Birth Equity – BE
3x
Non-Hispanic Black women are about 3 times
more likely than non-Hispanic white women to
die during or within a year of pregnancy from a
related complication.
2-3x
Compared to non-Hispanic white women, all
other racial and ethnic groups have higher rates of
severe complications during pregnancy and in the
year postpartum.
Join us for a BE Sustainability Webinar on December 16th!
Join ILPQC for a Birth Equity Sustainability Webinar on Monday, December 16th at 12pm CT! We are excited to hear from multiple teams on their progress towards BE initiative aims.
Click HERE to download the Birth Equity Sustainability Plan. Due to ILPQC and your PNA by September 27th!
Addressing maternal disparities and promoting Birth Equity
In 2021, the Illinois Perinatal Quality Collaborative (ILPQC) launched the statewide obstetric quality improvement initiative, Birth Equity (BE). This is an important statewide quality improvement initiative selected by the Illinois Department of Public Health (IDPH) Statewide Quality Council (SQC) and Perinatal Advisory Committee to engage hospital teams to implement strategies to address maternal health disparities and promote birth equity. Birth equity is the assurance of the conditions of optimal births for all people with a willingness to address racial and social inequities in a sustained effort.
ILPQC will work alongside hospital teams to achieve
this goal through: addressing social determinants of health during prenatal, delivery, and postpartum care; utilizing race/ethnicity medical record and quality data; engaging patients, support partners, and communities with a focus on patient-centered care; and engaging and educating providers, nurses, and staff to improve birth equity.
Collaborative Aim: By December 2023, 75% of IL hospitals will have actively participated in the Birth Equity Initiative to address maternal disparities and promote birth equity between June 2021 and December 2023.
Key Opportunities:
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1.
Implementation of universal social determinants of health screening prenatally and during delivery admission with linkage to appropriate resources and services
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2.
Review maternal health quality data stratified by race, ethnicity and Medicaid status to identify disparities and address opportunities for improvement
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3.
Take steps to engage patients and/or community members to provide input on QI efforts
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4.
Implement a strategy for sharing expected respectful care practices during delivery admission; and survey patients before discharge on their care experience (using the PREM tool) to provide feedback
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5.
Standardize system to provide patient education prior to hospital discharge on postpartum safety including urgent maternal warning signs and tools to improve communication with providers
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6.
Implement education for providers and staff on the importance of listening to patients, providing respectful care and addressing implicit bias and provide opportunities for discussion and feedback
Toolkit
- I. Introduction
- II. National Guidance ACOG/SMFM
- IV. Initiative Resources
- V. Social Determinants of Health (SDoH) & Linkage to Resources
- VI. Optimizing Race/Ethnicity Medical Record & Stratifying Quality Data
- VII. Sharing Respectful Care Practices on L&D & Using PREM Survey
- VIII. Engage Patients and/or Community Members to Provide Input on QI Efforts
- IX. Standardizing Postpartum Safety Education and Scheduling Early Postpartum Follow Up
- X. Educating Providers, Nurses, and Other Staff on the Importance of Implicit Bias / Respectful Care Training
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I. Introduction
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II. National Guidance ACOG/SMFM
a. ACOG Committee Opinions/Statements
- ACOG Committee Opinion #729: Importance of Social Determinants of Health and Cultural Awareness in the Delivery of Reproductive Health Care – Table 1 Sample Screening Tool for Social Determinants of Health
- ACOG Committee Opinion #825: Care for Patients Who Have Experienced Trauma
- ACOG Statement: Our Commitment to Changing the Culture of Medicine and Eliminating Racial Disparities in Women’s Health Outcomes
b. SMFM Guidance
- SMFM: Strategies To Overcome Racism’s Impact on Pregnancy Outcomes
- SMFM Position Statement: Racial Disparities in Health Outcomes
ACOG/SMFM et al. JOINT STATEMENT – Obstetrics and Gynecology: Collective Action Addressing Racism
