1 00:00:00,160 --> 00:00:02,480 This is Rosie Talaga with the Becker's Healthcare 2 00:00:02,480 --> 00:00:02,980 podcast. 3 00:00:03,520 --> 00:00:05,620 I'm thrilled today to be joined by Melissa 4 00:00:05,679 --> 00:00:09,199 Hassler, director of certified nurse midwifery at Fairview 5 00:00:09,199 --> 00:00:09,939 Health Services. 6 00:00:10,320 --> 00:00:11,919 Melissa, it's a pleasure to have you on 7 00:00:11,919 --> 00:00:12,980 the podcast today. 8 00:00:13,414 --> 00:00:15,734 Thanks, Rosie. Glad to be here. We have 9 00:00:15,734 --> 00:00:18,614 a super important and interesting conversation in store 10 00:00:18,614 --> 00:00:21,015 where we're gonna dive into black maternal health 11 00:00:21,015 --> 00:00:24,454 crisis, what's driving disparities in care, and how 12 00:00:24,454 --> 00:00:27,355 mHealth Fairview is working to create more equitable 13 00:00:27,414 --> 00:00:28,714 outcomes for all patients. 14 00:00:29,390 --> 00:00:30,989 Before we get into it, Melissa, can you 15 00:00:30,989 --> 00:00:32,670 please introduce yourself and just tell us a 16 00:00:32,670 --> 00:00:33,729 bit about your background? 17 00:00:34,189 --> 00:00:35,090 Sure. Absolutely. 18 00:00:35,630 --> 00:00:38,189 So I'm, Melissa Hassler. I'm a certified nurse 19 00:00:38,189 --> 00:00:40,270 midwife. I've been in practice for twenty one 20 00:00:40,270 --> 00:00:41,054 years now, 21 00:00:41,615 --> 00:00:44,414 and I actually have been in practice at 22 00:00:44,414 --> 00:00:46,655 Fairview that whole time. So I, 23 00:00:47,054 --> 00:00:49,375 have had a really wonderful experience with the 24 00:00:49,375 --> 00:00:51,215 health care system and had the opportunity to 25 00:00:51,215 --> 00:00:53,375 really get to know some of the really 26 00:00:53,375 --> 00:00:55,509 wonderful things that that system is doing in 27 00:00:55,509 --> 00:00:57,130 our state of Minnesota. So, 28 00:00:57,509 --> 00:00:59,369 I am in full clinical practice, 29 00:00:59,750 --> 00:01:02,549 and also have an administrative role. So get 30 00:01:02,549 --> 00:01:03,129 the opportunity 31 00:01:03,429 --> 00:01:04,090 to really, 32 00:01:04,790 --> 00:01:07,515 tie together what happens in clinical practice and 33 00:01:07,515 --> 00:01:09,755 what we're actually doing within our health care 34 00:01:09,755 --> 00:01:11,775 system to support optimal outcomes, 35 00:01:12,314 --> 00:01:13,534 specifically for 36 00:01:13,995 --> 00:01:15,375 pregnant people and 37 00:01:15,755 --> 00:01:18,094 birthing people in our state. 38 00:01:19,034 --> 00:01:20,715 That's wonderful. Thank you so much for the 39 00:01:20,715 --> 00:01:21,215 introduction. 40 00:01:21,880 --> 00:01:25,640 It's, particularly important and interesting that you have 41 00:01:25,640 --> 00:01:28,140 both the clinical practice side and the administrative 42 00:01:28,359 --> 00:01:30,280 role to really, like you said, tie the 43 00:01:30,280 --> 00:01:30,939 two together. 44 00:01:31,400 --> 00:01:32,299 Yeah. Exactly. 45 00:01:32,920 --> 00:01:35,400 It's really you know, it's one thing to 46 00:01:35,400 --> 00:01:36,200 sort of hear, 47 00:01:37,454 --> 00:01:40,414 talking points about what is happening in maternal 48 00:01:40,414 --> 00:01:42,914 health, but to be able to actually experience 49 00:01:42,974 --> 00:01:45,694 it both with the patients and also the 50 00:01:45,694 --> 00:01:46,194 providers, 51 00:01:46,655 --> 00:01:48,734 the obstetricians and the midwives that I support 52 00:01:48,734 --> 00:01:51,489 within our system, really figuring out what are 53 00:01:51,489 --> 00:01:53,250 we doing, and are we doing the best 54 00:01:53,250 --> 00:01:54,849 we can, and how can we structure our 55 00:01:54,849 --> 00:01:55,349 system 56 00:01:55,650 --> 00:01:57,349 to actually support and improve 57 00:01:57,730 --> 00:02:00,450 maternal health. There is absolutely no question we 58 00:02:00,450 --> 00:02:02,530 have a maternal health crisis in our entire 59 00:02:02,530 --> 00:02:04,390 nation. It is a problem, 60 00:02:04,994 --> 00:02:06,994 and it has been sort of there's been 61 00:02:06,994 --> 00:02:07,655 a rising 62 00:02:08,034 --> 00:02:09,175 swell of awareness, 63 00:02:10,034 --> 00:02:12,275 particularly over the past five years. But now 64 00:02:12,275 --> 00:02:13,814 we're really at a point where 65 00:02:14,194 --> 00:02:16,514 we see it. We know it's there. What 66 00:02:16,514 --> 00:02:18,114 are we gonna do about it? And how 67 00:02:18,114 --> 00:02:19,735 do we, within our health care 68 00:02:20,700 --> 00:02:23,300 system, structure our tools and our resources to 69 00:02:23,300 --> 00:02:25,099 help try and make an impact in that, 70 00:02:25,819 --> 00:02:26,639 maternal health 71 00:02:26,939 --> 00:02:27,439 crisis? 