Presentation
PS14 - Understanding Inequitable Experiences in Maternal Care Using Patient Journey Mapping
SessionPoster Session 2
DescriptionIntroduction
In the United States, childbirth is the most common cause of hospitalization, with over 3.5 million births annually. Additionally, maternal care represents birthing people’s first experience of prolonged interactions with the health care system. However, systems investigations have found maternal care to be fragmented and unresponsive to individual needs, particularly for Black birthing people. Many birthing people experience barriers to prenatal care such as lack of insurance, inflexible appointments, and conflicting life priorities which leads to few prenatal appointments, which is associated with adverse outcomes. Intrapartum care has inpatient environments that hinder maternal recovery and provide insufficient support from healthcare workers due to high patient ratios. A lack of timely care and shared decision-making have been identified during the postpartum period. Furthermore, Black birthing people may experience unwarranted mistreatment, racism, and discrimination during maternal care, including due to unfounded beliefs. These challenges may result in negative patient experiences and adverse outcomes. Thus, research is needed to holistically understand the experiences of birthing people throughout the maternal care journey to identify opportunities to improve equity and patient-centered care.
Patient Journey Mapping (PJM) is a tool used to capture and visualize a patient’s journey at different points in time through their interactions with their healthcare workers (HCWs) and the healthcare system. This method highlights positive and negative experiences in the patient’s journey and brings attention to their unmet needs at different points in their care. Thus, the research study aims to map the journey of prenatal and postpartum birthing people to understand their experiences with care access, continuity of care, and education to identify their needs and inform safer, more equitable, patient-centered care.
Methods
We sought to recruit pregnant and postpartum patients from a large academic hospital in the Southeastern US. We sought to over-sample Black birthing people (>75%) to understand equity-related challenges, as Black patients report more negative experiences in maternal care. Data was collected using surveys and interviews. Patients completed a survey at 24, 28, 32, and 36 gestational weeks, and 2, 4, 8, and 12 weeks after birth for the prenatal and postpartum groups respectively. Surveys focused on understanding the content of appointments, birthing people’s care experiences, expectations, education provided, and experiences of racism or discrimination during appointments. Patients participated in an interview to get a more in-depth understanding of their experiences. Interviews were conducted virtually on Zoom (Zoom Video Communications, Inc., San Jose, California, US) and transcribed using Rev AI Speech Transcription (Rev.com, Inc., San Francisco, California, US). The study was approved as a quality improvement project by the hospital.
Natural language processing was used to analyze the positive and negative sentiments expressed by patients in the interviews on a 5-tier scale from very negative to very positive. In addition, coding was conducted inductively using sentiment analysis in NVivo (Lumivero, Denver, Colorado) to identify themes related to accessing information, appointment experiences, consistent care and trust, and discrimination. The survey data, sentiment analysis, and themes were used to visualize individual patient journey maps using Miro (RealtimeBoard Inc., San Francisco, California), a digital whiteboard tool. Parallel journeys were used to compare the patient journey for White and Biracial prenatal patients, and Black and Biracial postpartum patients.
Results
The individual patient journeys of 10 participants were mapped, including 6 prenatal and 4 postpartum patients, using data collected from surveys and interviews. The journey maps included demographic information, preferences regarding their healthcare provided, content of appointments, education covered, and their experience. The format of the maps was designed to distinguish critical or notable themes that highlighted possible areas of improvement, such as negative experiences with healthcare workers, availability and use of resources, and the education participants received.
Throughout the prenatal period, participants reported positive experiences including compassionate HCWs, good communication, and continuity of care. During intrapartum, participants felt they were uninformed and unprepared for medical interventions. In addition, they wanted continuity of care between the prenatal and the intrapartum phases (i.e. the same healthcare worker from prenatal appointments as during labor), however, no participant experienced this. During postpartum, returning to work was reported as a challenge due to separation anxiety and difficulties maintaining a breastfeeding schedule.
