Departments of Obstetrics and Gynecology, SUNY Downstate Health Sciences University and Maimonides Medical Center, Brooklyn, New York.
Obstet Gynecol. 2021 Mar 1;137(3):481-485. doi: 10.1097/AOG.0000000000004283.
Multiple studies have demonstrated that low income and Black women in the United States are more likely to suffer from severe maternal morbidity and mortality during childbirth, even when accounting for the site of service. Structural racism, social determinants of health, and personally mediated racism are factors that may play a role. Assessing them is, therefore, critical in the attempt to deliver safe and equitable health care, which is a fundamental charge of performance-improvement committees. We argue that, for performance-improvement committees to fulfill their mandate, they must include equity as an organizing principle. A low rate of adverse outcomes in the overall population served by a hospital is not sufficient if, when stratified by race, a particular group is found to have rates above acceptable limits. In this piece we outline the process by which those charged with assuring optimal quality in departments of obstetrics and gynecology can include equity in their portfolio. This is a key step in moving beyond the recognition that disparities exist and toward a consideration of the specific ways in which inequity contributes to morbidity, and then to implementing steps to mitigate its effects.
多项研究表明，美国的低收入和黑人女性在分娩时更有可能遭受严重的孕产妇发病率和死亡率，即使考虑到服务地点。结构性种族主义、健康的社会决定因素和个人介导的种族主义是可能起作用的因素。因此，评估这些因素对于提供安全和公平的医疗保健至关重要，这是绩效改进委员会的基本职责。我们认为，为了履行绩效改进委员会的任务，他们必须将公平作为组织原则。如果一个特定群体的比率被发现超过可接受的限制，那么，如果按种族分层，医院服务的总体人群中的不良结果率较低，这是不够的。在这篇文章中，我们概述了负责确保妇产科部门最佳质量的人员可以将公平性纳入其投资组合的过程。这是超越认识到存在差异并考虑不公平如何导致发病率的关键步骤，然后是实施减轻其影响的步骤。
