At Penn Medicine Chester County Hospital (CCH), the Maternal Child Health care team is always striving to meet the needs of patients while searching for ways to improve patient care. CCH’s latest patient care initiative focuses on improving postpartum outcomes and decreasing health care disparities in the Hispanic community.

Identifying the problem

From left to right, Katherine Costantini, Melissa Welsh, Dr. Jennifer Cohen are the individuals who spearheaded this initiative

The CCH Maternal Child Health team was evaluating postpartum complication rates from July 2020 through June 2021, and they noticed an increased rate in complications, such as postpartum hemorrhage and postpartum infection, with Hispanic patients compared to the non-Hispanic population. Since approximately 20 percent of the patients in Maternity identify as Hispanic, the team knew that this patient population needed an extra focus.

For the last several years, multiple teams across Penn Medicine have been working together to improve maternal health outcomes and reduce racial and ethnic disparities system-wide. The United States has the highest maternal mortality rate of any developed country, and maternal health outcomes are even worse for racial and ethnic minorities. Considering the large Hispanic population in Chester County, the need to address disparities for a local community was clear to the CCH team.

The team brainstormed ideas and leveraged data to see what could be causing this uptick, and discovered that language barriers, access to care, overall culture, and possible biases were all overarching contributors to the increase in postpartum complication rates.

“The clinical team felt that there was a gap in how we were providing care, so we went to the data to see if that held true,” stated Katie Costantini, MSN, RNC-MNN, co-lead on this initiative.

Coming together as one team

An all-women clinical team group standing together who make up the CCH OB Clinic Team.
The CCH OB Clinic Team

The primary goal of the initiative is improving postpartum outcomes and addressing health care disparities in CCH Hispanic patients. The secondary goal, which is critical to the long-term success of this initiative, is to build trust with the Hispanic population.

“From my perspective, when you’re doing health equity work, you really need to meet patients where they are. So that was the main push for us to meet the patients out in the community and on a more personal level in the hospital,” said Costantini.

Building trust with a community is no small task, so the Maternal Child Health team partnered with the Patient Family and Advisory Council (PFAC) to obtain the “voice of the patient” through hospital and community-based interviews.

Partnering with PFAC Advisors also provided the opportunity to develop a cross-team task force to increase collaboration. The team was comprised of nurses, obstetricians, neonatologists, case management/social work, IT, interpreter services, OB/GYN clinic nurse practitioners, nursing leadership, and patients.

Meeting the patients where they are

Four members from the Patient Family and Advisory Council stand together.
Members of the Patient Family and Advisory Council (PFAC) at CCH

The team first established a survey that would create conversational interaction with patients. Working in pairs, a bilingual volunteer and a PFAC Advisor utilized the survey and conducted interviews with Hispanic patients in the Maternity unit after they received discharge instructions and viewed the discharge videos provided by the CCH nursing team.

This survey consisted of 22 questions and included topics such as overall experience, pain management, language interpretation, and after-discharge emergency information. A week after discharge, a follow-up phone call from a PFAC Advisor and the bilingual volunteers asked the patient an additional set of six questions, such as: “Do you remember any of the reasons why you might need to seek medical help after you leave the hospital?”, “Can you recall the 11 possible signs/symptoms of postpartum complications?”, “How is the baby doing?”, and “Do you have your post-partum visit scheduled?”

In total, the PFAC Advisors and their interpreter partners were able to interview 35 patients and connect with 21 of those patients in the follow-up phone survey.

“Bringing the PFAC into this project allowed us to get patients at the table and have their voices heard,” stated Carli Meister, director of Patient Experience and Risk at CCH. “It was a major turning point in building trust with our patients.”

Driving change using the patient’s voice

A group of clinical team members standing together who make up the CCH Interpreter Services Team.
The CCH Interpreter Services Team

Having data that reflected the voice of their patients, the team was able to make the needed changes to improve care for Hispanic mothers. Survey results indicated that patients felt they had limited access to interpreter service and minimal retention of discharge information. For example, 14 percent of patients could not remember postpartum warning signs one hour after being taught, and 38 percent of patients were unable to recall symptoms warranting medical attention within one week after being discharged.

With these survey results, the team made changes to improve patient care, including expanding weekday in-person Spanish interpreter services, initiating weekend hours, and creating an “on-call” position for interpreters.

Spanish-language education resources have also been updated and the task force team is currently working on adding Spanish-speaking volunteers who can assist incoming patients by introducing them to their future care team and provide tours of the maternity unit. Additionally, patients now have access to a call translation service, which assists them in connecting and communicating with a care team outside of normal business hours.

The future looks bright

With these solutions in place, the Maternal Child Health team noted that within the last two years, the postpartum complication rates among Hispanic patients at CCH have decreased from 4.9 percent to 2.0 percent. In October 2023, this initiative was recognized by The Health Care Improvement Foundation and the Maternal Child Health team won second place in the 2023 Excellence in Health Care Awards.

The Maternal Child Health care team plans to partner with community resources to better connect patients to long-term solutions, and they hope to expand their Spanish-speaking volunteer base to be able to provide more tours and additional support to all Hispanic patients.

“I greatly appreciate this service line recognized a disparity in care and worked tirelessly to address it,” said Jennifer Cohen, MD, MMSc, Medical Director Quality and Safety, Maternal Child Health at CCH, and co-lead of this initiative. “There were a lot of barriers that needed to be climbed over and this team took those challenges head on.”

 

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