In the United States, there are stark racial and ethnic disparities in pregnancy-related mortality. Based on the most recent 2018 Centers for Disease Control and Prevention statistics, the maternal mortality rate in the United States was 17.4 maternal deaths per 100,000 live births. Among non-Hispanic Black women, the rate was 37.3 per 100,000 live births, compared to 14.9 for non-Hispanic white women and 11.8 for Hispanic women.
With a commitment to addressing these disparities, Mount Sinai’s Department of Obstetrics, Gynecology and Reproductive Science has implemented innovative, data-driven initiatives focused on optimizing the patient experience and ensuring health equity.
“Non-Hispanic Black and American Indian/Alaska Native birthing people are nearly three times as likely to die from a pregnancy-related death. The data has shown that three out of five pregnancy-related deaths are preventable,” says Toni Stern, MD, MS, MBA, System Vice Chair, Clinical Transformation, and Chief Patient Experience Officer, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai.
“We know that more than one-third of pregnancy-related deaths occur within one week to one year following birth. As a result, putting a focus on the continuum of care for pregnant and birthing people is critical,” she says. “There are similar racial and ethnic disparities with regard to severe maternal morbidity.”
The department recognizes that the patient experience includes all interactions with patients, and values the voices of the patients, faculty, and staff as central to the strategic vision for the patient experience. In September 2020, the OB/GYN Department and Women’s Services held their inaugural Mount Sinai Hospital Patient Experience Summit, led by Dr. Stern and Erin Figueroa, MSN, RN, NE-BC, Senior Director of Nursing, Women’s Services, Mount Sinai Health System.
“We are focused on all aspects of our patient experience, because we know how critical it is to the quality and safety of all of our patients,” Michael Brodman, MD, the Ellen and Howard C. Katz Chairman’s Chair of Obstetrics, Gynecology and Reproductive Science, said during the summit. Dr. Stern discussed Mount Sinai’s values of safety, teamwork, creativity, agility, and empathy, which serve as the foundational elements for the work and the shared goals of the team.
“Additionally, equity has been adopted as another guiding value within our department,” Dr. Stern said. “Our interdisciplinary team has developed the Patient Experience Commitment, which outlines the commitment to our patients and equity. And the Mount Sinai Hospital resident physicians created a Departmental Anti-Racism Mission Statement that highlights our departmental commitment to addressing barriers to equitable treatment and implicit bias that may exist.”
“Putting a focus on the continuum of care for our pregnant people is critical.”
Toni Stern, MD, MBA
With the goal of utilizing a health equity lens for all metrics, the Obstetrics Patient Experience and Quality Dashboard was developed and incorporates a wide range of data in an easily accessible format.
“We engaged our interdisciplinary faculty and staff, and with the support of our excellent Clinical Decision Support Team, we developed the Dashboard,” Dr. Stern says. “The journey to provide full integration of key quality, patient experience, operational, and demographic metrics that are available for each obstetric facility, unit, provider, and group was very important.”
The overriding objective is to use the data to formulate a snapshot of relations, generating hypotheses and subsequent statistical significance analysis for racial and ethnic differences. With the health equity lens, all metrics can be evaluated by age, race and payor. Specific inpatient and operational and demographic metrics are available for all to review, and include patient experience measures, readmissions, length of stay, discharges and discharge before noon rates and delivery type.
“As we navigate our path forward on this journey, we must continue to utilize the voices of the patients and staff to formulate our strategic vision and our shared goals,” Dr. Stern says. “This involves creating spaces for safe discussions, optimizing linkages to care throughout pregnancy and during the postpartum period, as well as support with lactation goals, and standardized patient education.”
The Obstetrics Research Disparities Workgroup was created with an interdisciplinary team, including front-line staff, departmental leadership, and members of the Mount Sinai Clinical Decision Support and Office for Diversity and Inclusion teams, to develop a shared vision. With the development of the Core Equity Measures Dashboard by the Workgroup, identified indicators—including cesarean delivery, intensive care unit days, hemorrhage, hypertension, and exclusive breastfeeding—were included and can be evaluated through the equity lens.
“I am proud that the Mount Sinai Health System is focused on creating this infrastructure,” Dr. Stern says. “Every voice is valued as we work toward our goals of optimizing our patient experience, fostering a culture of accountability and equity, and eliminating disparities.”
Toni Stern, MD, MS, MBA
System Vice Chair for Clinical Transformation, and Chief Patient Experience Officer for Obstetrics, Gynecology and Reproductive Science