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 worse 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. Additionally, Black and Hispanic women have higher rates of SMM and MM than White women. To address the growing maternal health crisis in the U.S., 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 might improve maternal health overall – but even then, racial/ethnic disparities in outcomes remain. To assess the impacts of QCCs on maternal care and health, we will (1) conduct a first-of-its-kind survey of state public health departments, QCCs, and QCC collaborating hospitals, and (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, including 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 care and health outcomes. 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 reduce disparities in maternal cesarean births (CB), SMM, and MM? We will test the hypotheses that: (H1) generally, QCCs and QI toolkits improve maternal care processes (CB) and health outcomes (SMM, MM); (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 group differences (e.g. pre-existing health conditions); and/or (H3) the QCCs and QI toolkits that are most effective in reducing racial/ethnic disparities in care processes and outcomes 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 care and health outcomes which can help accelerate improvements in SMM and MM.
