by Megan Greig and Hannah Lambalot

Nearly one in 10 United States residents is born at an essential hospital. As a leading advocate for health equity in all U.S. communities, America’s Essential Hospitals has a responsibility to invest in association members’ efforts to lower morbidity and mortality rates among birthing patients and improve overall patient safety.

The rising rates of hypertension and hemorrhage in pregnant and postpartum patients over the past 20 years highlight the need to support and examine innovations to improve the safety of pregnancy and childbirth, especially for Black birthing patients, who are three times more likely than white patients to die from childbirth complications.

Mother holding baby with doctor

Photo courtesy of Erie County Medical Center

The Essential Hospitals Institute, the research, education, dissemination, and leadership development arm of America’s Essential Hospitals, has partnered with the CVS Health Foundation to develop a grant program supporting member hospitals’ work to prevent hemorrhage and hypertension in pregnant and postpartum patients.

The Institute’s Black Obstetrics Outcomes grant program provides funding and technical assistance to 12 member hospitals that proposed interventions to improve morbidity and mortality rates of pregnant and postpartum patients, particularly Black birthing patients.

Grantees also participate in a monthly learning collaborative to share their lessons learned and collaborate with patient safety specialists in the field of obstetric care. Each of the 12 funded interventions leverages existing efforts within the member organization to improve hypertension and/or hemorrhage rates.

Patient-Centered Experience and Education

Instilling a positive and proactive patient experience is crucial to forming relationships and establishing trust for providers and patients. Further, engaging and educating patients early in pregnancy is paramount, because health behaviors observed during pregnancy influence the health of both the patient and child. Focusing on improving patient experience and health literacy equips patients with the knowledge and ability to be active and aware in their care decisions.

Alameda Health System, in Oakland, Calif., is improving hypertension care through text-based remote blood pressure monitoring twice a day among birthing patients to identify potential blood pressure issues before they become a problem.

Grady Memorial Hospital, in Atlanta, is building stronger support and infrastructure for blood pressure monitoring through holistic treatment, including evaluating and improving patient education, increasing access to healthy food and blood pressure monitoring tools, and improving postpartum patient navigation.

MedStar Washington Hospital Center, in Washington, D.C., is expanding postpartum blood pressure surveillance through a home-based monitoring and tailored patient education program, with a goal to preemptively mitigate potential blood pressure problems.

Temple University Hospital, in Philadelphia, is enhancing early postpartum blood pressure monitoring via a text reminder program. The hospital also is improving patient education efforts by facilitating ongoing communication with a perinatal community health worker to enable early intervention. ​

The University of California, San Diego, in San Diego, is improving access to home blood pressure cuffs, increasing the frequency of anemia screening, and standardizing the use of intravenous iron infusions. Additionally, the health system is expanding patient education efforts and mandating staff training focused on caring for Black obstetric patients.

Orlando Health Winnie Palmer Hospital, in Orlando, Fla., is using a two-pronged approach of hypertension prevention and addressing social determinants of health. The hospital leverages telehealth and community resources to improve the current virtual antepartum visit platform, extends in-person services to patients who historically have received suboptimal or inadequate prenatal care, and screens and provides timely treatments for mental health and food insecurity needs.

Fortifying and Improving Organizational Structures

Grantees also submitted proposals focusing on systemic, organization-wide efforts to lower rates of hypertension or hemorrhage in pregnant and postpartum patients. These structural approaches include building systems for improved staff communication and taking inventory to better understand the preferences of the patient population. Grantees also build community programs to increase awareness of maternal health issues in the greater population and invite community members to view themselves as a part of the care team for their pregnant and postpartum neighbors. By strengthening the systems that support patients in pregnancy and postpartum, these grantees are ensuring patient safety not only through consistency of care but also by developing and applying new obstetric care standards and innovations.

SUNY Downstate Medical Center, in Brooklyn, N.Y., is creating a community-engaged workgroup for hypertensive disorders in pregnancy to facilitate early recognition, prompt treatment, and positive outcomes.

The University of Washington Medical Center, in Seattle, is improving its maternal early warning trigger system by making critical adjustments to reporting mechanisms, increasing physician education, and increasing opportunities for patients to access postpartum care.

Future Engagement

The Institute strives to identify and highlight promising practices from the field, conduct research, disseminate innovative strategies, and help our members improve their organizational performance. With that in mind, the 12 grantees will participate in the preconference workshop at America’s Essential Hospitals’ annual conference, VITAL2022, “Developing an Infrastructure to Combat Structural Racism.” Member hospitals will share their innovations in obstetric care and work to combat structural racism.

Additionally, VITAL2022 will showcase leaders from association member St. Joseph’s Health, in Paterson, N.J., who will discuss how they are restructuring power dynamics to elevate patients’ voices and develop systemic change in perinatal health. Consider joining us at VITAL2022 for valuable tools to respond to the maternal health crisis.