72 00:02:28,379 --> 00:02:31,099 That's really powerful. Thank you. And I'd like 73 00:02:31,099 --> 00:02:32,939 to talk more about that crisis. 74 00:02:33,525 --> 00:02:36,004 Such an important call out, especially coming off 75 00:02:36,004 --> 00:02:36,584 the heels 76 00:02:36,884 --> 00:02:39,044 of black maternal health week, which is an 77 00:02:39,044 --> 00:02:41,465 important moment for reflection and in the community. 78 00:02:42,245 --> 00:02:44,884 First, what is the black maternal health crisis 79 00:02:44,884 --> 00:02:47,305 in The US, and what factors are contributing 80 00:02:47,444 --> 00:02:48,104 to this? 81 00:02:49,290 --> 00:02:50,810 So in 2023, 82 00:02:50,810 --> 00:02:53,550 the maternal mortality rate in The US overall 83 00:02:53,689 --> 00:02:57,469 was about eighteen point six deaths per 100,000 84 00:02:57,530 --> 00:02:58,349 live births. 85 00:02:58,730 --> 00:03:02,110 That's quite high, particularly for a developed nation. 86 00:03:02,330 --> 00:03:04,189 And then when we break it down further, 87 00:03:04,935 --> 00:03:07,574 people who identify as black, that mortality rate 88 00:03:07,574 --> 00:03:10,534 is even higher. It's fifty point three deaths 89 00:03:10,534 --> 00:03:11,894 per 100,000 90 00:03:11,894 --> 00:03:13,675 live births in 2023. 91 00:03:13,735 --> 00:03:16,634 That's more than double the national rate. 92 00:03:17,250 --> 00:03:17,989 That is 93 00:03:18,610 --> 00:03:19,269 a problem. 94 00:03:19,729 --> 00:03:21,989 That is a stark reminder 95 00:03:22,289 --> 00:03:24,930 that we are not actually getting to the 96 00:03:24,930 --> 00:03:26,870 root of the problem of 97 00:03:27,329 --> 00:03:28,310 maternal mortality 98 00:03:28,769 --> 00:03:31,250 and then also identifying the fact that there 99 00:03:31,250 --> 00:03:34,074 have to be some factors that are contributing 100 00:03:34,134 --> 00:03:34,794 to that, 101 00:03:35,734 --> 00:03:38,715 increasing rates and very high rate for particularly 102 00:03:39,014 --> 00:03:40,555 black and brown birthing people. 103 00:03:41,814 --> 00:03:44,794 Absolutely. That is, like you said, a tragic 104 00:03:45,319 --> 00:03:48,760 tragic crisis that the black maternal mortality rate 105 00:03:48,760 --> 00:03:50,599 will be more than double the national rate. 106 00:03:50,599 --> 00:03:52,919 And like you said, that that does mean 107 00:03:52,919 --> 00:03:54,680 that there are factors contributing to this. This 108 00:03:54,680 --> 00:03:57,639 doesn't just happen naturally. So like I was 109 00:03:57,639 --> 00:03:59,879 saying, what are some of those factors that 110 00:03:59,879 --> 00:04:00,200 you, 111 00:04:01,025 --> 00:04:03,025 think are some of the highest causes for 112 00:04:03,025 --> 00:04:03,525 this? 113 00:04:04,625 --> 00:04:06,784 So there are a lot it's a very 114 00:04:06,784 --> 00:04:08,325 complex and complicated 115 00:04:09,265 --> 00:04:09,765 problem. 116 00:04:10,705 --> 00:04:12,724 But, really, what we've identified, 117 00:04:13,409 --> 00:04:16,689 particularly within our system, having an opportunity to 118 00:04:16,689 --> 00:04:19,089 reflect and see what is happening and really 119 00:04:19,089 --> 00:04:21,430 look at evidence based care and literature 120 00:04:21,889 --> 00:04:24,930 and evidence from our public health researchers and 121 00:04:24,930 --> 00:04:25,669 from our, 122 00:04:26,129 --> 00:04:27,889 clinical researchers and more, 123 00:04:28,290 --> 00:04:29,055 maternal care, 124 00:04:29,535 --> 00:04:32,014 looking at what is the evidence showing us. 125 00:04:32,014 --> 00:04:34,115 And what we do know for a fact 126 00:04:34,414 --> 00:04:36,435 is that race is often used 127 00:04:36,814 --> 00:04:37,634 as a proxy 128 00:04:37,935 --> 00:04:39,954 for biologic or genetic differences. 129 00:04:40,414 --> 00:04:42,194 And we know that race is actually 130 00:04:42,580 --> 00:04:45,560 not that. It's a social and societal construct 131 00:04:45,860 --> 00:04:48,020 that cannot be used as a proxy for 132 00:04:48,020 --> 00:04:51,220 biologic differences. So when we use race to 133 00:04:51,220 --> 00:04:53,800 determine a risk factor, we're really eliminating 134 00:04:54,675 --> 00:04:57,154 or over identifying people who are at risk 135 00:04:57,154 --> 00:04:58,774 for adverse income outcomes. 136 00:04:59,314 --> 00:05:01,495 So when we filter things inappropriately, 137 00:05:01,954 --> 00:05:04,035 that really changes the course of care for 138 00:05:04,035 --> 00:05:05,095 the pregnant person. 139 00:05:05,475 --> 00:05:07,794 And when that happens, we miss opportunities to 140 00:05:07,794 --> 00:05:09,175 intervene when we can. 141 00:05:09,490 --> 00:05:12,050 And it also obscures the true underlying cause 142 00:05:12,050 --> 00:05:15,089 of the adverse pregnancy outcomes, such as systemic 143 00:05:15,089 --> 00:05:15,589 racism. 