The Joint Commission Journal on Quality and Patient Safety publishes special issue on healthcare equity

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(OAKBROOK TERRACE, Illinois, January 4, 2024) – The Joint Commission Journal on Quality and Patient Safety (JQPS) today published a special 50th anniversary issue on healthcare equity. The issue includes several original articles, review articles and other reports to help healthcare organizations take a systems-based approach to achieve equity.

The study, “Investigating Racial and Ethnic Disparities in Maternal Care at the System Level Using Patient Safety Incident Reports,” is featured in the issue and sheds light on the disproportionate rates of mortality and severe maternal morbidity (SMM) among women and birthing people of color.

Researchers reviewed incidents reported in the labor and delivery unit (L&D) and the antepartum and postpartum unit (A&P) at a large academic hospital in 2019 and 2020. Deliveries associated with a reported incident were described by race/ethnicity, age group, method of delivery and other process variables. Differences across racial ethnic groups were statistically evaluated.

The researchers analyzed 528 incident reports that occurred among:

Non-Hispanic white (NHW) patients – 43.9%
Non-Hispanic Black (NHB) patients – 43.2%
Hispanic patients – 8.9%
Other patients – 4%

NHB patients were disproportionally represented in the incident reports, as they accounted for only 36.5% of the underlying birthing population. The odds of having a reported incident for NHB patients were attenuated when controlling for cesarean section. This indicates that cesarean delivery is a confounder for the association between race and reported incident.

Additionally, the study found that NHB patients accounted for the majority of the following event types:

Falls
Complications of care
Infrastructure failures
Medical records/patient identification
Transfusions

“Greater integration of patient safety and health equity efforts in hospitals are needed to promptly identify and alleviate racial and ethnic disparities in maternal health outcomes,” conclude the study authors. “Many of these challenges identified are recognized at the national or state level, but individual hospitals and health systems may be unaware of the racial and ethnic disparities in their maternal care and health outcomes.”

“These findings can directly inform safety and equity efforts in intrapartum care, and they show the potential value of using incident reporting system data to identify and address disparities,” notes an accompanying editorial by David W. Baker, MD, MPH, FACP, executive vice president, Healthcare Quality Evaluation and Improvement, The Joint Commission, and editor-in-chief, The Joint Commission Journal on Quality and Patient Safety.

Also featured in the special issue are:

Documentation of Disability Status and Accommodation Needs in the Electronic Health Record: A Qualitative Study of Health Care Organizations’ Current Practices (University of Colorado Anschutz Medical Campus, Aurora, Colorado)
Leveraging Technology and Workflow Optimization for Health-related Social Needs Screening: An Improvement Project at a Large Health System (Yale New Haven Health, New Haven, Connecticut)
Addressing Veteran Health-Related Social Needs: How Joint Commission Standards Accelerated Integration and Expansion of Tools and Services in the Veterans Health Administration (U.S. Department of Veterans Affairs, Washington, D.C.)
Disparities in Patient Safety Voluntary Event Reporting: A Scoping Review (Johns Hopkins University School of Medicine, Baltimore, Maryland)
Embedding Equity into the Hospital Incident Command System: A Narrative Review (Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland)
Self-Reported Accommodation Needs for Patients with Disabilities in Primary Care (University of Michigan, Ann Arbor, Michigan)
Multisite Quality Improvement Program Within the Project ECHO Diabetes Remote Network (University of Florida College of Medicine, Gainesville, Florida, and Stanford University School of Medicine, Stanford, California)
Equity and Performance Improvement: A Novel Toolkit That Makes Using an Equity Lens the Default (Montefiore Medical Center, Bronx, New York)
Improving Communication with Patients with Limited English Proficiency: Non-English Language Proficiency Assessment for Clinicians (research letter)
Bringing the Equity Lens to Patient Safety Event Reporting (commentary)

As part of its 50th anniversary celebration, each issue of JQPS in 2024 will focus on a theme relevant to healthcare’s most pervasive challenges. For more information, please visit the JQPS website.

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Note for editors

The article is “Investigating Racial and Ethnic Disparities in Maternal Care at the System Level Using Patient Safety Incident Reports,” by Myrtede C. Alfred, PhD; Dulaney Wilson, PhD; Elise DeForest; Sam Lawton; Amartha Gore, MD; Jeffrey T. Howard, PhD; Christine Morton, PhD; Latha Hebbar, MD; and Chris Goodier, MD. The article appears in The Joint Commission Journal on Quality and Patient Safety (JQPS), volume 50, number 1 (January 2024), published by Elsevier.