(188) Confronting Disparities: Piloting an Individualized Clinician Equity Dashboard for Labor Outcomes

An Equity in Labor Outcomes Dashboard can directly provide clinicians with individual performance data stratified by patient race with the goal of reducing disparities. Building on prior participatory mixed methods work, we assessed the feasibility, acceptability, and perceived clinical impact of implementing this Dashboard in a pilot cohort.

Study Design:

This prospective study enrolled ten obstetric clinicians (attending and trainee physicians; CNMs) at 2 units to receive bimonthly Dashboards via email from 9/2024-2/2025. Reports demonstrated individual outcomes (cesarean, hemorrhage, transfusion, ICU, and composite maternal morbidity) by patient race, benchmarked against unit aggregates (Figure). Outcomes were attributed to clinicians who wrote ≥1 labor note and/or attended delivery. Coaching sessions with quality leads were offered bimonthly. Participants completed the validated Feasibility and Acceptability of Intervention Measures [FIM/AIM; Likert 4-20] and qualitative interviews guided by the Consolidated Framework for Implementation Research 2.0.

Results:

All 30 planned individualized Dashboards (3/participant) were viewed at least once. Dashboards were considered feasible (16/20 IQR[16-17]) and acceptable (16.5/20 IQR[15-20]). Qualitative data (Table) revealed high acceptability, with participants expressing motivation for equity and appreciating opportunities for self-reflection. Most had no prior sense of individual performance by race. However, some reported negative feelings (“defensive,” “embarrassed”), and questioned utility, citing small sample sizes and attribution concerns, limiting perceived ability to alter care. Suggestions included making the Dashboard cumulative and interactive. Departmental expansion was viewed favorably, while national rollout raised concerns about punitive action and legal risk.

Conclusion:

This pilot demonstrates the feasibility and acceptability of an individualized Equity in Labor Outcomes Dashboard. These data underscore opportunities for refinement and the need for a larger-scale implementation study powered to examine impact on racial disparities.