(329) An “Equity in Labor Outcomes Dashboard”: a 3-phase participatory mixed-methods approach to development

Equity dashboards, showing individual clinician outcomes by patient race, may confront clinicians with their own care disparities, driving change. Here, we aimed to develop an acceptable obstetric Equity Dashboard.

Study Design:

This 3 phase participatory mixed-methods study developed an Equity in Labor Outcomes Dashboard. In Phase 1, focus groups of obstetric clinicians were divided into nurses, trainees, and attending physicians at 2 sites, to understand: (1) experience with and perspectives on receiving individualized feedback on patient outcomes by race, (2) outcome attribution in a shift- and team-based labor unit, (3) which outcomes to include, (4) ideal distribution method and frequency, and (5) potential impact on care. Transcripts were coded using a structured approach with high inter-rater reliability (k >0.8).  Phase 2 convened a multidisciplinary committee to synthesize Phase 1 results and develop a draft Dashboard. Phase 3 surveyed clinicians at the same sites to critically optimize the draft.

Results:

In Phase I (1/2023), 5 focus groups (n=18) were conducted, including nurses, CNMs, OBGYN, family medicine, and MFMs. Most had never received individual outcome feedback before (Table 1).  While participants found receiving individual data by patient race  “potentially uncomfortable,” it was also highly desired. Participants recommended an outcome be attributed to a given clinician if there were “meaningful patient interactions” [e.g. writing a note during labor and/or delivery participation]. Recommended outcomes included cesarean, ICU, hemorrhage, and patient-centered outcomes like birth trauma. Clinicians requested to receive the Dashboard with individual outcomes compared to unit averages by email q4 months alongside a disparity reduction toolkit for actionable response. Phase 2 (4/2023) developed a draft Dashboard. 85 clinicians completed the Phase 3 survey (8-10/2023; Table 2), with high acceptability, affirming Phase 2’s design.

Conclusion:

This work generated an Equity in Labor Outcomes Dashboard acceptable to clinicians. Its potential to drive reduced disparities should be tested.