The Impacts of State Quality Care Collaboratives on Maternal Health Disparities by Race/Ethnicity - PROJECT SUMMARY
Compared to many other high-income countries, the U.S. has stark maternal health outcomes – both severe
maternal morbidity (SMM) and maternal mortality (MM) have tripled in the U.S. since 1993. Overall, experts
estimate that nearly half of SMM and MM is preventable. Black and Hispanic women have borne the brunt
of this maternal health crisis with much higher rates of severe maternal mortality (SMM) and maternal
mortality (MM) than White women. To address the growing crisis, states increasingly use quality care
collaboratives (QCCs) that aim to train healthcare providers using quality improvement (QI) toolkits. These QI
toolkits outline maternal care processes designed to improve the diagnosis and treatment of maternal health
conditions with the overall aim of reducing SMM and MM. This project will provide the first detailed analysis
of the influence of state QCCs and their QI toolkits on maternal care and health outcomes overall, and
across racial/ethnic groups. The limited data evaluating a few states’ QCCs indicate that certain QCCs and
certain QI toolkits may improve maternal health overall – but even then, racial/ethnic disparities can persist. To
assess the impacts of QCCs on maternal care and health, particularly among Black and Hispanic women, we
will (1) conduct a first-of-its-kind survey of state public health departments, QCCs, and QCC
collaborating hospitals, (2) construct a national state-level database combining the survey data with key
maternal care and health outcomes and other publicly available data for 2003 to 2023. With this novel data,
we will estimate the effects of QCCs and their QI toolkits, particularly how their effects vary by maternal
race/ethnicity. These results will identify which QCCs and QI toolkits are most effective, particularly in addressing
racial/ethnic disparities in maternal health. Specifically, we will use the combined data to assess four research
questions: (Aim 1) How do trends in maternal care processes and health outcomes vary by race/ethnicity,
geography, and other characteristics? (Aim 2) How do QCCs differ? (Aim 3) Do QCCs and their QI toolkits
influence maternal care processes and health outcomes? And, (Aim 4) Which QCCs and QI toolkits most
effectively address disparities in maternal care processes and health outcomes? We will test the hypotheses
that: (H1) generally, QCCs and QI toolkits improve maternal care processes and health outcomes; (H2)
the QCCs and QI toolkits that are most effective in reducing racial/ethnic disparities are those that use
QI toolkits that focus on key drivers of disparities (e.g. pre-existing health and social conditions); and/or
(H3) the QCCs and QI toolkits that are most effective in reducing racial/ethnic disparities are those that
collaborate with hospitals serving greater proportions of the states’ Black and Hispanic women. In so
doing, our proposed study lays a strong foundation for a comprehensive research agenda on the effects of QCCs
on race/ethnic disparities in maternal health which can accelerate improvements in SMM and MM, particularly
among Black and Hispanic women who are disproportionately affected but may not benefit equally from QCCs.