144 00:05:16,050 --> 00:05:16,949 There are socioeconomic 145 00:05:17,490 --> 00:05:19,029 factors that play into this. 146 00:05:19,649 --> 00:05:21,649 And all of this really just exacerbates the 147 00:05:21,649 --> 00:05:23,189 health disparities by misattributing 148 00:05:23,685 --> 00:05:26,084 risk factors and failing to address the really 149 00:05:26,084 --> 00:05:27,544 true underlying causes 150 00:05:27,925 --> 00:05:29,785 that lead to these adverse outcomes. 151 00:05:30,644 --> 00:05:32,264 I can give you a couple of examples 152 00:05:32,564 --> 00:05:34,644 of, you know, things that we've done in 153 00:05:34,644 --> 00:05:35,305 our system 154 00:05:35,845 --> 00:05:38,270 that we are trying to sort of target 155 00:05:38,330 --> 00:05:38,990 the why 156 00:05:39,930 --> 00:05:41,790 of the outcomes that we're seeing. 157 00:05:42,649 --> 00:05:45,470 One thing we're able to do is in 158 00:05:45,689 --> 00:05:46,830 2023, 159 00:05:47,129 --> 00:05:47,790 we created, 160 00:05:48,410 --> 00:05:50,750 internally a birth justice initiative 161 00:05:51,175 --> 00:05:52,475 that was a cross, 162 00:05:53,254 --> 00:05:53,754 system 163 00:05:54,535 --> 00:05:55,514 sort of collaborative 164 00:05:55,975 --> 00:05:59,035 of all sorts of different people and employees 165 00:05:59,655 --> 00:06:01,835 to talk about and really explore 166 00:06:02,295 --> 00:06:04,455 what are the issues that are impacting this 167 00:06:04,455 --> 00:06:05,435 maternal mortality 168 00:06:05,810 --> 00:06:07,110 and how can we bring, 169 00:06:08,610 --> 00:06:09,910 justice and, 170 00:06:10,529 --> 00:06:13,970 you know, appropriate care for everybody that we 171 00:06:13,970 --> 00:06:16,870 care for. So in this birth justice initiative, 172 00:06:17,650 --> 00:06:20,129 we also were able to align looking at 173 00:06:20,129 --> 00:06:20,629 our 174 00:06:21,144 --> 00:06:21,644 systematic 175 00:06:22,104 --> 00:06:24,985 prenatal care that's provided to all pregnant people 176 00:06:24,985 --> 00:06:27,225 in our system and figure out what can 177 00:06:27,225 --> 00:06:29,324 we look at in that care provision 178 00:06:30,024 --> 00:06:33,305 that may be causing or perpetuating some of 179 00:06:33,305 --> 00:06:34,444 these adverse outcomes 180 00:06:34,824 --> 00:06:35,324 particularly 181 00:06:35,704 --> 00:06:36,600 related to race. 182 00:06:37,399 --> 00:06:38,220 So using 183 00:06:38,759 --> 00:06:41,879 both the birth justice initiative and all also 184 00:06:41,879 --> 00:06:45,560 our internal system and drive and commitment to 185 00:06:45,560 --> 00:06:46,379 our community 186 00:06:46,920 --> 00:06:48,699 and to equitable care, 187 00:06:49,185 --> 00:06:50,645 using those two powers 188 00:06:51,185 --> 00:06:53,264 to look at our own care and our 189 00:06:53,264 --> 00:06:55,425 care map is actually what we call it, 190 00:06:55,425 --> 00:06:57,425 which is the care map is sort of 191 00:06:57,425 --> 00:06:59,045 the process by which we, 192 00:06:59,504 --> 00:07:02,625 build our tools and provide care universally to 193 00:07:02,625 --> 00:07:05,160 all pregnant people within our system. So how 194 00:07:05,160 --> 00:07:07,900 do we use this birth justice initiative, 195 00:07:08,439 --> 00:07:11,420 our internal Fairview values and mission 196 00:07:11,800 --> 00:07:13,180 and focus on equity, 197 00:07:14,360 --> 00:07:17,925 and target that prenatal pregnancy and birth care 198 00:07:17,925 --> 00:07:18,904 to improve outcomes. 199 00:07:19,764 --> 00:07:21,305 And we found some opportunities, 200 00:07:21,605 --> 00:07:24,004 particularly with our screening tools that we were 201 00:07:24,004 --> 00:07:25,944 utilizing in pregnancy to determine 202 00:07:26,404 --> 00:07:27,145 how we, 203 00:07:28,324 --> 00:07:31,779 provide either additional care or different care for 204 00:07:31,779 --> 00:07:33,720 folks who have increased risks. 205 00:07:35,060 --> 00:07:37,539 And so a couple of strategies. We've looked 206 00:07:37,539 --> 00:07:38,019 at, 207 00:07:38,339 --> 00:07:41,475 genetic screening. We've looked at maternal serum screening, 208 00:07:42,435 --> 00:07:43,975 lead screening, preeclampsia 209 00:07:44,355 --> 00:07:46,055 screening, diabetes screening, 210 00:07:46,355 --> 00:07:48,514 all of these different aspects of care to 211 00:07:48,514 --> 00:07:49,014 determine 212 00:07:49,955 --> 00:07:52,035 what are we doing right and what can 213 00:07:52,035 --> 00:07:54,915 we how can we eliminate the race or, 214 00:07:55,154 --> 00:07:58,139 the social construct of race from that risk 215 00:07:58,139 --> 00:08:00,560 assessment and really get down to the biologic 216 00:08:00,779 --> 00:08:02,319 and physiologic factors 217 00:08:02,779 --> 00:08:04,480 that may contribute to an outcome. 