(467) Maternal Morbidity Disparities Amongst Native Hawaiian and Pacific Islander Populations Following Implementation of Safety Bundles

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Deepraj K. Pawar, MD

Resident Physician
University of Hawaii
Honolulu, HI, United States

Coauthor(s)

MT

Mary Tschann, PhD

University of Hawaii, John Burns School of Medicine
Honolulu, Hawaii, United States
JK

Julie Kathman, DNP

Health Association of Hawaii
Honolulu, Hawaii, United States
RD

Rebecca Delafield, PhD

University of Hawaii, Manoa
Honolulu, Hawaii, United States
PT

Pai-Jong Stacy Tsai, MD, MPH

University of Hawaii, John Burns School of Medicine
Honolulu, Hawaii, United States

Objective: The Alliance for Innovation on Maternal Health (AIM) has developed evidence-based patient safety bundles (PSB) to decrease severe maternal morbidity (SMM) for several obstetric outcomes including hemorrhage, severe hypertension, and sepsis. Ten of 12 hospitals with birthing facilities in Hawaii adopted AIM PSB in 2021. With evidence of racial disparity among SMM, there is limited data on Native Hawaiian and Pacific Islander people. Our goal was to examine racial and ethnic differences in SMM among OB hemorrhage cases since the implementation of AIM PSB in Hawaii.

Study Design: We abstracted AIM SBP data from the AIM Data Center, and stratified SMM among OB hemorrhage (excluding ectopic pregnancy and spontaneous abortion) by patient race and year. The groups reported were those with 5 or more incidence of hemorrhage in any given year: Japanese, Filipino, Native Hawaiian, Micronesian, Other Polynesian, Non-Hispanic White, and Hispanic.

Results: From 2016 to 2023, 9545 deliveries were included. Micronesian patients had the highest average SMM rates among OB hemorrhage (27.1%, Table 1), then Other Polynesian (22.7%) and Hispanic (22.1 %) patients. Japanese patients had the lowest rate (18.7%). By year, Micronesian patients had a 30.4% and 32.3% SMM rate in 2020 and 2021, respectively, to 20.2% by 2023 (Graph 1) . Similarly, patients identifying as Other Polynesian had a 38.6%, 22.8%, and 25% SMM rate from 2019-2021, to 14.9% and 18.9% in 2022 and 2023. Native Hawaiian patients had a SMM rate of 20.4% in 2021, 18.7% in 2022, and 22.1% in 2023.

Conclusion: Micronesian and Polynesian patients experienced clinically significant reduction in SMM among OB hemorrhage after the implementation of AIM PSB in 2021. Native Hawaiian patients did not experience a similar decrease. Native Hawaiian and Pacific Islanders are overrepresented in Hawaiʻi's birthing population compared to the general population, but experience worse outcomes relative to other racial groups. Further studies are warranted to investigate why select populations may benefit from these interventions and how we might provide more equitable care.