The Impact of Psychosocial Stress on Maternal Health Outcomes: A Multi-State PRAMS 8 (2016-2018) Analysis

Introduction: Significant racial disparities persist in maternal morbidity rates, disproportionately affecting Black women. Experiencing high levels of stress during pregnancy is associated with increased risk for preterm birth, infant mortality, and preeclampsia. This study investigates the impact of psychosocial life stressors on maternal morbidity and racial disparities utilizing the Pregnancy Risk Assessment Monitoring System (PRAMS) dataset. Methods: Participants (N=24,209) included were from Phase 8 (2016-2018) of the PRAMS survey across five states. Stressors were grouped into traumatic, partner-related, financial, or emotional. Maternal outcomes included gestational diabetes, hypertensive disorders of pregnancy, prenatal depression, and postpartum depression. The association between life stressors and maternal morbidity was evaluated using modified Poisson regression models with robust error variance to estimate adjusted prevalence ratios. Results: Black women were more likely to report all stressors, and Hispanic women had an increased prevalence of partner-related and financial stressors. Experiencing any maternal morbidity was associated with partner (38.0% versus 22.0%; p\u3c0.001), trauma (20.9% versus 10.9%; p\u3c0.001), financial (40.5% versus 25.7%; p\u3c0.001), and emotional stress (36.4% versus 28.3%; p\u3c0.001). Compared to mothers who reported no stressors, mothers who reported 1-3 stressors, 4-6 stressors, and ≥ 7 stressors had a 1.14, 1.38, and 1.45 higher adjusted prevalence ratio of maternal morbidity, respectively. Conclusions/Implications: Psychosocial stress has a substantial impact on maternal outcomes. Pregnant women should be screened and connected with resources to alleviate the burden of their respective stressful life events

Characteristics of High Versus Low-Performing Hospitals for Very Preterm Infant Morbidity and Mortality

International audienceObjective: To ascertain organizational attributes, policies, and practices that differentiate hospitals with high versus low risk-adjusted rates of very preterm neonatal morbidity and mortality (NMM).Methods: Using a positive deviance research framework, we conducted qualitative interviews of hospital leadership and frontline clinicians from September-October 2018 in 4 high-performing and 4 low-performing hospitals in New York City, based on NMM measured in previous research. Key interview topics included NICU physician and nurse staffing, professional development, standardization of care, quality measurement and improvement, and efforts to measure and report on racial/ethnic disparities in care and outcomes for very preterm infants. Interviews were audiotaped, professionally transcribed, and coded using NVivo software. In qualitative content analysis, researchers blinded to hospital performance identified emergent themes, highlighted illustrative quotes, and drew qualitative comparisons between hospital clusters.Results: The following features distinguished high-performing facilities: 1) stronger commitment from hospital leadership to diversity, quality, and equity; 2) better access to specialist physicians and experienced nursing staff; 3) inclusion of nurses in developing clinical policies and protocols, and 4) acknowledgement of the influence of racism and bias in healthcare on racial-ethnic disparities. In both clusters, areas for improvement included comprehensive family engagement strategies, care standardization, and reporting of quality data by patient sociodemographic characteristics.Conclusions and relevance: Our findings suggest specific organizational and cultural characteristics, from hospital leadership and clinician perspectives, that may yield better patient outcomes, and demonstrate the utility of a positive deviance framework to center equity in quality initiatives for high-risk infant care

Characteristics of High Versus Low-Performing Hospitals for Very Preterm Infant Morbidity and Mortality

Objective: To ascertain organizational attributes, policies, and practices that differentiate hospitals with high versus low risk-adjusted rates of very preterm neonatal morbidity and mortality (NMM). Methods: Using a positive deviance research framework, we conducted qualitative interviews of hospital leadership and frontline clinicians from September-October 2018 in 4 high-performing and 4 low-performing hospitals in New York City, based on NMM measured in previous research. Key interview topics included NICU physician and nurse staffing, professional development, standardization of care, quality measurement and improvement, and efforts to measure and report on racial/ethnic disparities in care and outcomes for very preterm infants. Interviews were audiotaped, professionally transcribed, and coded using NVivo software. In qualitative content analysis, researchers blinded to hospital performance identified emergent themes, highlighted illustrative quotes, and drew qualitative comparisons between hospital clusters. Results: The following features distinguished high-performing facilities: 1) stronger commitment from hospital leadership to diversity, quality, and equity; 2) better access to specialist physicians and experienced nursing staff; 3) inclusion of nurses in developing clinical policies and protocols, and 4) acknowledgement of the influence of racism and bias in healthcare on racial-ethnic disparities. In both clusters, areas for improvement included comprehensive family engagement strategies, care standardization, and reporting of quality data by patient sociodemographic characteristics. Conclusions and relevance: Our findings suggest specific organizational and cultural characteristics, from hospital leadership and clinician perspectives, that may yield better patient outcomes, and demonstrate the utility of a positive deviance framework to center equity in quality initiatives for high-risk infant care