Screening for social risk factors in routine clinical care and offering patients tailored resources to address needs could help improve maternal health outcomes, according to three new studies. These findings were presented today by MedStar Health researchers at the 2023 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical & Scientific Meeting (ACSM) and build on the health system’s commitment to improving the health and well-being of mothers and infants in Washington, D.C., through its D.C. Safe Babies Safe Moms initiative.
The District of Columbia has some of the highest maternal and infant mortality rates in the U.S. with disparities by race and place1,2 and Black birthing individuals are at much greater risk of poor maternal health outcomes than their White counterparts, even when education and employment levels are similar.
“We know that there are so many factors at play when we look to the root causes of what our maternal health rates are today in this country. Racial inequity is one of the major drivers of disparate health outcomes,” says Angela D. Thomas, DrPH, executive lead for the D.C. Safe Babies Safe Moms initiative and co-author for these research projects. “By examining the role that other stressors caused by structural racism play in patients’ lives, we can begin to provide support where gaps exist and develop interventions that help our patients thrive.”
The first study3 analyzed data collected from 930 patients who were screened for social risk factors (including food and housing insecurity, transportation, unmet legal needs, intimate partner violence, and trauma history) at their initial prenatal and postpartum visits, with most of these patients identifying as Black and receiving public-sponsored health insurance plans. Researchers found that 78% reported at least one social or environmental risk factor that could negatively impact their health.
The second study4 , led by Georgetown Law in partnership with MedStar Health Research Institute, researchers found that offering legal support to patients with unmet legal needs can be a powerful tool to help address maternal health disparities, particularly among birthing individuals who are a part of historically marginalized or underserved communities and are at a higher risk of poor health outcomes. For health systems to be successful in offering legal services or establishing a medical-legal partnership, study authors suggested a two-pronged approach:
1) Make screening for unmet legal needs and referrals to legal support services a routine part of prenatal and postpartum appointments. This will likely require changes to operational workflows and, as researchers predict, integrations with the electronic health record.
2) Train healthcare team members to recognize the importance of tackling social determinants of health as a part of clinical management, how to spot unmet legal needs of their patients, and how to effectively communicate with patients about how social and environmental factors impact their health.
“Overcoming barriers, especially ones rooted in the law, can cause tremendous amounts of stress, even in the best of circumstances. When you are pregnant and faced with daily struggles around housing, education, employment, legal status, and income supports, that stress can be tenfold and cause a domino effect on your health and other aspects of you and your family’s lives,” says lead author S. Roxana Richardson, Esq., director of Georgetown University Health Justice Alliance’s Perinatal Legal Assistance and Wellbeing (LAW) Project at MedStar Washington Hospital Center and lead author on the study. “The Perinatal LAW Project helps families tackle these issues head-on by adding lawyers to the care team and creating a low-barrier path to access justice through early legal intervention. It’s an honor to present our data about this program and continue to build the evidence base for medical-legal partnerships as a critical resource for this vulnerable patient population.”
The third study5 tested how using digital technologies like chatbots could provide critically important follow-up outreach to recently discharged birthing individuals during the postpartum period starting 24 hours after discharge through 42 days post-delivery. The research team developed a chatbot that patients could interact with using logic to both offer educational content on postpartum recovery and newborn care as well as address barriers to care. The team then solicited feedback from users and monitored the usage of the chatbot. Overall, they found 61% of participants opened the chatbot at any point in time, suggesting that the technology could be an effective channel to deliver information to birthing individuals.
However, the research team also found that the users who opened the chatbot were more likely to be White and have private insurance, suggesting the need for further exploration on how to use chatbot technology to ensure more equitable delivery across patient populations at higher risk for poor outcomes.
“The chatbot tool is a promising way to proactively reach and engage patients during a crucial period for birthing individuals and those with newborns, particularly for those who might not otherwise reach out with questions or have access to their healthcare provider after they leave the hospital,” says Hannah Arem, Ph.D., scientific director of implementation science at MedStar Health Research Institute and co-author of the study. “While we’ve seen early success with content developed by medical experts, our next phase of this work will be to incorporate user feedback to better tailor the tool to what patients most at risk for adverse outcomes need and want.”
The MedStar Health team’s work was funded through an investment made by the A. James & Alice B. Clark Foundation to establish the D.C. Safe Babies Safe Moms initiative which seeks to address maternal and infant health disparities in the District of Columbia.