Evaluating a Multi-pronged Initiative to Decrease Racial and Ethnic Inequities in the Identification of Maternal...

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Health Equity

Background:

• Racial and ethnic disparities persist in prenatal substance use screening and child protective services (CPS) referrals, despite similar substance use rates.
• Existing screening methods may contribute to inequities, necessitating standardized, unbiased approaches.

Purpose of the Study:

• To evaluate the impact and implementation of the Basic Obstetric Addiction Screen (BOAS) Initiative using the RE-AIM framework.
• To assess the initiative's effectiveness in reducing disparities in prenatal substance use screening and subsequent referrals.

Main Methods:

• Utilized the RE-AIM framework to evaluate the BOAS Initiative across two birthing facilities.
• Analyzed electronic health record data, social work referrals, and qualitative feedback from 21,342 pregnant patients and healthcare providers.
• Data collected between January 2022 and November 2023.

Main Results:

• Achieved 99% screening compliance, with 0.45% of patients screening positive.
• 71.9% of positive screens resulted in social work referrals.
• Qualitative data indicated high acceptability, improved equity perception, and successful EHR integration, though some concerns about sustainability and perceived inequities remain.

Conclusions:

• The BOAS Initiative demonstrates successful implementation and high acceptance among patients and clinicians.
• The standardized screening shows strong potential to mitigate biased toxicology testing and reduce unnecessary child protective services referrals.
• Continued efforts are needed to address lingering concerns and ensure long-term sustainability.