Leveraging Quality Improvement to Promote Health Equity: Prenatal Aspirin Recommendations by Race [A303

Abstract

INTRODUCTION: Black patients are disproportionately affected by preeclampsia and associated morbidity and mortality. Aspirin (ASA) reduces these risks and the United States Preventative Services Task Force (USPSTF) recommends ASA for pregnant patients at moderate to high risk for preeclampsia. We aimed to assess whether a quality-improvement intervention to standardize ASA screening and prescription resulted in similar rates of indicated ASA recommendations for patients who self-identified as Black versus non-Black. METHODS: Using a quality-improvement framework, we implemented universal prenatal screening according to the USPSTF recommendations for ASA to prevent preeclampsia. We analyzed 201 new OB (NOB) visits pre-intervention and 199 NOB visits 3 months post-intervention. Nurses utilized a checklist created from USPSTF guidelines to identify high-risk patients, defined as having 1 or more high-risk factor or 2 or more moderate-risk factors. ASA orders were signed by physicians. Results were stratified by self-identified Black versus non-Black race. RESULTS: Pre-intervention, 88% of Black patients met criteria, and 29% of those patients correctly received a recommendation for ASA. Among non-Black patients, 41% met criteria for ASA, and 27% of those patients a recommendation. Post-intervention, 93% and 41% of Black and non-Black patients met criteria, respectively, with 80% and 79% of those patients, respectively, receiving the recommendation. CONCLUSION: A strikingly high percentage of Black patients warrant a recommendation for ASA to reduce preeclampsia risk, as per USPSTF guidelines. Our standardized approach to prenatal screening and prescribing of ASA resulted in similar rates of correct prescriptions for ASA in Black and non-Black patients, suggesting a mechanism for delivering equitable preventative obstetric care.