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IV. Initiative Resources
- Birth Equity Sustainability Form*
- 10 Steps to Getting Started with the ILPQC Birth Equity Initiative
- BE Key Strategies for Improvement
- Birth Equity Aims and Measures
- Birth Equity Key Drivers Diagram
- Birth Equity Hospital Level Data Form *(UPDATED 5.2.2024)
- ILPQC PREM Data Form
- Birth Equity Readiness Survey
- Plan-Do-Study-Act Worksheet
- 30-60-90 Day Template
- I-PROMOTE IL Digital Resource Library
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V. Social Determinants of Health (SDoH) & Linkage to Resources
a. Social Determinants of Health Resource Mapping to assist linking patients to needed local resources and services
- ILPQC Social Determinants of Health Mapping Tool
- ILPQC Summary Of Online Tools to Identify Resources and Services to Address Social Determinants of Health
- ILPQC Tip Sheets (Editable version for teams – Updated 3/21/2023)
- AHA: Addressing Social Determinants of Health Presentation (Slide set to educate staff on Social Determinants of Health)
- ILPQC NowPow Access Guide
- FindHelp.org
- FIMR/IAMHP llinois Medicaid MCO Consumer Transportation Toolkit (English, Spanish)
- FIMR/IAMHP Illinois Medicaid MCO Maternal Benefits Toolkit (English, Spanish)
- Find Food IL Community Food Map
- Illinois Nutrition Program Matrix
b. Social Determinants of Health Screening Tools
- ILPQC Social Determinants Screening Tool Comparison
- Social Determinants of Health EMR Screener (Developed by Erie Health Center)
- Sample Screening Tool for Social Determinants of Health from ACOG committee opinion #729
- Social Determinants of Health in Pregnancy Tool (SIPT) with 5Ps (from Chicago PCC Communities Wellness Centers) and Actionable Map and Scoring Sheet
- Partner Healthcare Screening Tool from Massachusetts General Hospital Obstetrics & Gynecology, and Mass General Brigham)
c. Social Determinants of Health Folders: Patient and Provider Resources for SDoH Patients Who Screen Positiove
i. Resources to help providers and staff understand Social Determinants of Health
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- *ILPQC Social Determinants of Health Screening Checklist (NEW)
- *SDoH Process Flow (Screened Positive) (NEW)
- Empower Journey Map
- Principles for Patient-Centered Approaches to Social Needs Screening
- Patient-Centered Social Needs Screening Conversation Guide for Staff
- Social Determinants of Health Curriculum for Clinicians (E-modules)
- PQI Socio-Ecological Model – Perinatal Disparities
- AWHONN SBAR for Inclusive and Equitable Patient Care
ii. Patients handouts on SDoH resources (to be launched for patients who screen positive)
d. Incorporating discussion of social determinants of health for maternal morbidity reviews
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VI. Optimizing Race/Ethnicity Medical Record & Stratifying Quality Data
NEW ILPQC Disparity Data Guide
a. Improve patient-reported race/ethnicity data collection for EMR
- HPOE – Reducing health care disparities: collection and use of race, ethnicity and language data
- AHA: How to Ask the Questions Regarding Race/Ethnicity
- AHA: Staff Training and Scripts Examples
- AHA: Optimizing Real Data Collection
- AHA: Develop a Methodology for Data Collection
- ILPQC: Process Flow for Race & Ethnicity Data Collection with Staff Responses
b. Resources to stratify hospital maternal health quality data by race, ethnicity, and insurance status
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VII. Sharing Respectful Care Practices on L&D & Using PREM Survey
a. Sharing expected respectful care practices with providers, nurses, staff, and patients
- ILPQC Respectful Care Practices English
- ILPQC Respectful Care Practices Spanish
- Listen Campaign from Her Birth Right
- CDC: Hear Her Campaign
- Institute for Perinatal Quality Collaborative SPEAK UP Flyer
b. Patient Reported Experience Measure (PREM) patient survey
- NEW: PREM Survey Flyer with QR Codes (Updated 3.31.2023)
- NEW: Editable PREM Survey Flyer
- PREM Script Handout (11.22.2022)
- Example PREM Survey Flyer shared by SSM Health St. Mary’s Hospital- St. Louis (12.2022)
- ILPQC PREM Survey English Link
- ILPQC PREM Survey Spanish Link
c. Respectful Care Resources
Resources for Active Listening
- AWHONN SBAR for Equitable Patient Care
- CDC Hear Her Campaign
Resources for Shared Decision Making
- Ariadne Labs TeamBirth Labor and Delivery Planning Board
- Ariadne Labs Labor Support Discussion Tool
- Birth Place Lab Person-Centered Decision Making Tool
- Person-Centered Decision Making Key Elements
- CMQCC SHARE Model
- AHRQ SHARE Approach: For providers and patients
- Sparrow Health Labor Partnership Agreement: Booklet and Form
- ACNM Am I in Labor?
