DEI Starts Early in Hospital Labor and Delivery Rooms

Unexplained variations in outcomes are a long-running chronic condition in healthcare. It doesn’t matter whether it’s an administrative, clinical, financial or operational outcome. There will be variations that on the surface can’t be explained. The usual root causes are subjective differences in how people do things.

A new study in JAMA Pediatrics suggests that unexplained variations in healthcare outcomes start early. Early as in the hospital labor and delivery room.

Seven researchers affiliated with five university medical schools and medical societies wanted to know the extent to which hospitals collect race and ethnicity data on newborns who were hospitalized after birth or readmitted shortly after birth. The study pool was 112 hospitals and 32,700 patient encounters over a two-year period, February 2022 through January 2024.

The primary question the researchers asked “site leaders” at the hospitals was: How do you typically record a baby’s race and/or ethnicity in the hospital’s EHR system? The top three answers, regardless of whether the baby was hospitalized after birth or readmitted shortly after birth, were:

• The family self-reported the race and/or ethnicity of the baby to the hospital staff.
• The staff defaulted to the birth mother’s race and/or ethnicity in the mother’s medical record.
• The staff didn’t know.

Overall, about 15% of newborns’ medical records had no race and/or ethnicity data, with the percentage for hospitals ranging from 0% to 80%. In other words, at one hospital, none of the records were missing that information. At another, 80% of the records were missing that information. Now that’s variation!

“Except for the practices of defaulting to maternal newborn race and ethnicity and recording unknown, neither hospital characteristics, encounter type, nor reporting practices were associated with missingness rates,” the researchers said. Now that’s unexplained!

Why is this important?

It’s important information to have if you want to reduce health disparities and improve health equity for underserved patient populations. You remember underserved populations, don’t you? It’s said you need to measure something before you can manage it. Well, you can’t manage health disparities or inequities without measuring who your patient population is.

Regardless of the Trump administration’s anti-DEI agenda, it’s still the mission-driven responsibility of healthcare providers to treat all patients the same regardless of their race, ethnicity, age, sex or gender identity. That starts in the delivery room.

Build better healthcare.