouth, Massachusetts; the Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics & Gynecology, University of California San Diego Medical Center, San Diego, California
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