218 00:08:04,939 --> 00:08:07,019 And so and in addition to that piece, 219 00:08:07,019 --> 00:08:10,959 we're we're reconstructing things internally, providing care differently 220 00:08:11,420 --> 00:08:13,975 for people universally, and also advocating 221 00:08:14,595 --> 00:08:15,095 nationally 222 00:08:15,634 --> 00:08:16,375 for other, 223 00:08:17,235 --> 00:08:17,735 laboratory 224 00:08:18,355 --> 00:08:20,855 places that we send off our samples to 225 00:08:21,074 --> 00:08:21,735 to also 226 00:08:22,194 --> 00:08:24,514 eliminate race based screening to really get down 227 00:08:24,514 --> 00:08:26,835 to the root of how we need to 228 00:08:26,835 --> 00:08:28,375 care for pregnant people, 229 00:08:29,060 --> 00:08:30,120 for better outcomes. 230 00:08:30,500 --> 00:08:32,500 So it's sort of an internal move and 231 00:08:32,500 --> 00:08:34,419 then also a national move to try and 232 00:08:34,419 --> 00:08:35,879 make some change with this. 233 00:08:36,820 --> 00:08:39,139 Absolutely. And there's so much importance in what 234 00:08:39,139 --> 00:08:40,279 you just said, especially, 235 00:08:40,659 --> 00:08:43,004 I think, that call out for race being 236 00:08:43,004 --> 00:08:45,165 used often as a proxy, but it really 237 00:08:45,165 --> 00:08:47,565 being a social construct and getting back and 238 00:08:47,565 --> 00:08:49,504 getting down to those real biological 239 00:08:49,884 --> 00:08:50,384 factors. 240 00:08:51,565 --> 00:08:54,045 It's really nice to also hear about that 241 00:08:54,045 --> 00:08:55,904 birth justice initiative and, 242 00:08:56,379 --> 00:08:59,899 Fairview's internal drive and commitment. I particularly like 243 00:08:59,899 --> 00:09:01,579 how you called those your two powers, your 244 00:09:01,579 --> 00:09:03,199 drive and commitment to your mission. 245 00:09:03,740 --> 00:09:05,659 Yep. I'd like to hear with that context 246 00:09:05,659 --> 00:09:07,820 in mind a little more about how this 247 00:09:07,820 --> 00:09:08,320 issue 248 00:09:08,705 --> 00:09:11,664 kind of initially resonated with your organization, how 249 00:09:11,664 --> 00:09:14,945 it still is. So what motivated Fairview to 250 00:09:14,945 --> 00:09:18,085 address racial and ethnic disparities in maternal care? 251 00:09:19,184 --> 00:09:21,105 So, couple of years ago, I think it 252 00:09:21,105 --> 00:09:22,225 was 2022 253 00:09:22,225 --> 00:09:24,245 and the beginning of 2023, 254 00:09:24,860 --> 00:09:25,600 our organization 255 00:09:26,459 --> 00:09:29,039 just really made a focused intentional 256 00:09:29,659 --> 00:09:32,700 call out of bringing equity to all health 257 00:09:32,700 --> 00:09:33,200 care. 258 00:09:33,659 --> 00:09:36,000 And a part of that was intentionally 259 00:09:36,539 --> 00:09:37,039 evaluating 260 00:09:37,580 --> 00:09:39,044 all of our care maps, 261 00:09:39,524 --> 00:09:40,985 so our packages of care, 262 00:09:41,445 --> 00:09:43,945 evaluating them from a lens of equity 263 00:09:44,404 --> 00:09:46,424 and making sure that we are addressing 264 00:09:46,884 --> 00:09:48,584 every aspect that potentially 265 00:09:49,044 --> 00:09:50,105 could lead to 266 00:09:50,485 --> 00:09:52,024 inequity in outcomes 267 00:09:52,404 --> 00:09:53,865 or inequity in care. 268 00:09:54,269 --> 00:09:55,570 And that intentionality 269 00:09:56,590 --> 00:09:57,090 really, 270 00:09:57,710 --> 00:10:00,769 you know, the system provides resources and incredible 271 00:10:01,470 --> 00:10:04,029 people within our system who are subject matter 272 00:10:04,029 --> 00:10:05,170 experts on equity, 273 00:10:06,110 --> 00:10:07,570 within health care, particularly. 274 00:10:08,110 --> 00:10:08,930 Those resources 275 00:10:09,764 --> 00:10:10,264 helped, 276 00:10:11,365 --> 00:10:11,865 inform 277 00:10:12,245 --> 00:10:14,884 our new care map. And so that kind 278 00:10:14,884 --> 00:10:17,524 of it was a synergy between this really 279 00:10:17,524 --> 00:10:20,024 internal focus from Fairview on equity, 280 00:10:20,404 --> 00:10:21,945 the birth justice initiative, 281 00:10:22,419 --> 00:10:24,759 and then also kind of that national spotlight 282 00:10:24,980 --> 00:10:28,200 on what's happening with maternal morbidity and mortality. 283 00:10:29,059 --> 00:10:30,360 And it just came together 284 00:10:30,740 --> 00:10:31,240 really 285 00:10:31,620 --> 00:10:34,440 nicely in the end of twenty twenty three, 286 00:10:34,945 --> 00:10:37,105 that allowed us to really dig into this 287 00:10:37,105 --> 00:10:39,664 prenatal care map and and make sure you 288 00:10:39,664 --> 00:10:41,504 know, it was a call to action from 289 00:10:41,504 --> 00:10:41,985 our, 290 00:10:42,464 --> 00:10:42,964 internal 291 00:10:43,584 --> 00:10:44,884 employees and also 292 00:10:45,345 --> 00:10:48,084 our organization to say, what are we doing 293 00:10:48,509 --> 00:10:50,670 for maternal health care? And this was our 294 00:10:50,670 --> 00:10:52,929 answer. It was to break down our prenatal 295 00:10:53,070 --> 00:10:53,730 care process 296 00:10:54,269 --> 00:10:56,830 and rebuild it in a way that was 297 00:10:56,830 --> 00:10:58,210 really central to 298 00:10:58,670 --> 00:11:01,730 equity and care, but also equitable outcomes. 