Racial Equity in Urine Drug Screening Policies in Labor and Delivery

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Health Equity

Background:

• Black pregnant patients disproportionately undergo peripartum urine drug screening (UDS) and subsequent reporting to child protective services (CPS).
• Racial disparities exist in healthcare practices, necessitating targeted interventions to promote equity.

Purpose of the Study:

• To evaluate the impact of removing isolated cannabis use and limited prenatal care as indications for UDS.
• To assess the effect of clinician-facing clinical decision support on racial parity in UDS and CPS reporting.
• To determine if these changes improved racial equity in peripartum care.

Main Methods:

• A quality improvement study was conducted at a tertiary care center.
• The study compared 9396 pregnant patients before (June 2021-Sept 2022) and after (Oct 2022-Jan 2024) an intervention.
• The intervention involved updated UDS indications and clinical decision support.

Main Results:

• The intervention significantly reduced racial disparities in UDS and CPS reporting.
• Before the intervention, Black patients had higher UDS (23.2%) and CPS report rates (11.3%) compared to White patients (11.1% and 5.8%).
• After the intervention, these disparities were eliminated, with no significant difference in UDS or CPS reporting rates between racial groups.

Conclusions:

• Removing specific indications and implementing clinical decision support improved racial equity in UDS and CPS reporting.
• The intervention did not negatively affect the identification of non-cannabis substance use.
• This approach demonstrates a successful strategy for reducing racial bias in peripartum healthcare practices.