A survey of obstetrical anesthesia health equity practices at academic centers in the United States (US)

Abstract

BackgroundLimited research has explored obstetrical anesthesiologists' perceptions of healthcare disparities associated with labor and delivery. The objective of this study was to evaluate the perception of obstetrical anesthesia related healthcare disparities, drivers of disparities, and potential solutions. MethodsAn online survey was emailed to division leads at Accreditation Council for Graduate Medical Education (ACGME) accredited obstetrical anesthesiology programs in the United States. The survey included a mixture of yes/no, select all that apply, and free-text questions. Descriptive statistics were used to characterize variable distribution. Free text responses were categorized into themes by selective coding. Results149 surveys were delivered, 74 surveys were conducted (50 %), and 57 were completed entirely (38 %). Fifty-seven percent of participants reported perceived presence of obstetrical/obstetrical anesthesia related healthcare disparities. Most participants reported that they consider a patient's cultural preferences during clinical management, collect race/ethnicity data, implement specific practices to address disparities, and analyze outcome data by social determinants of health. The majority of participants reported using additional relevant practice features, including translator services, quality improvement practices, provider rounds, standardized protocols, and cultural competency or diversity training. Thematic analysis of free text responses into drivers of disparities mapped to 6 themes: language barriers, racism or bias, socioeconomics or social determinants of health, access or quality of care, patient-provider interactions or cultural sensitivity, and individual patient factors. ConclusionMost academic obstetrical anesthesia center division leads reported perceived presence of obstetric anesthesia related health care disparities. Efforts should be made to devise targeted solutions to this multifaceted, pervasive problem.