299 00:11:02,184 --> 00:11:04,425 And figuring out how do we provide that 300 00:11:04,425 --> 00:11:06,684 care within the pregnancy journey 301 00:11:07,144 --> 00:11:09,004 that leads to that equitable outcome. 302 00:11:09,384 --> 00:11:11,865 And it's different from standardizing care. We're not 303 00:11:11,865 --> 00:11:14,264 standardizing things across the board. I mean, in 304 00:11:14,264 --> 00:11:16,045 a sense, we are. We are providing, 305 00:11:17,065 --> 00:11:20,570 the highest evidence based care we can to 306 00:11:20,570 --> 00:11:22,490 every single person that steps through the door 307 00:11:22,490 --> 00:11:23,230 that's pregnant, 308 00:11:24,009 --> 00:11:26,730 but also understanding that within that care, we 309 00:11:26,730 --> 00:11:30,089 need to individualize it to meet the end 310 00:11:30,089 --> 00:11:30,589 goal 311 00:11:30,975 --> 00:11:31,714 of equitable 312 00:11:32,334 --> 00:11:35,214 outcomes. Right? So what's great for one person 313 00:11:35,214 --> 00:11:37,214 in the beginning might not be great for 314 00:11:37,214 --> 00:11:39,054 everybody. And so how do we build a 315 00:11:39,054 --> 00:11:39,554 system 316 00:11:39,934 --> 00:11:41,315 that takes that into consideration 317 00:11:41,934 --> 00:11:44,309 that lands us with the equitable outcomes and 318 00:11:44,309 --> 00:11:47,210 improved maternal and fetal outcomes at the end. 319 00:11:48,549 --> 00:11:50,309 Totally. I think that's a great call out 320 00:11:50,309 --> 00:11:53,670 too about it's not exactly standardization. I think 321 00:11:53,670 --> 00:11:55,690 that goes back to the difference just between 322 00:11:56,070 --> 00:11:56,570 equality 323 00:11:57,264 --> 00:11:59,764 being equal or being equitable. You know, standardization 324 00:11:59,985 --> 00:12:01,745 might be the same across the board, equal 325 00:12:01,745 --> 00:12:04,004 across the board, whereas your intentional, 326 00:12:05,264 --> 00:12:07,504 lens of equity for your care maps is 327 00:12:07,504 --> 00:12:08,324 more of that 328 00:12:08,625 --> 00:12:09,125 equitable, 329 00:12:09,664 --> 00:12:11,764 way of looking at things. Exactly. 330 00:12:12,410 --> 00:12:13,529 I know you did mention, 331 00:12:14,570 --> 00:12:17,129 specific steps that your organization is taking to 332 00:12:17,129 --> 00:12:20,009 confront this bias such as the birth justice 333 00:12:20,009 --> 00:12:22,649 initiative. I was hoping you could either talk 334 00:12:22,649 --> 00:12:25,049 about other strategies or go in more to 335 00:12:25,049 --> 00:12:26,750 depth for the birth justice initiative 336 00:12:27,125 --> 00:12:29,605 that you're implementing to reduce this bias in 337 00:12:29,605 --> 00:12:31,544 pregnancy and delivery care? 338 00:12:32,485 --> 00:12:34,804 Absolutely. I've got a couple of examples I'd 339 00:12:34,804 --> 00:12:35,945 like to focus on. 340 00:12:36,964 --> 00:12:38,904 One first example is 341 00:12:39,365 --> 00:12:42,040 our screening for preeclampsia risk in pregnancy. 342 00:12:42,740 --> 00:12:43,240 Preeclampsia 343 00:12:43,620 --> 00:12:46,040 is is a condition that's unique to pregnancy, 344 00:12:46,580 --> 00:12:48,899 and postpartum that results in high blood pressure 345 00:12:48,899 --> 00:12:51,560 and then end organ damage that can be 346 00:12:51,700 --> 00:12:53,720 potentially fatal for some people, 347 00:12:54,304 --> 00:12:56,144 and have long term effects on the pregnant 348 00:12:56,144 --> 00:12:57,764 person and for the fetus. 349 00:12:58,384 --> 00:12:59,204 And previously, 350 00:12:59,745 --> 00:13:02,225 our screening for identifying people who are at 351 00:13:02,225 --> 00:13:03,445 risk for this utilized, 352 00:13:04,065 --> 00:13:05,044 things such as, 353 00:13:05,664 --> 00:13:06,090 identifying 354 00:13:11,529 --> 00:13:12,830 risk factor for developing 355 00:13:13,370 --> 00:13:13,870 preeclampsia. 356 00:13:14,490 --> 00:13:17,629 We know now that that actually is not 357 00:13:17,850 --> 00:13:18,670 a specific 358 00:13:19,154 --> 00:13:21,095 risk factor for developing preeclampsia. 359 00:13:21,954 --> 00:13:24,054 What we wanna focus on is 360 00:13:24,514 --> 00:13:26,534 the pieces of the 361 00:13:26,995 --> 00:13:27,495 biology, 362 00:13:28,195 --> 00:13:29,894 the pieces of the genetics, 363 00:13:30,514 --> 00:13:32,834 and the conditions of the body that would 364 00:13:32,834 --> 00:13:33,480 lead to preeclampsia. 