1010 Reduction of racial disparities in readmission associated with a standardized postpartum hypertension management protocol

Abstract

Implementation of a standardized protocol has been demonstrated to improve racial disparities in many areas of obstetrics. This study sought to evaluate whether a protocol for management of postpartum hypertension improved racial disparities in readmission for hypertension. This is a retrospective pre-post study comparing racial disparities in readmission for hypertension before and after a standardized postpartum hypertension management protocol. Deliveries and hypertension readmissions were identified from a contemporaneously maintained obstetric database. Cases between January 1, 2019 and June 30, 2019 (PRE) were compared with those between January 1, 2020 and June 30, 2020 (POST). The primary outcome was rate of readmission for hypertension, which was compared by race. Additional characteristics were compared with univariable analyses. 60 women were identified as having been readmitted for hypertension (35 pre- and 25 post-protocol). There were a total of 5,763 deliveries (2881 pre- and 2882 post-) for a readmission rate of 1.21% pre- and 0.87% post-protocol (p = 0.19). The rate of readmission for white women rose non-significantly from 0.76% (PRE) to 0.85% (POST, p = 0.77), while for Black women it fell significantly from 2.86% (PRE) to 1.08% (POST, p = 0.0097). Post-protocol readmission rates mirrored the racial distribution of deliveries during the same era more closely than the pre-protocol rates. The distribution of pre-existing hypertensive diagnoses changed after protocol implementation (p=0.043); readmission with chronic hypertension fell (11.4% PRE, 0% POST), while readmission of women without known hypertension rose (62.9% PRE, 72% POST). We found that a standardized postpartum hypertension management protocol was associated with a decreased hypertension readmission rate for Black women. The similarity of the racial distribution of readmissions to the racial distribution of deliveries increased. Further research is needed to address the systemic racism underlying racial disparities and assess the applicability of this protocol to other hospital systems.View Large Image Figure ViewerDownload Hi-res image Download (PPT)