STRUCTURAL EQUITY PLAN

Massachusetts General Hospital (MGH) and Mass General Brigham (MGB) have launched several strategic initiatives to address structural inequities in our healthcare system, including the Mass General Structural Equity 10-Point Plan and the MGB United Against Racism initiative.

INITIATIVE 4: EQUITY IN ACCESS TO AND DELIVERY OF CLINICAL CARE

As key partners in this work, the Disparities Solutions Center and the Edward P. Lawrence Center for Quality and Safety are leading implementation of Initiative 4 of the 10-point plan, "Assure Equity in Access to and Delivery of Clinical Care."

Efforts are underway to identify and eliminate disparities in all aspects of care, from the time patients arrive at the hospital, throughout their stay, and when they return home. We are expanding our current work to identify and address disparities in quality of care at Mass General through our Annual Report on Equity in Health Care Quality, as well as innovation grants to support quality improvement projects that address disparities.

DOORSTEP

DOORSTEP

DOORSTEP

Community

Emergency Department/ Ambulatory Care

  • Primary care

  • Specialty care

Post Acute Care

EQUITY

Access to Care

Patient Experience

Quality of Care

Safety of Care

Inpatient Hospital Stay

BEDSIDE

MGB United Against Racism

ADDRESSING DISPARITIES IN RATES OF NTSV C-SECTION & EXCLUSIVE BREASTFEEDING

As part of Initiative 4, we are working with the Department of Obstetrics and Gynecology to address disparities in C-section rates among low-risk, first time birthing individuals, as well as disparities in exclusive breastfeeding.

Disparities in NTSV C-Section Rates

Monitoring and analysis through the MGH Annual Report on Equity in Health Care Quality revealed disparities in NTSV (Nulliparous, Term, Singleton, Vertex) Cesarean rates, with Black patients having Cesarean deliveries at a higher rate than White patients (32.1% vs. 21.%, respectively from 2016-2019). Research shows high rates of mistreatment of birthing patients in the US, especially patients of color. The OB/Gyn Department, the Disparities Solutions Center, the Center for Quality and Safety, and MGH Equity and Community Health are collaborating on a QI initiative to better understand and address this disparity. We are conducting in-depth semi-structured qualitative interviews with up to 25 NTSV C-Section patients to explore their experience with their delivery and the care they received at Mass General. Goals of the project include:

  • Investigating the experience of patients who had an NTSV Cesarean birth at Mass General

  • Understanding patients’ expectations for the birth and how they feel about having had a C-Section

  • Understanding patients’ perspectives on the reason(s) for having a C-Section

  • Comparing patients’ understanding of why they had a C-Section with the reasons recorded in their chart

  • Exploring patients’ perceptions of the birth experience, how they were treated, and satisfaction with the results of care

  • Understand patients’ experience of care provided by physicians, nurses, midwives, and other staff

Disparities in Breastfeeding

Analysis of exclusive breastfeeding rates also revealed disparities, with lower rates among Black and Asian patients, as well as patients of other races and Hispanic ethnicity compared with white and non-Hispanic patients. Rates were also lower among patients who speak a language other than English and patients on Medicaid compared to commercial and other payers. The first stage of work to address this disparity involves creating new documentation workflows in Epic to better capture breastfeeding in post-partum visits to enable tracking of outcomes.

Future phases of this work are likely to involve development of a patient education improvement plan, with a focus on education at antenatal visits and on locations where birthing patients of color, and those who are on MassHealth, are seen. Patient education will be provided in multiple languages through partnerships with community organizations, a peer support model, and the use of technology where possible. Over time, we anticipate expanding these efforts to post-partum support and focusing on improving provider communication and documentation.