Selected Podcast
Ep. 7: Improving Maternal Health Equity
Roxanna Gapstur and her guest Carlos Roberts discuss maternal health equity.
Featuring:
Carlos Roberts, MD | Carlos Roberts, MD
Dr. Roberts currently serves as Vice-Chairman of the OB/Gyn Dept. at WellSpan York Hospital, President of the Medical Staff and WellSpan York Hospital, Director of Robotics & Minimally Invasive Surgery at WellSpan York Hospital, and as Co-Medical Director of the Women’s and Children’s Service Line for WellSpan Health. Dr. Roberts joined the WellSpan Medical Group in Sept. 2008. He completed a residency in obstetrics and gynecology at WellSpan York Hospital. Dr. Roberts earned his medical degree from Howard University College of Medicine in Washington, D.C. Transcription:
Michael Carrese (Host): Welcome to Inspiring Health, a series of conversations with Roxanna Gapstur and other WellSpan leaders about WellSpan 2025. I’m Michael Carrese and Roxanna what are we going to be talking about today?
Roxanna Gapstur: Today, we’re going to be talking about health equity, specifically as it relates to racial and ethnic disparities affecting birth and perinatal outcomes.
Host: And who is our special guest?
Roxanna: Our special guest today is Dr. Carlos Roberts. He is the Vice Chair of the OBGYN Department at WellSpan York Hospital. And also the Co-Medical Director of the Women and Children’s Service Line at WellSpan Health.
Host: Well welcome Dr. Roberts. We’re going to have Roxanna start. How about you define health equity for us?
Roxanna: Sure. Health equity is the attainment of the highest level of health for all people. And the only way to achieve that is by purposefully addressing avoidable inequalities. We talk about healthcare disparities which could be based on race, age, gender, ethnicity or language. So, it’s really important that we recognize disparities are not just simple differences but rather they are inequities that systematically and negatively affect less advantaged people.
Host: Now on one of the earlier episodes of the podcast, we talked about WellSpan’s journey to creating a more inclusive workplace. Is health equity related to that?
Roxanna: Yes, it is. Out inclusivity efforts and our health equity goals are really rooted in WellSpan’s mission. We really want to see the health of our communities improve. And so if we say that our mission is improving health for all, and our vision is to be a trusted partner and our core value is respect for all; then we really must do this work and do it well for our communities.
Host: So, what are some examples of how WellSpan is going about that?
Roxanna: Well I think in one of our other podcasts, we talked with Maria Royce about community benefit. Certainly our community benefit work touches on health equity but we’re also creating a quality management approach internally so that we can identify and analyze improvements in healthcare equity across populations. It’s really exciting work and something that requires a village really. So, we have an entire team that works on this. members from quality, data scientists, clinical improvement, service lines and clinical teams and medical group professionals who are all working together to identify opportunities for improvement.
Host: And has that team identified disparities in care?
Roxanna: Yes, actually we have. And we’re going to be talking about one of those disparities today. so, I’d like to ask Dr. Roberts to share with us a little bit more about some of the maternal healthcare disparities that we’ve identified that impact women not only nationally but here at WellSpan.
Carlos Roberts, MD, FACOG, FPMRS (Guest): Thank you Roxanna. Nationally, black women are three to four times more likely to die from some type of pregnancy related cause. And they have more than a two fold risk of severe maternal morbidity than white women. And racial and ethnic minority women especially, they experience more maternal deaths, comorbid illness and adverse perinatal outcomes than white women. In our service line, we have folks that work on this with us and we have data scientists that have helped us to look at our data and they were able to identify things that are increasing the risk for black women in our population as it relates to severe morbidity and maternal mortality.
Host: So, Dr. Roberts can you share a more specific maternal medical complication that black women experience more than others?
Dr. Roberts: So, after we evaluated the data that we have for our communities, we recognized that preeclampsia and eclampsia are the most significant risk factors for this subset of women. And when we compare black women to white women, black women are significantly at higher risk for these conditions. Furthermore, cardiovascular disease in addition to preeclampsia seems to be the leading cause of severe maternal morbidity and mortality and it really has been a focus of ours in our service line to help to reduce those disparities.
