PNQIN Maternal Equity Bundle Toolkit - download PDF here

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PNQIN Quality Improvement Toolkit - download PDF here

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EVIDENCE FOR EQUITY WORK​​

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• Equity bibliography ( download PDF )- collated by Bonnell Glass, MN, RN​

• Massachusetts Report of the Special Commission on Racial Inequities in Maternal Health

  • Extensive review of the current state of maternal health in Massachusetts and recommendations to eliminate racial inequities

• Sivashanker, Karthik, and Tejal K. Gandhi. "Advancing safety and equity together." The New England journal of medicine 382.4 (2020): 301-303.

  • There are widespread inequities in health outcomes in the United States based on race, sex, language, and other factors. But there is no such thing as high-quality, safe care that is inequitable. Health systems can leverage patient-safety programs to advance equity.

• Voice Your Vision – Share Your Birth Story: A Conversation on Maternal Health in New York State

  • Report on seven community listening sessions around New York State in the summer of 2018 with an emphasis on engaging Black birthing people who have experienced an adverse birth outcome. A comprehensive report on the birthing experience and need for change in maternal care.​

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BUILDING AN EQUITY TEAM​​

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• Creating a Department Level Equity Team 

  • ​Ha D, Ghebrendrias S, Meadows A, LaCoursiere DY, Lewis A, Lawson M, Morales M, Gyamfi-Bannerman C, Brubaker L. The Culture and Justice Quorum at University of California, San Diego: A Departmental Approach to Dismantling Structural Racism. Academic Medicine ():e005200, March 01, 2023. | DOI: 10.1097/ACM.0000000000005200 

• Patient and family engagement​​

• • ​2023 NNEPQIN Spring Conference (June 8, 2023)

    • ​Recordings of all the sessions are now available here.

  • ​Illinois PQC's Patient and Family Engagement Toolkit

  • ​MoMMA's Voices

    • ​​Training for patients with lived experience and people working in maternal health organizations that would like to partner with community members to aid in creating sustainable, equitable and impactful partnerships

  • National Network of Perinatal Quality Collaboratives - Patient and Family Engagement: Changing the Narrative and Building Trust to Improve Perinatal Health Outcomes (PDF)

    • Watch the recording here (start at 7min 39sec)​

    • Read a literature review of family engagement and a proposed framework to engage family at a systems level

  • ​Dworetzky B, Hoover CG, Walker DK. Family Engagement at the Systems Level: A Framework for Action. Matern Child Health J. 2023 Mar 13. doi: 10.1007/s10995-023-03619-2. Epub ahead of print. PMID: 36913032.

  • Voices of Impact: Jamie's Story

    • Like Jamie, nearly 50,000 U.S. women experience unintended, potentially life-threatening maternal conditions or complications each year. In addition to the women who nearly lose their lives, another 700 U.S. women die each year as a result of pregnancy or delivery complications. Obstetric hemorrhage is the most common serious complication of childbirth and the most preventable cause of maternal mortality.​

  • Hear Her Texas Video Campaign

    • The Hear Her Maternal Health Campaign aims to empower women and their support networks to know the urgent maternal warning signs and speak up when they have concerns. The campaign is also dedicated to encouraging everyone, including providers, caregivers, friends, and family to listen and act.

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CREATING AN ANTI-RACISM STATEMENT

 

From Dr. Meadows:

"We suggest a structure of the 4As (Acknowledge, Analyze, Action, and Accountability).  A DEI statement that accomplishes that would suffice ( acknowledges and defines racism, pledges to act offering action items / tangible and measurable steps to address and disrupt racism by developing anti-racist policies and creating a culture of antiracism, and announces action for accountability (with expectation for commitment from all employees)."

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• PQI-PNQIN Equity Webinars

  • ​Creating Anti-Racism Statements for Perinatal Facilities

• UMass Memorial Health Department of OBGYN's  Statement About Racism and Discrimination

• University of California, San Diego Department of OBGYN & Reproductive Sciences Anti-Racism Statement 

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​BUNDLE SPECIFIC RESOURCES

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• PNQIN Maternal Equity Bundle Driver Diagram (PDF)

• ​Likert scale appendix for data submission (PDF)

• CME Credit Claim Document

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EDUCATIONAL WEBINARS and TRAININGS

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• Diversity Science

  • Implicit bias and reproductive justice training​

• Harvard Center for Mindfulness and Compassion 

  • watch grand rounds here ​

    • includes topics on creating an anti-racist clinical practice, resilience and handling grief ​

