# A Systems Investigation of Maternal Care

> **NIH AHRQ R03** · MEDICAL UNIVERSITY OF SOUTH CAROLINA · 2021 · $100,000

## Abstract

PROJECT SUMMARY
Despite having the most expensive maternity care in the world, the maternal mortality rate (MMR) in the US
increased to 16.9 deaths per 100,000 live births in 2017, with estimates as high as 26.4 in 2015. For every
maternal death there are 50 - 100 cases of severe maternal morbidity (SMM) and this rate has also increased
sharply – rising 45% between 2006 and 2015. Women of color are more likely to suffer mortality and SMM;
Black women are 3 to 4 times more likely to die from pregnancy-related causes than white women. Maternal
mortality and SMM cost billions of dollars each year. However, 45 – 60% of all maternal deaths and SMM are
preventable with timely and appropriate care. Thus, disparities in mortality and SMM are not only related to
individual-level variables but also to multilevel contributors, which suggests that there are opportunities to
improve health service quality. Examination of the structures and processes of care would help uncover
challenges in the clinical systems that contribute to poor maternal care and disparities and identify also
features of the system of care that are amenable to interventions. Despite 20 years of systems research in
healthcare, few studies have examined the contribution of clinical systems to adverse outcomes and disparities
in maternal care. Initial observations in the maternal care units - antepartum, labor and delivery (L&D), and
postpartum - and review of patient safety incidences identified a range of systems issues such as
understaffing, extensive use of inexperienced contract nurses, missing equipment and supplies, and
malfunctioning equipment, that impacted patient care. Preliminary analysis of 19 months of administrative data
found that the hospital’s L&D unit delivered 4,057 patients, an average of 225.39 patients each month, and the
cesarean delivery rate was 38%. There were 45 readmissions during this period, 15 recorded cases of SMM
(hemorrhage, hysterectomy, and abscess) and one maternal death. This data was not disaggregated by race.
This research proposes a mixed methods approach to investigate systems safety and equity by conducting a
prognostic risk assessment and examining distributions of incidents as a preliminary assessment of disparate
care. This research will describe, in more detail than has ever been available before, how the clinicians
delivering maternal care are predisposed to success or failure by the design of the work system and offer a
reasonable approximations of disparate quality of care in the health system. Specifically, the following three
aims will be conducted: AIM 1: Develop a sociotechnical systems model of maternal care using a work
systems analysis; AIM 2: Examine risks in maternal care units using patient safety incident reports; and AIM 3:
Identify sociotechnical factors contributing to disparities in adverse events in maternal care. This research
coalesce patient safety and disparities efforts to generate and test hypotheses that will ultimate...

## Key facts

- **NIH application ID:** 10218800
- **Project number:** 1R03HS027680-01A1
- **Recipient organization:** MEDICAL UNIVERSITY OF SOUTH CAROLINA
- **Principal Investigator:** Dulaney A. Wilson
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $100,000
- **Award type:** 1
- **Project period:** 2021-09-30 → 2023-03-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10218800

## Citation

> US National Institutes of Health, RePORTER application 10218800, A Systems Investigation of Maternal Care (1R03HS027680-01A1). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10218800. Licensed CC0.

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