Host: What is preeclampsia?
Dr. Roberts: Preeclampsia is a hypertensive disorder that is specific to pregnancy. And there are some very specific hallmark signs of it that the care provider team would be looking for. And it also has some specific risk factors for the baby in addition to mom.
Host: So, now that WellSpan’s identified that disparity, what are you doing to address it?
Dr. Roberts: So, we’ve put together a multidisciplinary team which includes data analysts, as well as folks in quality and we have members from the Women’s and Children’s Service Line and other clinical experts and we’ve made significant first steps to address the disparity and to work to eliminate the preventable maternal mortality and severe morbidity across WellSpan and our communities and we’ve done this by trying to identify black women who are at moderate risk for preeclampsia and what we’re doing is recommending low dose aspirin therapy which when we look at the literature; it seems to reduce the risk of developing preeclampsia. We’re trying to standardize that care among all patients to help to reduce the risk of preeclampsia. And we also introduced some safety bundles which we know will help to reduce the time around delivery, reducing that risk of hypertension and also reduce the risk of hypertension later in life after the delivery.
Host: So, you mentioned these were just the first steps. What did you mean when you said that?
Dr. Roberts: So, there are many constraints to addressing maternal health equity, not just at WellSpan but nationally. Our efforts to eliminate these disparities in maternal health are constrained by the lack of reliable data and also there’s a challenge with trying to identify people by their correct demographics and some of that has to do with how that data is reported and recorded. So, we’re trying to educate our staff and trying to get more consistency in the accuracy of that recording and reporting of that demographic information. And we’re also trying to educate our workforce about their own biases when it comes to understanding these conditions, not from their own perspective but from the perspective of those patients who we know are at severe risk and we’re treating differently because of those biases.
Host: Now Roxanna, we’ve talked about implicit bias before, haven’t we?
Roxanna: Yes, we did Michael. We talked about it when Kim Brister was a guest here on Diversity and Inclusion. And we know that WellSpan’s actively redesigning our implicit bias training. So, understanding our own biases is really the first step in being able to help the team and our patients and every member of our community and so to Dr. Roberts earlier point, we are also providing education for our team members to ensure that they have accurate patient information and they understand why we are collecting that information on our patients. And then as our patients come in, helping them understand the purpose of why we are asking them for additional data, particularly important for people of color and some of our other populations that may have experienced exploitation in research. So, we really want to help them understand that the purpose for collecting this information is to help improve health equity and outcomes in every population and that we really want to provide care for all in our communities.
I’ve also got some quality improvement projects that are being designed that can help us in both hospital and outpatient settings. We assess our gaps in knowledge on certain race, ethnicity and language data collection and we target our education and interventions to those. The team working on our maternal health equity goal has partnered with Care Management to screen for social determinants as well which we addressed in one of our other podcasts. We know how important social determinants are for people’s health and we can track some of these things now through our Baby Scripts app which is just a fantastic way of having a remote connection to the obstetrician’s office. And we can integrate social service referrals in that electronic manner, so we have a lot of tools at our fingertips to be able to help with this health equity work.
Host: So, as we wrap up let’s get into how WellSpan employees can help to improve maternal health equity and Dr. Roberts, let’s start with you. What do you think?
Dr. Roberts: We need to listen better as doctors and healthcare workers, and we have to listen through the lens of the patient and the implicit bias training that we will be implementing I think that would help us to bridge that gap and trying to understand patients better. Black women often feel they are not being heard when they raise concerns about certain aspects of their care. And we also need to get better at communicating the warning signs of cardiovascular conditions to pregnant women and post-partum women so they can identify these problems early and seek timely treatment so that we can help to reduce their risks.
Host: Roxanna, what would you add to that?
Roxanna: Well I agree with Dr. Roberts. I think he made a really good point there being a better listener and understanding our own implicit biases will be very helpful to our communities and our patients. I would recommend to our employees that you take an implicit bias test online. We’ve actually posted some of those on our website. They are at www.wellspan.org/blindspot and it links to Project Implicit Organization’s website. So, take the test. Understand your own implicit biases and think about how you could interrupt those biases at times as you are working with our patients and families. We serve a very diverse community across our geography and we want to make sure that we’re providing safe, respectful and inclusive care for everyone.
