Table 1:

Reduction of Peripartum Racial–Ethnic Disparities Bundle: Commentary Linkage

Theme in Commentary	Domain in Bundle
Inability to assess disparities because they are not reliably measured	1. Readiness
	• Establish systems to accurately document self-identified race, ethnicity, and primary language
	2. Reporting and Systems Learning
	• Build a culture of equity, including systems for reporting, response, and learning similar to ongoing efforts in safety culture
Lack of recognition of disparities at both the personal and systems level	1. Readiness
	• Provide staff-wide education on peripartum racial and ethnic disparities and their root causes
	2. Recognition
	• Provide staff-wide education on implicit bias
	• Establish a mechanism for patients, families, and staff to report inequitable care and episodes of miscommunication or disrespect
	3. Response
	• Ensure a timely and tailored response to each report of inequity or disrespect
Specific knowledge of the magnitude of racial and ethnic disparities that exist within a health care system	1. Readiness
	• Engage diverse patient, family, and community advocates who can represent important community partnerships on quality and safety leadership teams
	2. Reporting and Systems Learning
	• Develop a disparities dashboard that monitors process and outcome metrics stratified by race and ethnicity with regular dissemination of the stratified performance data to staff and leadership
	• Implement quality improvement projects that target disparities in health care access, treatment, and outcomes
	• Consider the role of race, ethnicity, language, poverty, literacy, and other social determinants of health, including racism at the interpersonal and system level when conducting multidisciplinary reviews of severe maternal morbidity, mortality, and other clinically important metrics
Communication barriers	1. Readiness
	• Evaluate non-English language proficiency (e.g., Spanish proficiency) for providers who communicate with patients in languages other than English
	• Educate all staff (e.g., inpatient, outpatient, community-based) on interpreter services available within the health care system
	2. Response
	• Engage in best practices for shared decision-making
Differences in the structure of care Fragmentation of care	1. Recognition
	• Provide convenient access to health records without delay (paper or electronic), at minimal to no fee to the maternal patient, in a clear and simple format that summarizes information most pertinent to perinatal care and wellness
	2. Response
	• Address reproductive life plan and contraceptive options not only during or immediately after pregnancy, but at regular intervals throughout a woman’s reproductive life
	• Establish discharge navigation and coordination systems post childbirth to ensure that women have appropriate follow-up care and understand when it is necessary to return to their health care provider

Note. Bundle domains are from American College of Obstetricians and Gynecologists. Patient safety bundle: reduction of peripartum racial/ethnic disparities. Council on Patient Safety in Women’s Health Care. Washington, DC; American College of Obstetricians and Gynecologists: 2016. Retrieved from http://safehealthcareforeverywoman.org/patient-safety-bundles/reduction-of-peripartum-racialethnic-disparities/. Reprinted with permission.