The Virtual Perinatal Quality Improvement Prioritization By Affected Communities (V‐QPAC) Protocol

Abstract

Research ObjectiveTo facilitate community participation in prioritizing perinatal improvement (QI) recommendations across six theorized domains of the Patient Reported Experience Measure of Obstetric Racism© (PREM‐OB Scale™) to mitigate obstetric racism during hospital‐based labor and birth. PREM‐OB Scale™ Domains Perinatal QI Priorities and Mitigations Safety & Accountability Shame, Stigma, Love, Grace, and Dignity: Birthing While Black Patient/Community Feedback in EHR Language and Patient Handoff Autonomy & Social Capital/Kinship Black Birthing Rights in Hospital Settings Black Women's/People's Autonomy: Asset vs Threat Communication & Information Exchange Pre‐Escalation Steps Prior to Calling Hospital Security Use of Mediation with a Professional and Community Representative External to Hospital Racism Redesign and expansion of care team Anti‐Racism Community Advisory & Accountability Board/Taskforce Empathy & Humanity Human Resources Accountability Metric: What is your Why? and Empathy‐specific Competency Based Screening/Interviews SACRED Birth Assessment/Checklist for Black People Focused Care Dignity in Blackness & Holistic Care Explicit Informed Consent/Refusal for Every Cervical Exam Racial Equity Caucus for Restoration of Dignity in Blackness for patients, community, clinicians, staff, and physicians with hospital privileges Study DesignThe Virtual Quality Improvement Prioritization by Affected Communities (V‐QPAC) is an adaptation of the Research Prioritization by Affected Communities (RPAC) protocol. V‐QPAC applies Black feminist ethnographic methodology to describe different forms of resistance and resilience that Black women community leaders adopt to mitigate the dimensions of obstetric racism and power inequities that emerge from supporting Black mothers and birthing people during hospital births. The V‐QPAC protocol is implemented using a web‐based video conferencing tool and presentation software for interactive real‐time input. The components include: 1) preparation; 2) facilitated group work to generate a list of potential techniques and topics (Session 1); 3) interim analysis by the same two Black women researchers; 4) facilitated group work to prioritize topics (Session 2); and 5) summary analysis using reflexive thematic analysis. We used both inductive coding and theoretical coding in this analytic approach.Population StudiedWe enrolled a total of 24 participants from 15 different Black women‐led community organizations across California, who support Black women and people experiencing pregnancy, birth, and lactation. Twenty participants completed the demographic survey and identified as Black women, ranging in age from 28 to 72 years, with prior perinatal QI experience (n = 7), other QI experience (n = 3), no prior QI experience (n = 10), previous hospital births in California (n = 13), and experience supporting a Black mother during a hospital birth in California (n = 15).Principal FindingsCommunity leaders identified 74 and prioritized 44 potential perinatal QI topics across the PREM‐OB Scale™ Domains. Then they further prioritized QI topics down to the top two mitigations for each domain.ConclusionsThe V‐QPAC protocol is a novel method for generating rapid, in‐depth knowledge of socio‐cultural QI priorities from Black women community leaders who support Black mothers and birthing people during hospital births.Implications for Policy or PracticeV‐QPAC offers potential mitigations against obstetric racism beyond pathology centered – risk reduction strategies described in existing QI safety bundles through the intellectual thought and political activism of Black women community leaders.Primary Funding SourceThe California Health Care Foundation.