Host: That’s Roxanna Gapstur. You’ve been listening to her and her special guest Dr. Carlos Roberts today on Inspiring Health, a series of conversations with Roxanna and other WellSpan leaders about WellSpan 2025. Thanks for listening.
Michael Carrese (Host): Welcome to Inspiring Health, a series of conversations with Roxanna Gapstur and other WellSpan leaders about WellSpan 2025. I’m Michael Carrese and Roxanna what are we going to be talking about today?
Roxanna Gapstur: Today, we’re going to be talking about health equity, specifically as it relates to racial and ethnic disparities affecting birth and perinatal outcomes.
Host: And who is our special guest?
Roxanna: Our special guest today is Dr. Carlos Roberts. He is the Vice Chair of the OBGYN Department at WellSpan York Hospital. And also the Co-Medical Director of the Women and Children’s Service Line at WellSpan Health.
Host: Well welcome Dr. Roberts. We’re going to have Roxanna start. How about you define health equity for us?
Roxanna: Sure. Health equity is the attainment of the highest level of health for all people. And the only way to achieve that is by purposefully addressing avoidable inequalities. We talk about healthcare disparities which could be based on race, age, gender, ethnicity or language. So, it’s really important that we recognize disparities are not just simple differences but rather they are inequities that systematically and negatively affect less advantaged people.
Host: Now on one of the earlier episodes of the podcast, we talked about WellSpan’s journey to creating a more inclusive workplace. Is health equity related to that?
Roxanna: Yes, it is. Out inclusivity efforts and our health equity goals are really rooted in WellSpan’s mission. We really want to see the health of our communities improve. And so if we say that our mission is improving health for all, and our vision is to be a trusted partner and our core value is respect for all; then we really must do this work and do it well for our communities.
Host: So, what are some examples of how WellSpan is going about that?
Roxanna: Well I think in one of our other podcasts, we talked with Maria Royce about community benefit. Certainly our community benefit work touches on health equity but we’re also creating a quality management approach internally so that we can identify and analyze improvements in healthcare equity across populations. It’s really exciting work and something that requires a village really. So, we have an entire team that works on this. members from quality, data scientists, clinical improvement, service lines and clinical teams and medical group professionals who are all working together to identify opportunities for improvement.
Host: And has that team identified disparities in care?
Roxanna: Yes, actually we have. And we’re going to be talking about one of those disparities today. so, I’d like to ask Dr. Roberts to share with us a little bit more about some of the maternal healthcare disparities that we’ve identified that impact women not only nationally but here at WellSpan.
Carlos Roberts, MD, FACOG, FPMRS (Guest): Thank you Roxanna. Nationally, black women are three to four times more likely to die from some type of pregnancy related cause. And they have more than a two fold risk of severe maternal morbidity than white women. And racial and ethnic minority women especially, they experience more maternal deaths, comorbid illness and adverse perinatal outcomes than white women. In our service line, we have folks that work on this with us and we have data scientists that have helped us to look at our data and they were able to identify things that are increasing the risk for black women in our population as it relates to severe morbidity and maternal mortality.
Host: So, Dr. Roberts can you share a more specific maternal medical complication that black women experience more than others?
Dr. Roberts: So, after we evaluated the data that we have for our communities, we recognized that preeclampsia and eclampsia are the most significant risk factors for this subset of women. And when we compare black women to white women, black women are significantly at higher risk for these conditions. Furthermore, cardiovascular disease in addition to preeclampsia seems to be the leading cause of severe maternal morbidity and mortality and it really has been a focus of ours in our service line to help to reduce those disparities.
Host: What is preeclampsia?
Dr. Roberts: Preeclampsia is a hypertensive disorder that is specific to pregnancy. And there are some very specific hallmark signs of it that the care provider team would be looking for. And it also has some specific risk factors for the baby in addition to mom.
Host: So, now that WellSpan’s identified that disparity, what are you doing to address it?