365 00:13:46,264 --> 00:13:46,764 Hypertension 366 00:13:47,144 --> 00:13:49,804 disorders of pregnancy, a history of diabetes, 367 00:13:50,424 --> 00:13:53,325 multifetal gestation, or, you know, multiple 368 00:13:53,865 --> 00:13:54,365 fetuses, 369 00:13:54,745 --> 00:13:56,684 twins, triplets, and so on, 370 00:13:57,065 --> 00:13:59,165 kidney disease and autoimmune disease. 371 00:13:59,519 --> 00:14:01,620 So those are examples of specific 372 00:14:02,240 --> 00:14:04,660 conditions that would lead someone to 373 00:14:05,040 --> 00:14:08,420 have preeclampsia potentially be at risk for preeclampsia. 374 00:14:08,800 --> 00:14:10,800 And by identifying those, we can then take 375 00:14:10,800 --> 00:14:13,735 interventions that help decrease those risks throughout the 376 00:14:13,735 --> 00:14:14,235 pregnancy. 377 00:14:15,254 --> 00:14:18,394 Another example is gestational diabetes screening. 378 00:14:18,934 --> 00:14:20,314 Previously, we utilized, 379 00:14:21,014 --> 00:14:24,634 screening high risk qualifiers as people who identified 380 00:14:24,934 --> 00:14:26,235 as African American, 381 00:14:26,615 --> 00:14:27,115 Latino, 382 00:14:27,750 --> 00:14:28,490 Native American, 383 00:14:28,870 --> 00:14:29,370 Asian, 384 00:14:29,830 --> 00:14:30,889 Pacific Islander. 385 00:14:31,830 --> 00:14:34,410 We know now that that race based screening 386 00:14:34,549 --> 00:14:36,009 is actually not comprehensive 387 00:14:36,389 --> 00:14:39,190 enough and is not accurately reflecting the folks 388 00:14:39,190 --> 00:14:41,210 who are at risk for gestational diabetes. 389 00:14:41,684 --> 00:14:44,345 So now we've pivoted to a universal 390 00:14:44,804 --> 00:14:47,304 hemoglobin a one c testing, which is, 391 00:14:47,845 --> 00:14:50,325 everyone who's pregnant and enters care in our 392 00:14:50,325 --> 00:14:52,664 system will receive that blood work 393 00:14:52,965 --> 00:14:55,684 that tells us their stratifies their risk for 394 00:14:55,684 --> 00:14:56,745 developing diabetes. 395 00:14:57,830 --> 00:14:58,490 So really 396 00:14:58,870 --> 00:15:00,250 moving away from 397 00:15:00,790 --> 00:15:02,730 those social constructs of race 398 00:15:03,110 --> 00:15:06,410 and pivoting to the actual biologic and physiologic 399 00:15:06,710 --> 00:15:09,670 factors that would play into increasing those risk 400 00:15:09,670 --> 00:15:10,170 factors. 401 00:15:10,875 --> 00:15:13,035 But it doesn't end there. It's not enough 402 00:15:13,035 --> 00:15:16,235 to just eliminate race and screen for everything 403 00:15:16,235 --> 00:15:18,475 else because we know the root of the 404 00:15:18,475 --> 00:15:18,975 problem 405 00:15:19,355 --> 00:15:20,654 is deeper than that. 406 00:15:21,195 --> 00:15:23,215 So we have added screenings. 407 00:15:23,754 --> 00:15:26,575 We've added social determinants of health screenings. 408 00:15:27,169 --> 00:15:29,750 We have added screening for transportation 409 00:15:30,129 --> 00:15:30,629 barriers. 410 00:15:31,649 --> 00:15:32,629 We've added, 411 00:15:33,089 --> 00:15:34,870 screening for food insecurity, 412 00:15:35,570 --> 00:15:36,470 housing stability. 413 00:15:37,089 --> 00:15:39,509 Those are pieces that we know actually 414 00:15:40,209 --> 00:15:40,709 influence 415 00:15:41,009 --> 00:15:42,149 and contribute 416 00:15:43,065 --> 00:15:45,004 to maternal outcomes that are negative. 417 00:15:45,545 --> 00:15:47,804 So not only are we identifying 418 00:15:48,105 --> 00:15:51,165 those risks from social determinants of health aspect, 419 00:15:51,384 --> 00:15:54,504 but then also creating wraparound services and access 420 00:15:54,504 --> 00:15:55,245 to resources 421 00:15:55,625 --> 00:15:59,039 that help intervene in those social determinants that 422 00:15:59,039 --> 00:16:00,580 can impact that pregnancy. 423 00:16:01,759 --> 00:16:02,259 Absolutely. 424 00:16:02,720 --> 00:16:04,960 That's really important again to go back to 425 00:16:04,960 --> 00:16:07,379 that idea of moving away from the social 426 00:16:07,440 --> 00:16:10,879 constructs of within the screening processes and risk 427 00:16:10,879 --> 00:16:12,019 identifying processes. 428 00:16:12,504 --> 00:16:13,944 I'd like to dive into that a little 429 00:16:13,944 --> 00:16:14,584 bit deeper, 430 00:16:15,225 --> 00:16:17,225 and have you talk about how these race 431 00:16:17,225 --> 00:16:18,684 based screenings and calculations 432 00:16:19,464 --> 00:16:21,644 negatively impact care and outcomes. 