UAB – committed to addressing health disparities, maternal mortality – responds to AP

On May 22, 2023, the Associated Press posted a story that inaccurately characterized the University of Alabama at Birmingham's institutional role as it relates to the very real challenges in health disparities and maternal health across the nation and in Alabama. UAB made addressing health disparities and improving maternal mortality a priority years ago and is a local, state and national leader in making positive change. 

We believe it is important for our patients, employees and other stakeholders to know more about UAB’s work in this important area and to have access to the information we provided to the publication.

These are the questions UAB was asked for the story:

1. Can you specifically address or share how UAB is working to ensure it is delivering equitable care -- especially through the lens of how the state (like most of the country) is currently dealing with a Black maternal mortality crisis.
2. What are the avenues available for birthing patients or their partners to file complaints or seek help if they feel they are experiencing racism or discrimination? 
3. Do you have any sort of internal tracking mechanism that allows you to capture complaints filed by patients who specifically allege they faced discrimination or racism? If so, can you share how many complaints you receive on a yearly basis that cite discrimination and/or racism and bias? 
4. I see the hospital system has a chief diversity officer who was appointed in 2021. What are the responsibilities of his role and how does that include addressing bias or racism in medicine? Is that a key tenet of this role?
5. Since creating this role, has UAB realized any tangible successes in improving its care?

This is UAB’s full response provided to the reporter on May 2, 2023: 

The University of Alabama at Birmingham and UAB Medicine maintain intentional, proactive efforts in addressing health disparities and maternal mortality — not just at UAB, but across Alabama and beyond. While patient privacy laws limit our ability to comment publicly on an individual’s care, the following answers your questions and provides important information and context.  

UAB Hospital is the eighth-largest hospital in the United States and welcomes almost 2 million patient visits a year (35 percent of patients were Black in FY22; Alabama’s Black population is roughly 27 percent). UAB Hospital is the only American College of Surgeons-recognized Level I trauma center in Alabama — our case mix index is among the highest in the nation (i.e., we care for patients who are among the highest acuity, most complex and sickest). 

As you know, Alabama has high rates of medical comorbidities — including diabetes, high blood pressure and heart disease — which complicate risks and add to complexity of care. As the most advanced hospital in Alabama, UAB strives daily to provide the highest-quality health care to all our patients, including the most vulnerable.  

UAB is a state and national leader in maternal mortality initiatives, is committed to a transparent and open dialogue with the patient and their family to answer questions and address any concerns and give them opportunities to raise concerns, and has long been a champion of diversity, equity and inclusion, and is a leader in addressing health disparities. 

Here are some key results:

• UAB Hospital’s Department of Obstetrics and Gynecology collected 1,309 Mothers on Respect Index (MORi) surveys (see attached) in 2022, where patients were asked 14 questions about their care. Patients were asked to score each response from 1 to 6, with 1 representing “feelings of low respect” from caregivers and 6 representing “feelings of high respect” from caregivers. Of the 1,309 completed MORi surveys, 708 (57%) responses came from Black or African American women, and the average total score from all questions was 75.4 out of a possible 84 points (~90th percentile) — a number which indicates that our Black or African American patients are largely feeling respected. 
• UAB Hospital was rated as “high-performing”— the highest level possible — in the 2022-2023 U.S. News & World Report Best Hospitals for Maternity Care rankings. 
• UAB’s Department of Obstetrics and Gynecology programs were ranked No. 5 in the nation in the 2022 U.S. News & World Report survey, which evaluated obstetrics and gynecology programs at 233 United States hospitals.
• UAB received nine 2023 Women’s Choice Awards designations — which represent the top 10 percent of hospital practices nationally — for women’s health practice areas, including Obstetrics. Best Hospital designations were awarded based on the hospital’s achievement in clinical excellence and patient experience and satisfaction.

UAB is a state and national leader in maternal mortality initiatives — here are few key examples of our intentional investments: 