• Institute for Perinatal Quality Improvement (PQI) 

  • Implicit and explicit bias training​

  • SPEAK UP Program

  • PQI-PNQIN Equity Webinars

    • ​Creating Anti-Racism Statements for Perinatal Facilities

    • Improving Data Collection and Review Process by Race/Ethnicity

    • Performing Team and Family Debriefs from a Racial/Equity Lens

    • Ensuring Maternal Care Standards are Met for Birth Equity

• March of Dimes 

  • Awareness to Action: Dismantling Bias in Maternal and Infant Healthcare™

• National Birth Equity Collaborative

  • Racial equity training

  • ​Birth Equity Index (BEI) and Birth Equity Toolkit Assessment Survey

• Project Implicit

  • Everyone has implicit biases, the first step in combatting them is knowing what biases you hold. Project Implicit helps uncover those biases.

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EHR RESOURCES

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• Epic​

  • Guide on how to collect and report race, ethnicity and language (REaL) data

  • Available Dashboards: 

    • OB Maternal Equity Dashboard (released August 2021)

      • ​ OB clinicians and L&D leadership can view key access, quality, and outcome metrics stratified by race, ethnicity, and preferred language to help identify disparities in their OB population. They can drill down to SlicerDicer sessions from each component to further investigate areas of concern as they plan interventions. Then, they can track whether outcomes are improving based on those interventions.

    • Maternal Safety Pulse Dashboard (released August 2020)

      • ​This dashboard provides insight into statistics related to maternal safety, such as maternal morbidities, hypertension event rates, and the percentage of completed postpartum depression screenings. With this data, L&D managers can benchmark against other Epic community members and monitor the effectiveness of their own organizational procedures or interventions.

    • Pregnancy Dashboard (released May 2021)

      • ​ Obstetric clinicians and leadership can conveniently manage care for their population of pregnant and recently pregnant patients with this dashboard. They can track patients who meet certain criteria, such as those with gestational hypertension, and access patient charts right from the dashboard.

    • OB Provider Metrics Dashboard (released 2015, stratifying by REaL data released November 2022)

      • ​Obstetricians can monitor their own performance, quality, and compliance measures and compare themselves against their department's, location's, or facility's average using the OB Provider Metrics dashboard.

    • OB Nurse Manager Metrics Dashboard (released 2015, stratifying by REaL data released November 2022)

      • ​Nurse managers can monitor performance, quality, and compliance measures for their department and drill down to see the measures for providers in their department, or look to location or facility level metrics, using the OB Nurse Manager Metrics dashboard.

  • For more information about EPIC tools to promote maternal health equity check out the Maternal and Infant Safety Page

  • For questions about how to implement the dashboard please reach out to your individual EPIC technical representative​​​

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GRAPHICS

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• ​PQI’s Equality vs. Equity Graphic (PDF)

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PATIENT REPORTED EXPERIENCE MEASURES (PREMs)

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• Birth Place Lab's validated instruments to assess perinatal services

  • Request access to the Mothers Autonomy in Decision Making scale (MADM) and Mothers on Respect Index (MORi) ​

    • ​Vedam S, Stoll K, Martin K, et al. The Mother’s Autonomy in Decision Making (MADM) scale: Patient-led development and psychometric testing of a new instrument to evaluate experience of maternity care. PLOS ONE. http://dx.doi.org/10.1371/journal.pone.0171804.

    • Vedam S, Stoll K, Rubashkin N, et al. The Mothers on Respect (MOR) index: measuring quality, safety, and human rights in childbirth. Social Science and Medicine: Population Health.  http://dx.doi.org/10.1016/j.ssmph.2017.01.005.

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• PNQIN-TeamBirth Patient Reported Experience Measures (PREM) ​

  • Download the PREM here

  • We teamed up to create a PREM that allows birthing facilities to assess patients' experience in receiving respectful care during their birthing experience 

    • ​​these are are based on the respectful care guidelines from ILPQC and NYSPQC (see below)

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QUALITY IMPROVEMENT TOOLS

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• Frameworks

  • Arrington LA. The 5D Cycle for Health Equity: Combining Black Feminism, Radical Imagination, and Appreciative Inquiry to Transform Perinatal Quality Improvement. J Midwifery Womens Health. 2022 Nov;67(6):720-727. doi: 10.1111/jmwh.13418. Epub 2022 Nov 25. PMID: 36426881.​