Dr. Roberts: So, we’ve put together a multidisciplinary team which includes data analysts, as well as folks in quality and we have members from the Women’s and Children’s Service Line and other clinical experts and we’ve made significant first steps to address the disparity and to work to eliminate the preventable maternal mortality and severe morbidity across WellSpan and our communities and we’ve done this by trying to identify black women who are at moderate risk for preeclampsia and what we’re doing is recommending low dose aspirin therapy which when we look at the literature; it seems to reduce the risk of developing preeclampsia. We’re trying to standardize that care among all patients to help to reduce the risk of preeclampsia. And we also introduced some safety bundles which we know will help to reduce the time around delivery, reducing that risk of hypertension and also reduce the risk of hypertension later in life after the delivery.
Host: So, you mentioned these were just the first steps. What did you mean when you said that?
Dr. Roberts: So, there are many constraints to addressing maternal health equity, not just at WellSpan but nationally. Our efforts to eliminate these disparities in maternal health are constrained by the lack of reliable data and also there’s a challenge with trying to identify people by their correct demographics and some of that has to do with how that data is reported and recorded. So, we’re trying to educate our staff and trying to get more consistency in the accuracy of that recording and reporting of that demographic information. And we’re also trying to educate our workforce about their own biases when it comes to understanding these conditions, not from their own perspective but from the perspective of those patients who we know are at severe risk and we’re treating differently because of those biases.
Host: Now Roxanna, we’ve talked about implicit bias before, haven’t we?
Roxanna: Yes, we did Michael. We talked about it when Kim Brister was a guest here on Diversity and Inclusion. And we know that WellSpan’s actively redesigning our implicit bias training. So, understanding our own biases is really the first step in being able to help the team and our patients and every member of our community and so to Dr. Roberts earlier point, we are also providing education for our team members to ensure that they have accurate patient information and they understand why we are collecting that information on our patients. And then as our patients come in, helping them understand the purpose of why we are asking them for additional data, particularly important for people of color and some of our other populations that may have experienced exploitation in research. So, we really want to help them understand that the purpose for collecting this information is to help improve health equity and outcomes in every population and that we really want to provide care for all in our communities.
I’ve also got some quality improvement projects that are being designed that can help us in both hospital and outpatient settings. We assess our gaps in knowledge on certain race, ethnicity and language data collection and we target our education and interventions to those. The team working on our maternal health equity goal has partnered with Care Management to screen for social determinants as well which we addressed in one of our other podcasts. We know how important social determinants are for people’s health and we can track some of these things now through our Baby Scripts app which is just a fantastic way of having a remote connection to the obstetrician’s office. And we can integrate social service referrals in that electronic manner, so we have a lot of tools at our fingertips to be able to help with this health equity work.
Host: So, as we wrap up let’s get into how WellSpan employees can help to improve maternal health equity and Dr. Roberts, let’s start with you. What do you think?
Dr. Roberts: We need to listen better as doctors and healthcare workers, and we have to listen through the lens of the patient and the implicit bias training that we will be implementing I think that would help us to bridge that gap and trying to understand patients better. Black women often feel they are not being heard when they raise concerns about certain aspects of their care. And we also need to get better at communicating the warning signs of cardiovascular conditions to pregnant women and post-partum women so they can identify these problems early and seek timely treatment so that we can help to reduce their risks.
Host: Roxanna, what would you add to that?
Roxanna: Well I agree with Dr. Roberts. I think he made a really good point there being a better listener and understanding our own implicit biases will be very helpful to our communities and our patients. I would recommend to our employees that you take an implicit bias test online. We’ve actually posted some of those on our website. They are at www.wellspan.org/blindspot and it links to Project Implicit Organization’s website. So, take the test. Understand your own implicit biases and think about how you could interrupt those biases at times as you are working with our patients and families. We serve a very diverse community across our geography and we want to make sure that we’re providing safe, respectful and inclusive care for everyone.
Host: That’s Roxanna Gapstur. You’ve been listening to her and her special guest Dr. Carlos Roberts today on Inspiring Health, a series of conversations with Roxanna and other WellSpan leaders about WellSpan 2025. Thanks for listening.