Health care disparities, defined as variation in quality and safety of care by patient sociodemographic characteristics, have been a significant and persistent problem in American health care.  While California hospitals and hospital systems have often been at the forefront of the quest to achieve health care equity, significant work still remains ahead of us.

This page is intended to provide hospitals with select current resources and wisdom that can assist them in measuring, understanding, and alleviating disparities in care. 

Disparities in Maternal Mortality and Morbidity

Introduction

While California hospitals in recent years made definite strides to improve the overall maternity care, there continue to be large racial disparities in maternal mortality and morbidity.  For example, Black women are 3 to 4 times more likely to die during childbirth than white women and their risk of severe maternal morbidity is twice that of white women, even after adjusting for demographic and socioeconomic factors, and comorbidities.  Significant evidence points to implicit bias and racism as major factors in these perinatal inequities. 

For a comprehensive review of issues and interventions taking place in California, visit California Health Care Foundation’s website Improving Birth Equity in California’s Health Care System.

SB-464

California legislature brought attention to perinatal disparities in SB-464 (California Dignity in Pregnancy and Childbirth Act.)  Among other provisions, SB-464 stipulates that California hospitals implement evidence-based implicit bias training programs for all health care staff involved in the perinatal care of patients.  The law became effective on 1/1/2020.

Free e-Learning Modules for California Hospitals

In consultation with key stakeholders (including HQI), California Health Care Foundation funded a team of pre-eminent national experts to develop a set of brief, interactive e-learning modules for perinatal providers and staff, focused on mitigating racism and negative effects of implicit bias.

The first module is now available on Diversity Science website and subsequent modules are expected to be released by January 2021.  The modules are available free of charge and designed to align with the training requirements of SB-464.

Broad-Based Strategies and Tools for Addressing Disparities

• HQI Webinar Transgender Healthcare: Safety Considerations for Both Patient and Institution
• HQI Webinar Addressing Racial Inequity in Healthcare Outcomes with a Focus on Cherished Futures for Black Moms and Babies
• HQI webinar The Impact of Bias on Quality and Patient Safety discusses factors that support vs. undermine the ability of individuals and organizations to provide equitable care.  
• HQI webinar Protecting Patients from Social Identity Threat & Racial Trauma discusses the nature of these often overlooked but powerful manifestations of structural inequities and ways to mitigate their negative impact in health care settings.
• To assess your hospital’s ability to identify and act on health care disparities, use the Hospital Health Equity Organizational Assessment Tool, which HQI co-developed when working in partnership with HSAG as part of HSAG’s Hospital Improvement Innovation Network (HIIN). 
• Read key findings and recommendations from HQI’s study of gaps in the collection of race, ethnicity and language data.
• Institute for Healthcare Improvement’s (IHI) white paper with guidance for health care organizations: Achieving Health Equity: A Guide for Health Care Organizations
• American Hospital Association’s (AHA) #123 for Equity Pledge to Act Campaign provides a pledge and a blueprint for how hospital and health system leaders can take action on eliminating health disparities.  Click on the link to see if your hospital has signed the pledge!
• Hospital Association of Southern California’s (HASC) Diversity, Equity & Inclusion Resources