For the prenatal group, the patient journey was compared between two participants who identified as White and Biracial. Both have had previous births, and the White participant had a chronic condition, whereas the Black participant did not. Differences were noted in HCW preference, proximity of prenatal clinic, number of appointments, and education received during appointments. Only the biracial participant specifically sought a HCW of similar racial/ethnic background. The White participant had fewer appointments up until 24 weeks, and only had their first prenatal appointment between 13-16 weeks due to lack of Medicaid insurance coverage. In addition, the length of appointments was typically between 16-30 minutes for both participants, however, the White participant travelled further to get to their appointments. During appointments, the White participant reported receiving more education during appointments than the Biracial participant such as their delivery plan, medications, and warning signs of complications. Both reported positive experiences during interactions with their HCWs such as the length and quality of appointments, their access to information, and overall satisfaction and trust in their HCW.
For the postpartum group, the patient journey was compared between two participants who identified as Black and Biracial. Both participants had previous births and chronic conditions. The Black participant was looking for a HCW of similar religious and racial/ethnic background, but this was not important to the Biracial participant. The Black participant had more prenatal appointments even though they both had chronic conditions, and both participants travelled a similar amount of time to get to their appointments. The Biracial participant had a birthing plan, whereas the Black participant did not. The Biracial participant reported a positive birthing experience because they were well-informed, treated fairly and respectfully by HCWs, and had a positive experience with pain management during labor and delivery. Conversely, the Black participant reported negative experiences at multiple points in their patient journey including perceived discrimination when being admitted to the hospital, challenges with intrapartum pain management, and lack of informed consent and shared decision-making during labor. Both participants missed their postpartum follow-up due to illness.
Conclusion
This study has revealed that many patients had positive experiences throughout their interactions during appointments with their healthcare workers, but some experienced challenges related to education and decision-making in medical interventions during labor, lacked continuity of care in the postpartum period from their prenatal care and faced mental health challenges. Examining the journey between participants of different race/ethnicities allowed us to identify opportunities for improvement to ensure all patients are receiving equitable, responsive care within the same health system. As this study only included 10 participants, further research should be conducted to investigate interventions and process improvements to improve continuity of care during the postpartum period and consent processes and provide resources to birthing people to focus on patient support and advocacy. Addressing these challenges can lead to more equitable, patient-centered safer maternal care for birthing people, and creates a valuable and user-friendly resource for healthcare workers and policy makers.
In the United States, childbirth is the most common cause of hospitalization, with over 3.5 million births annually. Additionally, maternal care represents birthing people’s first experience of prolonged interactions with the health care system. However, systems investigations have found maternal care to be fragmented and unresponsive to individual needs, particularly for Black birthing people. Many birthing people experience barriers to prenatal care such as lack of insurance, inflexible appointments, and conflicting life priorities which leads to few prenatal appointments, which is associated with adverse outcomes. Intrapartum care has inpatient environments that hinder maternal recovery and provide insufficient support from healthcare workers due to high patient ratios. A lack of timely care and shared decision-making have been identified during the postpartum period. Furthermore, Black birthing people may experience unwarranted mistreatment, racism, and discrimination during maternal care, including due to unfounded beliefs. These challenges may result in negative patient experiences and adverse outcomes. Thus, research is needed to holistically understand the experiences of birthing people throughout the maternal care journey to identify opportunities to improve equity and patient-centered care.
Patient Journey Mapping (PJM) is a tool used to capture and visualize a patient’s journey at different points in time through their interactions with their healthcare workers (HCWs) and the healthcare system. This method highlights positive and negative experiences in the patient’s journey and brings attention to their unmet needs at different points in their care. Thus, the research study aims to map the journey of prenatal and postpartum birthing people to understand their experiences with care access, continuity of care, and education to identify their needs and inform safer, more equitable, patient-centered care.
Methods
We sought to recruit pregnant and postpartum patients from a large academic hospital in the Southeastern US. We sought to over-sample Black birthing people (>75%) to understand equity-related challenges, as Black patients report more negative experiences in maternal care. Data was collected using surveys and interviews. Patients completed a survey at 24, 28, 32, and 36 gestational weeks, and 2, 4, 8, and 12 weeks after birth for the prenatal and postpartum groups respectively. Surveys focused on understanding the content of appointments, birthing people’s care experiences, expectations, education provided, and experiences of racism or discrimination during appointments. Patients participated in an interview to get a more in-depth understanding of their experiences. Interviews were conducted virtually on Zoom (Zoom Video Communications, Inc., San Jose, California, US) and transcribed using Rev AI Speech Transcription (Rev.com, Inc., San Francisco, California, US). The study was approved as a quality improvement project by the hospital.