- My Birth Matters
- Lamaze Keep Calm and Labor On
Other Respectful Care Resources
- FREE ACOG Respectful Care eModules
- FREE AWHONN Respectful Maternity Care Toolkit – contact info@ilpqc.org for access
- Doula Engagement Strategies
- CMQCC Webinar: Integrating Midwives, Doulas, and Community-based Birth Care
- CMQCC Toolkit to support vaginal birth and reduce primary cesareans, INDEX pp 80-107
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VIII. Engage Patients and/or Community Members to Provide Input on QI Efforts
a. Involving patients and/or community members to provide input or engage with QI work
- ILPQC 30-60-90 Day Plan Template to Engage Patient Partners (NEW 2/8/2024)
- ILPQC Steps to Engaging Patient Partners Guide
- ILPQC Doula Flyer
- ILPQC Patient Family Engagement Guide
- ILPQC Patient Advisor Toolkit and Webinar Series
- Health Research & Educational Trust, Robert Wood Johnson Foundation, and American Hospital Association: Guide to help build community partnerships – A Playbook for Fostering Hospital Community Partnerships
- ILPQC partnerships with Everthrive IL and LaToshia Rouse (patient advisor consultant) – Additional support to engage patients and/or community members to provide input on QI efforts will be available through ILPQC partnerships with Everthrive IL and LaToshia Rouse. These patient and community member engagement experts will facilitate conversations on patient and/or community member engagement through regional meetings in collaboration with the regional perinatal system, statewide teams webinars addressing common opportunities and strategies, and other consultation. This work will build on any already existing efforts to engage community at the hospital level.
b. Respectful Care Breakfast Strategy
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IX. Standardizing Postpartum Safety Education and Scheduling Early Postpartum Follow Up
a. Standardizing early postpartum follow up visit to two-weeks
- I-PROMOTE-IL Postpartum Medicaid Expansion Flyer
- AIM Postpartum Discharge Transition Bundle Resources
- AIM Urgent Maternal Warning Signs (NEW 1/8/2024)
-
March of Dimes Benefits of Healthy Pregnancy Spacing (patient handout) English and Spanish
- ILPQC Benefits of Early Postpartum Care (patient handout)
- Improving Postpartum Access to Care (IPAC) Factsheet
- ILPQC Early Postpartum Visit Maternal Health Safety Checklist
b. Improving communication with patients and healthcare providers by providing postpartum safety patient education materials and support for early postpartum follow up
- NEW Early Postpartum Visit & Postpartum Warning Signs Flyer 8.31.2023
- NEW Postpartum Warning Signs Flyer 8.31.2023
- AWHONN POST-BIRTH Warning Signs
- Council on Patient Safety Urgent Maternal Warning Signs English and Spanish
- CDC Hear Her Maternal Warning Signs: Translated to 17 languages below:
- CDC Hear Her Patient Conversation Guide
- Available in poster
- Conversation Guide Palm Cards Translated to 17 languages below:
- CDC Hear Her Listening and
Acting Quickly could help save her life One Pager- English pdf icon[PDF – 778 KB]
- Spanish pdf icon[PDF – 720 KB]
- Arabic pdf icon[PDF – 286 KB]
- Bengali pdf icon[PDF – 291 KB]
- French pdf icon[PDF – 179 KB]
- German pdf icon[PDF – 161 KB]
- Haitian Creole pdf icon[PDF – 165 KB]
- Korean pdf icon[PDF – 277 KB]
- Nepali pdf icon[PDF – 194 KB]
- Portugese (Brazilian) pdf icon[PDF – 171 KB]
- Russian pdf icon[PDF – 168 KB]
- Simplified Chinese pdf icon[PDF – 215 KB]
- Somali pdf icon[PDF – 253 KB]
- Swahili pdf icon[PDF – 204 KB]
- Tagalog pdf icon[PDF – 226 KB]
- Traditional Chinese pdf icon[PDF – 222 KB]
- Vietnamese pdf icon[PDF – 172 KB]
- Illinois Public Health Institute Breastfeeding Education for Providers and Patients NEW RESOURCES:
- NHSA Fatherhood Advocacy Toolkit and Advocacy Stories from Fatherhood Practitioners
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X. Educating Providers, Nurses, and Other Staff on the Importance of Implicit Bias / Respectful Care Training
a. Addressing implicit bias to educate and engage providers, nurses, and staff
- E-modules on implicit bias and respectful care:
b. Grand Rounds Slide Set (available for grand rounds, OB providers meeting, Townhalls and other small group presentations and discussions)
- Grand Rounds Slide Set and Speakers Bureau (coming soon)
c. Using National Guidance to Address Provider Buy-in
- ACOG/SMFM Committee Opinions/Statements
- ACOG Committee Opinion #729: Importance of Social Determinants of Health and Cultural Awareness in the Delivery of Reproductive Health Care – Table 1 Sample Screening Tool for Social Determinants of Health
- ACOG Committee Opinion #825: Care for Patients Who Have Experienced Trauma
- ACOG Statement: Our Commitment to Changing the Culture of Medicine and Eliminating Racial Disparities in Women’s Health Outcomes
- SMFM: Strategies To Overcome Racism’s Impact on Pregnancy Outcomes
- SMFM Position Statement: Racial Disparities in Health Outcomes
- ACOG/SMFM et al. JOINT STATEMENT – Obstetrics and Gynecology: Collective Action Addressing Racism
