Internal data analysis conducted by Boston Medical Center’s Health Equity Accelerator team found that the hospital’s Black pregnant patients were 1.7 times more likely to experience severe complications during birth than its white pregnant patients.
This number was not surprising, as the national mortality rate for Black pregnant people is staggering, especially for a nation with ample resources. “The magnitude [here at BMC] is not that different from the numbers nationwide,” says director of equity and inclusion and director of wellness in sexual health at BMC, Tejumola Adegoke, MD, MPH. “This is on par with what happens to Black birthing people across the United States. I think one difference here at BMC is that we’re trying to be very introspective and intentional in how to address it,” add Adegoke.
To further examine why such a stark disparity exists between the two groups, a team of doulas, midwives, physicians, operational experts, and researchers was created. They set out to discover the root of the problem.
After months of thorough research, the team learned that Black pregnant patients experience disproportionately more complications of preeclampsia disorder, which is characterized by high blood pressure and only occurs during pregnancy and the postpartum period. Preeclampsia affects at least 5-8% of all pregnancies and is rapidly progressive, with the only cure being delivery. When diagnosed, preeclampsia requires immediate decision-making to determine if the pregnant patient should be induced into labor and sometimes undergo a C-section to avoid complications. In the instance of BMC’s Black pregnant patients, the Accelerator’s team found that the patient’s providers’ decision-making process was taking longer than that of white pregnant patients, causing increased hemorrhaging.
Identifying areas of health inequity
In an effort to address data that exemplified health inequities, the Health Equity Accelerator was launched in November 2021. Led by co-executive directors Elena Mendez Escobar, Ph.D., MBA, and Thea James, MD, the goal of the Accelerator is to speed up the action taken when health inequities are discovered, and the action plans are created and implemented to address them. The Health Equity Accelerator targets where care is lacking, with a focus on race and ethnicity.
“These inequities are not new problems. If you look at data on health inequities over the last 15 or 20 years, there’s a lot of trying to explain reasons while pinning the problem on the patient,” says Dr. Adegoke, “What’s different about the Health Accelerator is our approach. We’re thinking about what we do as a system and as individuals within an institution and looking at the way our systems are structured, how this contributes to and perpetuates inequities and what we can do to address and fix our institutional and individual roles in this.”
Given that BMC’s patients predominately identify as Black or Latino, BMC recognized that it was the hospital’s job to more explicitly address and close racial and ethnic gaps in health care to make its health system a more equitable place to receive care. Beyond that, with U.S data showing increases in overall racial health inequities, the hospital has conducted its own research among the population it serves to assist in outlining and identifying the greatest impact of health inequities on patients of color. The Accelerator’s team analyzed the data from several sources and identified 5 clinical areas with the most crucial health inequities occur:
- Equity in Pregnancy
- Infectious Diseases
- Behavioral Health
- Chronic Conditions
- Oncology/End-Stage Renal Disease
Creating an action plan
To tackle increased severe complications for Black pregnant patients, BMC quickly developed new strategies and programs to decrease the rate at which this patient population had these experiences during birth. Some of these efforts include:
- Growing “Birth Sisters”, an innovative multicultural doula service that offers women “sister-like” support during pregnancy, childbirth, and the postpartum period
- Expanding the remote blood pressure monitoring program that provides early detection of preeclampsia
- Exploring new partnerships to support Black and/or African-American patients
- Increasing patient awareness of preeclampsia by disseminating informational videos on preeclampsia
- Updating clinical protocols to further standardize preeclampsia management based on data from our own patients
If it had not been for the creation of the Health Equity Accelerator, a health equity gap such as this may have not been attended to, and action may not have been taken as quickly.
The Health Equity Accelerator makes it possible to address overall disparities by opening communication between clinical experts, researchers, healthcare staff, and patients themselves allowing them to identify problem areas and take the necessary approach to tackle problems, and constantly make changes. As an academic medical center, BMC can take immediate action and implement solutions without relying on research to be done, and solutions to be found by other entities.
This article is adapted from a MedCity News article.
