Patients spend some of their most vulnerable moments inside our walls, and Texas Health believes quality and safety outcomes should not vary depending on gender, race, economic status or social or demographic factors.

Clinical care equity is one of six strategic priorities to advance Diversity, Equity and Inclusion initiatives across our health system and throughout our North Texas communities. Over the last 18 months, Texas Health has been working to:

• Facilitate access to equitable care that is timely, high-quality and safe across the system regardless of consumers’ race, ethnicity, social conditions, economic status or any dimension of diversity.
• Recognize and address social determinants of health: the economic and social conditions that influence individual and group differences in health status.
• Deliver culturally competent, sensitive care in alignment with our Vision of partnering with consumers for a lifetime of health and well-being.

While there are opportunities for improvement across many patient journeys, we’ve prioritized addressing maternal health to better care for those who give life and our most precious newborn patients.

Tragically, maternal deaths in the United States more than doubled over the last two decades, according to a study in the Journal of the American Medical Association.

And these heartbreaking losses have not impacted all groups equally.

Pregnancy-related mortality rates are 3.2 times higher for Black women and 2.3 times higher for American Indian/Alaska Native women than their White counterparts, according to the Centers for Disease Control and Prevention. In addition, non-White and Hispanic mothers undergo C-sections more frequently.

In 2023, Texas Health deployed new clinical processes to help address the primary causes of maternal morbidity and reduce C-sections in first-time mothers with low-risk deliveries.

Reducing C-sections — which now make up 30% of U.S. births — keeps patients safer.

“C-sections greatly multiply the risks of giving birth,” said Mary Robinson, Ph.D., R.N., NEA-BC, chief nursing executive for Texas Health. “Anesthesia complications, wound infections and deep vein thrombosis all enter the picture in a non-vaginal birth. Women also experience longer lengths of stay in the hospital, longer-term pain and fatigue and are more likely to have problems with subsequent births.”

From 2022 to 2023, Texas Health saw a 2.9% reduction in C-section rates across first-time mothers with low-risk deliveries. The system is expanding efforts this year with additional training and support for caregivers and physicians, clinical standardization, improved management of maternal hypertension and continued engagement with advocacy groups, including the Tarrant County Maternal & Infant Health Coalition.

Efforts also extend beyond the bedside, with a team of Texas Health nurses launching an initiative to collect data for use in research. The Texas Health Perinatal Research Repository will serve as a mechanism for collecting and storing data from postpartum patients for use in research by Texas Health nurses.

In January, nurses began asking patients if they were willing to participate in creating the first-of-its-kind, systemwide repository to help understand and address healthcare disparities in pregnancy outcomes. The patient’s information, if they consent, is collected during their stay, and they agree to complete a survey every six months for three years.

“We know that there are disparities in the outcomes for maternal patients, and we want to take a deep dive in understanding why,” said Patty Newcomb, Ph.D., R.N., nurse scientist and one of the primary investigators for the repository. “Our goal is to use the data we collect to conduct research that contributes to the body of knowledge regarding disparities. We hope to identify addressable needs and advance policy to reduce disparities for pregnant women here in North Texas as well as throughout the country,” Newcomb said.

Additionally, Texas Health began gathering data on five of the social determinants of health for all patients upon admission in 2023. This information is used to identify and address needs to better support Texas Health’s Mission of improving the health of the people in the communities we serve. Care transition managers at Texas Health also gather more information in their case management assessments and use the findings to help make sure patients go home to safe situations where they can get better and stay healthy. 

The research repository will include more detailed information on the social determinants of care for postpartum patients.

“The repository will support Texas Health’s existing health equity work and will provide us with a more comprehensive look at the obstacles that prevent our postpartum patients from having a fair and just opportunity to have as healthy a pregnancy and birth as possible,” said Robinson.

Clinicians hope to begin using the data for research by the end of 2024.