d. Facilitating Feedback and Discussion:
- (In)equity Inbox – Example of a strategy to provide opportunity for anonymous feedback of workplace and patient interactions to improve equity (example from Massachusetts General Hospital OB Department)
e. Other Resources:
- Institute for Perinatal Quality Collaborative SPEAK UP Training – ILPQC will sponsor one QI team member per hospital to attend ILPQC hosted SPEAK UP train the trainer session
- CDC Hear Her Messaging Campaign: Provider Resources
- Harvard Project Implicit Association Test- Implicit bias self-assessment for providers, nurses and staff
- Resource for providers to review and share with patients to promote understanding and communication – Protecting your birth: a guide for black mothers. New York Times, 2020. (Also, includes guidance for healthcare providers)
- New England Journal of Medicine: Standing Up against Gender Bias and Harassment— A Matter of Professional Ethics (Mello & Jagsi, April 2020)
f. Addressing diversity within health care hiring
- ILPQC: Summary of Strategies to Promote Diversity in Healthcare Hiring and Learner Candidate Selection
- SMFM Official Position Statement: Diversity and Inclusion in Leadership (Jan. 2017)
- The Chronicle of Higher Education: The Case for Cluster Hiring to Diversify Your Faculty
- Duke University: Inclusive Recruiting Checklist
- AAMC Informational Video: Addressing Implicit Bias in Virtual Interviews
- Academic Medicine: Implicit Racial Bias in Medical School Admissions
**Key Resource
The following material is an example only and not meant to be prescriptive. The resources provided in this toolkit are for informational purposes only. The exclusion of a resource, program, or website does not reflect the quality of that resource, program or website. Note: Websites and URLs are subject to change.
Webinars
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Upcoming Webinars
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Recordings/Slides
- September 16, 2024: Birth Equity Sustainability Webinar
- June 17, 2024: Introduction to Birth Equity Initiative Sustainability Plan
- April 15, 2024: Expanding Patient Access to Home Visiting Resources
- March 18, 2024: Expanding Patient Access to Community-Based Doulas
- February 19, 2024: Holding Respectful Care Breakfasts – Lessons Learned
- January 22, 2024: Patient Partners on BE QI Teams – how to make it happen!
- December 11, 2023: Sustainable Equity Strategies to Promote Postpartum Safety
- September 18, 2023: REDCap PREM Data Dashboard Review
- Birth Equity 2023 QI Summer Series Slides
- August 21, 2023: Meaningful Connections for SDoH Linkages
- July 17, 2023: The Importance of Patient Voices – Engaging Patient Partners on QI Teams
- June 5, 2023: Key Takeaways from F2F and Next Steps for Getting to Green on Key Strategies
- April 17, 2023: Using PREM Survey Data Feedback to Improve Respectful Care
- March 20, 2023: Strategies to Increase PREM Survey Completion
- February 20, 2023: Achievable Patient/Community Engagement Strategies
- December 19, 2022: Actionable Respectful Care Strategies and PREM Survey Implementation
- September 19, 2022: Postpartum Safety Patient Education
- August 15th, 2022: Implementing postpartum early schedule two-weeks
- August 2nd, 2022: BE QI Topic Call for PREM and RCP
- July 18th, 2022: BE Review of Key Strategies & Team Sharing
- April 18th, 2022: Engaging patients and community in QI / Birth Equity work
- February 21st, 2022: Implementing a comprehensive implicit bias training for provider/nurse education
- January 31st, 2022: Recap of topics covered so far…SDoH Screening Tool and Respectful Care & PREM
- December 20th, 2021: Implementing Respectful Care Practices and PREM
- November 15th, 2021: Universal Social Determinants of Health Screening and mapping resources
- September 20th, 2021: Review maternal health quality data stratified by race, ethnicity, and Medicaid status
- August 16th, 2021: Optimizing race / ethnicity data collection for OB patients
- June 21st, 2021: Birth Equity Statewide Launch Call
- July 30th, 2021: Birth Equity Data Discussion Webinar
Clinical Quick Start Resources
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- Birth Equity One Pager Factsheet
- ILPQC Summary Of Online Tools to Identify Resources and Services to Address Social Determinants of Health
- ILPQC Tip Sheets (Editable version for teams)
- ILPQC Respectful Care Practices English
- ILPQC Respectful Care Practices Spanish
- ILPQC PREM Survey English Link
- ILPQC PREM Survey Spanish Link
Birth Equity
Clinical Leadership
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Ann Borders
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Barrett Robinson
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Daniell Ashford
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Emily White VanGompel
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Jamila Pleas
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Kai Tao
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Robin Jones