Achieving Health Equity

In December 2018, CPQCC launched the Health Equity Taskforce to “achieve health equity and improve care outcomes for small and sick newborns and their families across California.” The 31-member task force is a multidisciplinary, multi-stakeholder effort that engages providers and family representatives from across the state and includes leadership from both CPQCC and CMQCC. Members convene once a month to identify and define taskforce priorities. Three subgroups have been formed to tackle issues of equity within a specific area of focus: disparities in care delivery between NICUs; disparities in care delivery within NICUs; and disparities during the transition to home.

Research conducted by CPQCC has found differences in care between hospitals, with hospitals which score low on overall quality of care tending to treat more Black and Hispanic infants, and within hospitals, with vulnerable families receiving different and suboptimal care.  Considerable disparities in the referral of vulnerable infants to follow-up care post discharge have also been found.

The subgroups are currently working to define quality improvement aims that address equity issues within their domains and to create pilot projects that engage NICUs across the state to test solutions aligned with those aims.

CPQCC is also developing a health equity report for each member NICU that will be available through the NICU Reports site. The report will display information on societal factors that might affect the equity of care at each NICU as well as resources that can help NICU staff to understand these local factors and to refer families to community-based support. More information on the health equity reports will be made available once they are launched.

The Health Equity team, led by Dr. Jochen Profit, recently presented their work at the AAP Perinatal Practices and Strategies Meeting in March and at the Florida Quality Collaborative Annual Conference and Pediatric Academic Societies Annual Meeting in April.

Recent Notable Perinatal Health Equity Publications:

• Liu J, Sakarovitch C, Sigurdson K, Lee HC, Profit J. "Disparities in Health Care-Associated Infections in the NICU." Am J Perinatol. 2019.

This population-based cohort study of 20,692 VLBW infants born between 2011-2015 at CPQCC member hospitals found that while Hispanic infants had higher odds of contracting healthcare-associated infections (HAI) overall, race/ethnicity did not affect variation in infection rates.

• Leonard SA, Main EK, Scott KA, Profit J, Carmichael SL. “Racial and Ethnic Disparities in Severe Maternal Morbidity Prevalence and Trends.” Ann Epidemiol. 2019.

This study examined the prevalence and trends of severe maternal morbidity (SMM) among births in California from 1997-2014 and found that while the prevalence of SMM varied considerably by race/ethnicity, it increased in similarly high rates among all racial/ethnic groups. Comorbidities, cesarean births, and other factors did not fully explain the disparities in SMM, which remained persistent over time.

• Horbar JD, Edwards EM, Greenberg LT, Profit J, Draper D, Helkey D, Lorch SA; Lee HC; Phibbs CS; Rogowski J, Gould JB, Firebaugh G. “Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants.” JAMA Pediatr. 2019.

This cohort study of 743 NICUs in the Vermont Oxford Network (VON) found that Black, Hispanic, and Asian infants were segregated across NICUs, reflecting the racial segregation of minority populations in the United States.  After accounting for substantial differences in NICU quality between geographic regions, the study shows that Asian infants received care at higher-performing NICUs whereas Black infants received care at lower-performing NICUs.