433 00:16:23,064 --> 00:16:25,064 Yeah. So so when we 434 00:16:25,629 --> 00:16:27,549 eat there's a couple of different ways. Number 435 00:16:27,549 --> 00:16:30,049 one, it's if you focus on the race 436 00:16:30,509 --> 00:16:33,889 based screening, you miss an opportunity for interventions 437 00:16:34,029 --> 00:16:34,769 for folks 438 00:16:35,149 --> 00:16:35,649 who 439 00:16:36,110 --> 00:16:38,689 may not have self identified as a specific 440 00:16:38,829 --> 00:16:39,809 race. For example, 441 00:16:40,705 --> 00:16:41,845 many of us, 442 00:16:42,544 --> 00:16:45,205 have many different ethnic backgrounds, 443 00:16:46,384 --> 00:16:48,625 and many of us don't actually know what 444 00:16:48,625 --> 00:16:49,445 our specific 445 00:16:50,065 --> 00:16:53,345 ethnic or, you know, specific genetic risk factors 446 00:16:53,345 --> 00:16:56,029 are. And so if we don't know to 447 00:16:56,029 --> 00:16:58,129 identify ourselves as a specific 448 00:16:58,829 --> 00:17:01,149 race or or count ourselves in that specific 449 00:17:01,149 --> 00:17:03,870 race, it really is not capturing anyone who 450 00:17:03,870 --> 00:17:05,329 potentially could be at risk. 451 00:17:05,789 --> 00:17:06,450 In addition, 452 00:17:06,910 --> 00:17:10,164 it obscures the true underlying cause of the 453 00:17:10,164 --> 00:17:12,984 adverse pregnancy outcomes, like racism 454 00:17:13,365 --> 00:17:13,865 within 455 00:17:14,164 --> 00:17:16,345 the health care system or socioeconomic 456 00:17:16,805 --> 00:17:17,305 factors. 457 00:17:18,005 --> 00:17:19,464 And then it just also 458 00:17:19,765 --> 00:17:21,305 exacerbates the health disparities 459 00:17:21,684 --> 00:17:22,664 by misattributing 460 00:17:23,125 --> 00:17:23,865 risk factors 461 00:17:24,230 --> 00:17:27,130 And then again, not addressing those true underlying 462 00:17:27,190 --> 00:17:30,630 causes, which which we think are more likely 463 00:17:30,630 --> 00:17:31,609 related to 464 00:17:32,070 --> 00:17:32,570 socioeconomic 465 00:17:33,269 --> 00:17:34,009 and social 466 00:17:34,470 --> 00:17:35,690 constructs versus 467 00:17:36,715 --> 00:17:37,615 actual biologic, 468 00:17:38,795 --> 00:17:40,735 contributing factors for the outcome. 469 00:17:41,195 --> 00:17:44,315 So it can really impact both missing people 470 00:17:44,315 --> 00:17:44,815 and 471 00:17:45,674 --> 00:17:47,934 actually adding people to, 472 00:17:48,715 --> 00:17:51,720 a risk based profile that is actually misattributing 473 00:17:52,099 --> 00:17:52,759 their risk, 474 00:17:53,700 --> 00:17:55,559 and that can can really 475 00:17:56,180 --> 00:17:58,259 change the course of their care and hinder 476 00:17:58,660 --> 00:18:01,140 and in addition, hinder efforts to address the 477 00:18:01,140 --> 00:18:02,680 root cause of what's really 478 00:18:03,059 --> 00:18:04,839 the reason for the health disparity. 479 00:18:05,994 --> 00:18:07,775 Absolutely. It is so important 480 00:18:08,394 --> 00:18:10,154 to really be focusing on the root cause, 481 00:18:10,154 --> 00:18:12,255 and I think that that's a really powerful 482 00:18:12,634 --> 00:18:13,134 note 483 00:18:13,994 --> 00:18:16,474 to say that, you know, patients maybe can't 484 00:18:16,474 --> 00:18:18,634 put themselves into a box or quite literally 485 00:18:18,634 --> 00:18:21,375 check a box that they identify with one, 486 00:18:21,980 --> 00:18:24,460 self identify with one particular race because, you 487 00:18:24,460 --> 00:18:25,279 know, as 488 00:18:25,740 --> 00:18:28,380 as time progresses, that's just getting trickier and 489 00:18:28,380 --> 00:18:29,840 trickier for everyone. So 490 00:18:30,220 --> 00:18:32,299 zooming out a bit for our last question, 491 00:18:32,299 --> 00:18:34,940 I'd like to connect this maternal care work 492 00:18:34,940 --> 00:18:37,815 to the broader organization. So I'm wondering how 493 00:18:38,434 --> 00:18:40,615 this initiative and this mission 494 00:18:41,075 --> 00:18:42,215 aligns with the organization's 495 00:18:42,595 --> 00:18:43,414 broader commitment 496 00:18:43,875 --> 00:18:44,934 to health equity. 497 00:18:45,875 --> 00:18:47,875 This is a great question and something I'm 498 00:18:47,875 --> 00:18:50,055 really passionate about because I 499 00:18:50,380 --> 00:18:52,619 I have stayed in this organization for a 500 00:18:52,619 --> 00:18:54,720 long time for a reason and continue 501 00:18:55,099 --> 00:18:56,799 to choose to stay here because 502 00:18:57,579 --> 00:18:59,359 of the focus on 503 00:19:00,220 --> 00:19:01,599 patient centered care 504 00:19:02,380 --> 00:19:04,640 that evolves from dignity 505 00:19:05,295 --> 00:19:06,035 and respect, 506 00:19:06,575 --> 00:19:07,955 but also providing 507 00:19:08,335 --> 00:19:11,215 the highest quality of care we can. And 508 00:19:11,215 --> 00:19:12,275 it doesn't happen 509 00:19:12,894 --> 00:19:15,154 alone. It happens within our communities. 