Quayson Delisa, Alston Meredith, Fabbri Stefka
Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, USA.
Obstetrics and Gynecology, Saint Joseph Hospital, Intermountain Health, Denver, USA.
Cureus. 2023 Mar 13;15(3):e36090. doi: 10.7759/cureus.36090. eCollection 2023 Mar.
Background While there is a plethora of evidence describing racial and ethnic disparities in obstetric care and outcomes, little has been published evaluating potential inequities in departmental Patient Safety and Quality Improvement (PSQI) processes. Objective The study aims to describe the distribution of patient-reported race or ethnicity for safety events at a single safety net teaching hospital. We hypothesized that the observed versus expected case distribution for each racial or ethnic group would be similar, signifying proportional representation in the PSQI reporting and review process. Study design We performed a cross-sectional study including all Safety Intelligence (SI) events filed on obstetric and gynecologic patients and all cases reviewed at monthly PSQI multidisciplinary departmental meetings from May 2016 to December 2021. We compared the distribution of patients' self-reported race or ethnicity as documented in the medical record to our patient population's expected race or ethnicity distribution based on historical institutional data. Results Two thousand and five SI events were filed on obstetric and gynecologic patients. Of those, 411 cases were selected for review by the departmental multidisciplinary PSQI committee, which meets once monthly. Of the 411 cases reviewed by the PSQI committee, 132 met Severe Maternal Morbidity (SMM) criteria defined by the American College of Obstetricians and Gynecologists (ACOG). Fewer SI reports were filed on Asian patients and those who declined to provide race or ethnicity (observed 4.3% versus expected 5.5%, p=0.0088 and 2.9% versus expected 1%, p<0.0001, respectively). For cases reviewed by the departmental PSQI committee and for those which met SMM criteria, there was no significant difference in race/ethnicity distribution. Conclusions There was a disparity between fewer safety events filed for Asian patients and those not reporting race/ethnicity. It was reassuring that our process did not identify other racial/ethnic disparities. However, given the widespread systemic inequities in healthcare, further evaluation of our PSQI process, and PSQI processes beyond our institution, is needed.
背景 尽管有大量证据描述了产科护理及结局方面的种族和民族差异，但关于部门患者安全与质量改进（PSQI）流程中潜在不公平现象的评估却鲜有发表。 目的 本研究旨在描述一家安全网教学医院中患者报告的种族或民族在安全事件中的分布情况。我们假设每个种族或民族组的观察到的与预期的病例分布会相似，这表明在PSQI报告和审查过程中各比例代表情况相当。 研究设计 我们进行了一项横断面研究，纳入了2016年5月至2021年12月期间提交的所有关于妇产科患者的安全情报（SI）事件以及每月PSQI多学科部门会议审查的所有病例。我们将病历中记录的患者自我报告的种族或民族分布与基于机构历史数据得出的我们患者群体的预期种族或民族分布进行了比较。 结果 共提交了2005起关于妇产科患者的SI事件。其中，411例被部门多学科PSQI委员会选作审查对象，该委员会每月开会一次。在PSQI委员会审查的411例病例中，132例符合美国妇产科医师学会（ACOG）定义的严重孕产妇发病（SMM）标准。针对亚洲患者以及那些拒绝提供种族或民族信息的患者提交的SI报告较少（观察到的比例分别为4.3%和2.9%，而预期比例分别为5.5%和1%，p值分别为0.0088和p<0.0001）。对于部门PSQI委员会审查的病例以及符合SMM标准的病例，种族/民族分布没有显著差异。 结论 为亚洲患者以及未报告种族/民族信息的患者提交的安全事件较少，存在差异。令人欣慰的是，我们的流程未发现其他种族/民族差异。然而，鉴于医疗保健领域普遍存在系统性不公平现象，需要对我们的PSQI流程以及本机构之外的PSQI流程进行进一步评估。
