The Massachusetts Department of Health (MDPH) is responding to funding opportunity number CDC-RFA-DP22-2207, Component A. MDPH will use this funding to support the Perinatal-Neonatal Quality Improvement Network (PNQIN), the statewide perinatal quality collaborative. Like the rest of the country, rates of pregnancy-associated mortality and severe maternal morbidity (SMM) in Massachusetts have steadily risen with start inequities by race and ethnicity. Currently, Black non-Hispanic (BNH) birthing people in MA are 1.9 times as likely to die during pregnancy or within one year postpartum compared to white non-Hispanic (WNH) birthing people. SMM is increasing faster in MA among BNH birthing people compared to all other groups, widening the existing inequities in perinatal health outcomes. In 2011, BNH birthing people had an SMM rate of 85.4/10,000 births compared to 42.9/10,000 for white non-Hispanic (WNH); by 2019, BNH birthing people had an SMM rate of 198.2/10,000 compared to 74.6/10,000 for WNH, for an SMM rate ratio of 2.66. Racism and discrimination are increasingly recognized as an etiology of such racial inequities in obstetrical outcomes. Another etiology is adverse social determinants of health (SDoH) which occur more often among BNH, Hispanic, and/or low-income families and contribute to poorer health and well-being across the life span. Despite the high prevalence of low-income, BNH, and Hispanic families that experience adverse perinatal outcomes that may benefit from screening and referral of SDoH, only one neonatal intensive care unit (NICU) in Massachusetts is routinely screening for SDoH.
The purpose of this proposal is to conduct quality improvement (QI) activities that build on our current work to achieve health equity in perinatal care delivery in MA. Our projects will (1) identify and address adverse SDoH in the neonatal setting; and (2) implement the PNQIN Maternal Equity Safety Bundle measures to reduce overall SMM and close the Black-White gap in SMM. We will prioritize five NICUs for goal 1 and five maternity hospitals for goal 2 in year 1 that predominantly serve non-white birthing people and those with public insurance, to reduce inequities and improve healthcare practices equitably, with the plan to expand to all birth hospitals within five years. By the end of Year 5 of this grant (September 2027), we aim to achieve the following outcomes: (1) integrate standardized SDoH screening in greater than 80% of NICU/SCNs in MA and greater than 50% of prenatal clinics associated with birth centers in MA with no inequity by race/ethnicity or language in SDoH screening/referral; (2) decrease rates of SMM and gap among race/ethnicity groups and ensure existence of infrastructure and hospital policies that ensure safe and equitable maternal care across all MA birth hospitals.