Natural language processing was used to analyze the positive and negative sentiments expressed by patients in the interviews on a 5-tier scale from very negative to very positive. In addition, coding was conducted inductively using sentiment analysis in NVivo (Lumivero, Denver, Colorado) to identify themes related to accessing information, appointment experiences, consistent care and trust, and discrimination. The survey data, sentiment analysis, and themes were used to visualize individual patient journey maps using Miro (RealtimeBoard Inc., San Francisco, California), a digital whiteboard tool. Parallel journeys were used to compare the patient journey for White and Biracial prenatal patients, and Black and Biracial postpartum patients.
Results
The individual patient journeys of 10 participants were mapped, including 6 prenatal and 4 postpartum patients, using data collected from surveys and interviews. The journey maps included demographic information, preferences regarding their healthcare provided, content of appointments, education covered, and their experience. The format of the maps was designed to distinguish critical or notable themes that highlighted possible areas of improvement, such as negative experiences with healthcare workers, availability and use of resources, and the education participants received.
Throughout the prenatal period, participants reported positive experiences including compassionate HCWs, good communication, and continuity of care. During intrapartum, participants felt they were uninformed and unprepared for medical interventions. In addition, they wanted continuity of care between the prenatal and the intrapartum phases (i.e. the same healthcare worker from prenatal appointments as during labor), however, no participant experienced this. During postpartum, returning to work was reported as a challenge due to separation anxiety and difficulties maintaining a breastfeeding schedule.
For the prenatal group, the patient journey was compared between two participants who identified as White and Biracial. Both have had previous births, and the White participant had a chronic condition, whereas the Black participant did not. Differences were noted in HCW preference, proximity of prenatal clinic, number of appointments, and education received during appointments. Only the biracial participant specifically sought a HCW of similar racial/ethnic background. The White participant had fewer appointments up until 24 weeks, and only had their first prenatal appointment between 13-16 weeks due to lack of Medicaid insurance coverage. In addition, the length of appointments was typically between 16-30 minutes for both participants, however, the White participant travelled further to get to their appointments. During appointments, the White participant reported receiving more education during appointments than the Biracial participant such as their delivery plan, medications, and warning signs of complications. Both reported positive experiences during interactions with their HCWs such as the length and quality of appointments, their access to information, and overall satisfaction and trust in their HCW.
For the postpartum group, the patient journey was compared between two participants who identified as Black and Biracial. Both participants had previous births and chronic conditions. The Black participant was looking for a HCW of similar religious and racial/ethnic background, but this was not important to the Biracial participant. The Black participant had more prenatal appointments even though they both had chronic conditions, and both participants travelled a similar amount of time to get to their appointments. The Biracial participant had a birthing plan, whereas the Black participant did not. The Biracial participant reported a positive birthing experience because they were well-informed, treated fairly and respectfully by HCWs, and had a positive experience with pain management during labor and delivery. Conversely, the Black participant reported negative experiences at multiple points in their patient journey including perceived discrimination when being admitted to the hospital, challenges with intrapartum pain management, and lack of informed consent and shared decision-making during labor. Both participants missed their postpartum follow-up due to illness.
Conclusion
This study has revealed that many patients had positive experiences throughout their interactions during appointments with their healthcare workers, but some experienced challenges related to education and decision-making in medical interventions during labor, lacked continuity of care in the postpartum period from their prenatal care and faced mental health challenges. Examining the journey between participants of different race/ethnicities allowed us to identify opportunities for improvement to ensure all patients are receiving equitable, responsive care within the same health system. As this study only included 10 participants, further research should be conducted to investigate interventions and process improvements to improve continuity of care during the postpartum period and consent processes and provide resources to birthing people to focus on patient support and advocacy. Addressing these challenges can lead to more equitable, patient-centered safer maternal care for birthing people, and creates a valuable and user-friendly resource for healthcare workers and policy makers.
Event Type
Poster Presentation
TimeTuesday, April 14:45pm - 6:15pm EDT
LocationFrontenac Foyer