Implementing a Health Equity Grading System into Obstetrics and Gynecology

Introduction

Maternal morbidity and mortality rates in the United States have risen, disproportionately affecting women of color across all income and education levels. While factors like hypertension and diabetes are often cited, they fail to account for the broader impact of structural inequities, including implicit bias and racism. The persistence of these trends indicates systemic contributors to these poor outcomes.

To date, few provider case review tools effectively capture the impact of health inequity on patient complications. Traditional health equity teaching in medical education is largely didactic and does not address real-time clinical decision-making. Case review formats, like Morbidity and Mortality (M&M) conferences, focus on patient outcomes but overlook the role of health inequities in complications.

The uChicago Health Inequity Classification System (CHI-CS) was developed in the Department of Surgery as a structured framework to implement health equity into M&M case discussions. Building on prior implementation, this study sought to assess CHI-CS’s effectiveness in Obstetrics and Gynecology and examine its generalizability to other medical specialties.

Methods

CHI-CS was implemented into OBGYN M&M conferences for 6 months. Residents reported deidentified M&M data to determine the frequency of bias-or-access related complications.

A pre-intervention survey was administered to assess participants’ beliefs, recognition, discussion and understanding of bias and access. After six months, a post-intervention survey was distributed to evaluate CHI-CS’s impact on clinical practice and participant’s understanding of health equity.

Results

The pre-intervention survey was distributed to 29 residents and 82 faculty members in the department of Obstetrics and Gynecology. Among them, 54 participants completed the survey (48.6% response rate). Of the 54 participants, 68% were faculty (n=37) and 31% were residents (n=17).

On the pre-intervention survey, residents reported stronger beliefs and greater confidence recognizing bias’s contribution to complications compared to faculty. Participants indicated greater understanding of access issues.

During the study period, 21 cases were presented at monthly M&M conferences. Bias or access contributed to 57% of cases presented during the study.

The post-intervention survey was distributed to 30 residents and 83 faculty in the department. Preliminary results from the post- intervention survey indicate increased recognition, understanding, and discussion of bias and access. Participants reported having more conversations about bias and access since implementation, indicating an improvement in care delivery. Additionally, nearly half of respondents stated that they have changed their clinical practice to address bias and access, aiming to improve patient outcomes. Lastly, the majority of respondents indicated that CHI-CS has improved M&M conferences.

Conclusion

While post-intervention survey results are still being collected, preliminary results are promising and suggest that CHI-CS may be a useful health equity training tool across diverse practice settings. Results from the in-house pilot study, as well as the iteration in Obstetrics and Gynecology support the notion that CHI-CS can positively impact the way providers view, discuss and think about health disparities and their impact on patient outcomes. Ultimately, CHI-CS may lead to improved care for patients impacted by healthcare disparities.