510 00:19:15,934 --> 00:19:18,735 And our our Fairview Health System is really 511 00:19:18,735 --> 00:19:20,130 focused on not just 512 00:19:20,609 --> 00:19:22,690 caring for the people within the doors of 513 00:19:22,690 --> 00:19:24,230 our health care facilities, 514 00:19:24,769 --> 00:19:26,930 but the community in which we live. We 515 00:19:26,930 --> 00:19:28,150 do not just 516 00:19:28,529 --> 00:19:30,390 aim to keep people, 517 00:19:31,250 --> 00:19:34,384 to fix people's pathology. Right? We aim to 518 00:19:34,384 --> 00:19:38,065 really provide whole person care that keeps people 519 00:19:38,065 --> 00:19:39,045 out of our facilities 520 00:19:39,424 --> 00:19:41,924 and promotes health and well-being within the community. 521 00:19:42,384 --> 00:19:44,404 So making sure that we are 522 00:19:45,000 --> 00:19:47,579 really looking at how we provide that care, 523 00:19:47,880 --> 00:19:50,539 pulling the customer, the consumer, or the patient 524 00:19:50,599 --> 00:19:51,820 into that process, 525 00:19:52,279 --> 00:19:53,339 and better understanding 526 00:19:53,640 --> 00:19:55,640 how we can do that within the walls 527 00:19:55,640 --> 00:19:57,980 of our hospital and also within our community. 528 00:19:58,599 --> 00:20:02,035 So we have a lot of initiatives related 529 00:20:02,035 --> 00:20:03,494 to community advancement 530 00:20:03,955 --> 00:20:06,434 and, ensuring that the voice of the the 531 00:20:06,434 --> 00:20:08,195 community member and the customer is a part 532 00:20:08,195 --> 00:20:09,894 of the care that we build and provide, 533 00:20:10,755 --> 00:20:13,095 but also internally really changing 534 00:20:13,859 --> 00:20:16,500 the barriers, the systemic barriers that we've been 535 00:20:16,500 --> 00:20:18,359 seeing historically in health care. 536 00:20:18,819 --> 00:20:21,299 We can't do it overnight. It's a huge, 537 00:20:21,299 --> 00:20:21,799 long 538 00:20:22,420 --> 00:20:25,220 initiative that we are so committed to and 539 00:20:25,220 --> 00:20:26,680 continue to commit to 540 00:20:26,994 --> 00:20:29,234 year after year after year because that we 541 00:20:29,234 --> 00:20:31,654 know that when we keep our patients healthy, 542 00:20:31,954 --> 00:20:35,075 we keep our communities healthy. And particularly with 543 00:20:35,075 --> 00:20:35,575 pregnancy, 544 00:20:36,355 --> 00:20:37,414 pregnant people 545 00:20:38,194 --> 00:20:41,059 have babies. Right? And these babies are members 546 00:20:41,059 --> 00:20:42,759 of our community, and those babies 547 00:20:43,140 --> 00:20:45,620 grow up in these communities and become adults. 548 00:20:45,620 --> 00:20:47,160 And the more we can provide 549 00:20:47,779 --> 00:20:50,840 health and well-being at the root of that, 550 00:20:51,299 --> 00:20:54,259 the healthier communities are, the healthier our state 551 00:20:54,259 --> 00:20:55,535 is. And hopefully, 552 00:20:55,914 --> 00:20:57,775 you know, we can have a national impact. 553 00:20:58,634 --> 00:21:01,035 But we've gotta start somewhere. And Fairview has 554 00:21:01,035 --> 00:21:02,975 really driven home a commitment 555 00:21:03,355 --> 00:21:04,414 of health equity 556 00:21:04,795 --> 00:21:07,115 and getting to the root cause and making 557 00:21:07,115 --> 00:21:08,654 sure that what we're doing 558 00:21:09,169 --> 00:21:10,470 is, you know, again, 559 00:21:10,769 --> 00:21:14,390 from from the patient centered aspect of dignity, 560 00:21:14,849 --> 00:21:17,109 respect, and highest quality of care. 561 00:21:17,809 --> 00:21:19,809 That's a great point. I love the idea 562 00:21:19,809 --> 00:21:21,410 of, you know, you have to start somewhere. 563 00:21:21,410 --> 00:21:23,809 Where's the root cause and what better place 564 00:21:23,809 --> 00:21:26,585 to start than maternal care where these Right. 565 00:21:26,744 --> 00:21:28,664 Humans are entering the world. I mean, talking 566 00:21:28,664 --> 00:21:30,044 about whole person care. 567 00:21:30,505 --> 00:21:32,264 That's great. And it's so great to hear 568 00:21:32,264 --> 00:21:34,924 your passion for this mission that is so 569 00:21:35,144 --> 00:21:37,164 clearly a big part of Fairview's purpose. 570 00:21:37,544 --> 00:21:38,044 Absolutely. 571 00:21:38,424 --> 00:21:38,924 Yep. 572 00:21:39,440 --> 00:21:41,279 Well, thank you so much, Melissa. That is 573 00:21:41,279 --> 00:21:42,640 all the time we have for today, but 574 00:21:42,640 --> 00:21:44,339 it's been an absolute pleasure, 575 00:21:45,200 --> 00:21:47,359 hearing your insights about all the important work 576 00:21:47,359 --> 00:21:48,339 happening at Fairview. 577 00:21:48,720 --> 00:21:51,200 These conversations are truly vital as we work 578 00:21:51,200 --> 00:21:54,000 towards a more equitable maternal care. So it 579 00:21:54,000 --> 00:21:54,980 has been a pleasure, 580 00:21:55,391 --> 00:21:57,011 and thank you all for listening. 581 00:21:57,391 --> 00:21:58,371 Thank you, Rosie.