• Run and Control Charts

  • Excel Templates

    • Control Chart Template

    • Run Chart Template

  • Gupta M, Kaplan HC. Improving Quality Improvement in Neonatal-Perinatal Care. Clin Perinatol. 2017 Sep;44(3):xvii-xix. doi: 10.1016/j.clp.2017.06.002. pages 965-966

  • Using Run and Control Charts to Understand Variation (56:02): https://www.youtube.com/watch?v=j4ZYHYJ0XUo

  • Run Chart Specific:​​

    • The Dartmouth Institute for Health Policy & Clinical Practice A One Page Book to guide you through how to interpret your chart     

    • Perla RJ, Provost LP, Murray SK. The run chart: a simple analytical tool for learning from variation in healthcare processes. BMJ Qual Saf. 2011 Jan;20(1):46-51. doi: 10.1136/bmjqs.2009.037895.

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RACE, ETHNICITY & LANGUAGE (REaL) DATA UTILIZATION

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• NNPQC and IHI discuss REaL data utilization

  • recorded webinar, slides​

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PATIENT AND FAMILY ENGAGEMENT RESOURCES

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• 4 Tips for Including and Engaging Family Partners in Your Work 

  • NICHQ article here 

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RESPECTFUL CARE RESOURCES​

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• PNQIN-Teambirth Respectful Care Commitments Poster

  • download PDF, order prints through Canva  here

• AWHONN Respectful Maternity Care Toolkit 2022

• Illinois PQC Respectful Care Commitments 

• NYC Health Standards for Respectful Care

• Respectful Care in Birth (video)

  • ​​Created by Kaprice S. Welsh CNM, MSN, MPH -  Director of Women’s Services at the Georgia Department of Community Health (Medicaid)​

• Systematic Review on Respectful Care 2015

• ​USAID Landscape Analysis 2010​

• "Can US Medical Schools Teach About Structural Racism?" Milbank Quarterly Article

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TOOLKITS (non-PNQIN)

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• AIM Reduction of Peripartum Racial/Ethnic Disparities Safety Bundle (Archived)

• California Birth Equity Toolkit​

• Illinois Birth Equity Toolkit​​​

• Essential Hospitals Institute and Patient Safety Movement: Improving Black Obstetric Outcomes Learning Collaborative Performance Improvement Toolkit 

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ADDITIONAL RESOURCES REFERRED TO DURING WEBINARS​

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• Kick-off (9/27/22)

  • CDC updated pregnancy related deaths data 

  • ​"Voices of Impact: Irving Family’s Story" (video)

  • "Lost Mothers: Maternal Care and Preventable Deaths" (NPR & ProPublica Series)

• Practical PREMs (10/18/22)

  • TeamBirth publications: design, outcomes and implementation​

  • "Why TeamBirth" (video)

• REaL Data (1/17/23)

  • Keynote speaker, Lauren A. Arrington, DNP, CNM, FACNM, answers questions to attendees' questions, click here to download

• Equity Teaming #2 (4/18/23)

  • Davidson C, Denning S, Thorp K et al. Examining the effect of quality improvement initiatives on decreasing racial disparities in maternal morbidity. BMJ Quality & Safety 2022;31:670-678.

• Equity Data Dashboards (5/16/23)

  •  

    ​"On Racism: A New Standard For Publishing On Racial Health Inequities" by Rhea W. Boyd, Edwin G. Lindo, Lachelle D. Weeks, and Monica R. McLemore (July 2, 2020).

  • Reichman V, Brachio SS, Madu CR, Montoya-Williams D, Peña MM. Using rising tides to lift all boats: Equity-focused quality improvement as a tool to reduce neonatal health disparities. Semin Fetal Neonatal Med. 2021 Feb;26(1):101198. doi: 10.1016/j.siny.2021.101198. Epub 2021 Jan 22. PMID: 33558160; PMCID: PMC8809476.

  • Chandra L. Ford, Collins O. Airhihenbuwa. The public health critical race methodology: Praxis for antiracism research.
    Social Science & Medicine, Volume 71, Issue 8, 2010, Pages 1390-1398, ISSN 0277-9536. https://doi.org/10.1016/j.socscimed.2010.07.030.

  • Weikel BW, Klawetter S, Bourque SL, Hannan KE, Roybal K, Soondarotok M, St Pierre M, Fraiman YS, Hwang SS. Defining an Infant's Race and Ethnicity: A Systematic Review. Pediatrics. 2023 Jan 1;151(1):e2022058756. doi: 10.1542/peds.2022-058756. PMID: 36575917; PMCID: PMC10099553.

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Please feel free to email Kali Vitek at PNQINAdmin@pnqinma.org with any questions.