• The UAB Medicine Community Health Equity service line was created in 2021, dedicated to addressing underlying economic and social inequities that affect community health outcomes, and Verlon Salley, MHA, was named VP of Community Health Equity. 
• UAB’s Martha Wingate, DrPH, directs the Alabama Maternal Health Task Forcecreated to improve maternal health across Alabama.
• UAB’s Rachel Sinkey, M.D., helped found (with the Alabama Department of Public Health) and chaired the Maternal Mortality Review Committee, which examines each maternal death to learn about causes and contributing factors (2016 Report, 2020 Report).
• Obstetrics and Gynecology Assistant Professor and Residency Program Director Audra Williams, M.D., educates and leads training sessionson Black maternal health and disparities in care.
• The Department of Obstetrics and Gynecology holds a quarterly health equity conference that focuses on the social determinants of health and how they affected care and patient’s outcomes here at UAB Hospital. 
• UAB Hospital provides Implicit Bias Trainingto staff, including nurses, providers and everyone who work in labor and delivery.
• We introduced full-time perinatal nurse navigators to our prenatal system. All patients are immediately connected with a perinatal nurse the moment they call UAB to establish prenatal care. These nurses identify patients with higher-risk pregnancies and guide them.
• We have a protocol for managing hypertensive emergencies in pregnancies, which is one of the biggest contributors to maternal mortality. 
• We have created the UABaby birth journey program, which empowers our OB patients to make decisions regarding their birth journey based on their wishes. 
• UAB is leading an NIH study of a single-dose antibiotic to prevent maternal sepsis and death.
• Just last week, Alan Tita, M.D., the Mary Heersink Endowed Chair of Global Health and professor of OB/Gyn, was recognized with the National Clinical Excellence Award from the Clinical Research Forum for his landmark study on treating hypertension in pregnancy. 
• Our work with rural hospitals in Alabama has helped Whitfield Regional Hospital in Demopolis, Ala., re-open OB services in 2022 after being closed for eight years. The Alabama Rural Health Collaborative and SimUAB® Mobile Simulation Lab helped to make this possible. 
• A team from the Center for Women’s Reproductive Health at UAB is serving as the coordinating center for a national network, leveraging expertise to help train the next generation of pregnancy health equity researchers, providing consultation and guidance, compiling data reports, and coordinating the administration of the initiative.
• UAB faculty is leading the P3Providing an Optimized and emPowered Pregnancy for You (P3OPPY) study to evaluate promising interventions to reduce disparities and improve health care access and quality among pregnant women and their infants from historically marginalized communities. 

We are committed to a transparent and open dialogue with the patient and their family to answer questions and address any concerns and give them opportunities to raise concerns. There are many opportunities for patients to raise concerns about their care, including:

• Upon admission to UAB Hospital, all patients in MEU, Mother-Baby and High-Risk Obstetrics receive a printed UAB Medicine welcome guidebooklet that includes instructions on how to provide feedback and a Patient Bill of Rights. The UAB Medicine Patient and Visitor Guide booklet is also posted online. 
• Signs directing patients who to connect with if they have issues with their care are prominently displayed in our Maternity Evaluation Unit, Mother-Baby Unit and High-Risk Obstetrics Unit:
• If a patient voices any complaint or concern to a member of their care team, the provider immediately informs the patient how to contact a trained patient advocate.
• We send digital surveys to patients post-discharge.
• Nurses and nurse leaders round on patient floors to encourage real-time dialogue about the care experience.
• The UAB Hotline allows people — including patients — to anonymously submit concerns via online form or phone.  
• The following is from a webpage dedicated to directing patients to share concerns:
  • Where should I direct any concerns or grievances? If you have issues with any aspect of your care, feel free to address them using any or all of the following resources: Contact Guest Services by dialing *55 on any in-house telephone or calling 205-934-CARE (2273). If you have a problem or complaint, you may talk with your health care team to resolve the problem. If unresolved, you have the following contact options:
  • Contact Guest Services to request assistance from a patient advocate by dialing *55 from an in-house phone or 205-934-CARE (2273).
  • Send a written letter of unresolved grievance to: UAB Hospital/Ambulatory Clinics, Chief Operating Officer, Suite 502, 500 22nd Street South, Birmingham, AL 35233

UAB tracks patient concerns and takes any complaint from any patient seriously; we follow up on every complaint. Regardless of the nature of the complaint, we connect with all of those involved and make every effort to resolve the situation. 

In addition to maternal care, UAB has long been a champion of diversity, equity and inclusion, and is a leader in addressing health disparities. Here are just a few among many examples:  

• UAB’s Minority Health and Health Equity Research Centerhas long provided a critical connection between investigators and vulnerable populations. Our research and training programs enable young scientists to pursue research on health disparities, while our community outreach program addresses urgent health questions and needs. 
• When COVID hit, UAB focused effortsto educate and care for communities of color. When Black Alabamians were underrepresented in vaccine uptake statewide, UAB’s mass vaccine sites’ data showed almost 30 percent of those vaccinated by UAB were Black (~27  percent of Alabamians are Black). UAB Heersink School of Medicine Dean (at the time) Selwyn Vickers, M.D., helped educate people of color to encourage vaccinations (e.g., Black dean of UAB School of Medicine able to discuss COVID health inequities, vaccine hesitancy in minority populations). 
• UAB has invested millions of dollars in its Grand Challenge, Live HealthSmart Alabama, a transformational movement to make good health simple for all Alabamians, addressing determinants.  
• UAB has performed more kidney transplants in Black patients than any hospital in the world. 
• UAB is consistently recognized for diversity, equity and inclusion efforts, including being named Forbes’ No. 1 Employer for Diversity among colleges and universities in 2021, and we are consistently listed among the few Diversity Champions nationally by Insight into Diversity.  

Chief Diversity Officer

As you see from the information above, diversity, equity and inclusion, and health disparities efforts at UAB and UAB Medicine are a team effort in which our faculty, physicians, researchers and staff aggressively work to improve care for our patients and people around the world. Andre Lessears, MBA, was appointed as chief diversity officer in 2021, but this is not a new position. Prior to then, the position was held by Deborah Grimes, who is now the senior vice president and chief diversity officer at Ochsner Health.