Development of a disparities in labor outcomes dashboard: an implementation strategy for obstetric interventions. - In the US, there are significant, unacceptable disparities between Black and non-Black women in cesarean delivery rates, as well as maternal and neonatal morbidity. Standardization of labor induction is a promising intervention to reduce such racial disparities in obstetric outcomes. In a completed prospective cohort study, our group used a pre- and post-implementation mixed- methods analysis to determine effectiveness of our induction protocol on overall obstetric outcomes, as well as racial disparities, while simultaneously evaluating implementation outcomes across two sites. To encourage implementation of the induction protocol, we harnessed several implementation strategies, including unit-level audit and feedback reports distributed by site. As a part of this work, we performed qualitative interviews with site clinicians to determine protocol acceptability, as well as assess our implementation endeavors. A critical theme emerged: clinicians felt that these general, unit-level audit and feedback reports demonstrating disparate outcomes could not represent their individual care; they needed individual-level feedback to feel responsible. The central hypothesis of this proposal is that a Disparities Dashboard, detailing clinician- level utilization of evidence-based practices, as well as clinical outcomes, by patient demographics, has the potential to drive clinician behavior change. We plan to test this hypothesis in a 2-aim approach. First, we propose a three-phase mixed-methods study that includes iterative feedback from clinicians and patients with the purpose of developing an acceptable Disparities in Labor Outcomes Dashboard. Second, we plan to compare 6 months where both sites will continue to use unit-level audit and feedback as the primary implementation strategy, to 6 months where Site #1 will continue to use unit-level audit and feedback, but clinician-level Disparities Dashboards will be implemented at Site #2. We will evaluate the Dashboard’s impact on intervention fidelity (adherence to the labor induction protocol) as well as clinical outcomes potentially impacted by increases in these evidence-based practices (cesarean delivery, maternal morbidity) in a difference-in-differences study design. Creation and evaluation of Disparities Dashboards as an implementation strategy to reduce disparities in obstetrics is an important clinical question yet to be studied in the literature. Dr. Hamm is an R01 and U24-funded maternal fetal medicine physician trained in clinical epidemiology with an established interest in implementation research. This proposal will leverage collaboration with senior investigators (Drs. Srinivas, Ashcraft, and Howell) and Penn’s programs in obstetrics, implementation science, health disparities, and qualitative methods. The results of this R21 will be invaluable to supporting a planned R01-level application for a stepped-wedge hybrid effectiveness implementation trial evaluating implementation of the standardized induction protocol at diverse sites, using the Disparities Dashboard as a critical implementation strategy for success.
