Can a community & health system partnership improve Black birth outcomes?

Monday, September 16, 2024

A research collaboration between Providence CORE, PSU researcher Dr. Roberta Hunte and the Healthy Birth Initiatives (HBI), is studying the impact of a cross-sector partnership on Black maternal health outcomes.
Early findings reveal how the partnership has supported culture change and specific policy changes, while also emphasizing the importance of strong leadership, cultural responsiveness, and sustained collaboration to improve healthcare systems.
The research highlights opportunities for better care coordination, greater recognition of structural racism in healthcare, and more culturally responsive practices.

Since the 2010 passage of the Affordable Care Act, U.S. health systems have increasingly partnered with community organizations to address patient needs and provide more culturally appropriate care and support. While evidence of the potential benefits of these partnerships is growing, literature on best practices for developing and sustaining them remains sparse. A research collaboration between the Providence Center for Outcomes Research and Education (CORE) and Portland State University Researcher Dr. Roberta Hunte aims to change that by examining how a partnership between a local health department program (Healthy Birth Initiatives [HBI]) and a major health system (Providence) can impact Black birth outcomes, policies, and practices.

Initial findings from this ongoing collaborative research point to several key considerations for developing these types of partnerships, as well as the potential benefits.

Read on for highlights from the project, or click here to download the executive summary.

A chance meeting leads to a research collaboration

The collaboration between HBI and CORE began at a talk where Dr. Hunte described her ongoing study of the partnership between HBI and Providence’s Portland Maternal Health Division. CORE Research Scientist Monique Gill was in attendance and saw an opportunity to expand this work by leveraging the CORE team’s experience studying health inequities, patient experiences, and cross-sector collaborations. To support the research, Gill secured support through CORE’s flex spending fund, a pool of funding supported by the Hearst Foundation and used by CORE for promising projects focused on health equity.

Between 2023 and 2024, Hunte, Gill and the CORE team worked together to understand the impacts of the HBI-Providence relationship on cultural responsiveness, policies, and practices at Providence and to identify opportunities for improvement. The initial research focused on analyzing and coding a series of in-depth interviews that Dr. Hunte conducted with staff from HBI and Providence, which enabled the researchers to identify themes and recommendations for leaders at both organizations.

Partnering across sectors to address health inequities

CDC data show that Black women are two to three times more likely to die from pregnancy-related complications than white women, experience 2.4 times the infant mortality rate, and have double the likelihood of giving birth to low birth weight or premature babies. Past research has linked multiple factors to these disparities, including structural racism that results in reduced quality of healthcare.

Recognizing the need to enact meaningful change in these outcomes, Providence and HBI have partnered for the past five years on various efforts to improve policies, practices, and outcomes related to Black maternal and child health. Those efforts include HBI trainings for Providence caregivers, collaboration between HBI case managers and medical providers, and stronger connections to HBI support for Providence maternal health patients.

Key findings from the study

The researchers’ work to date has revealed several valuable insights for organizations seeking to build these types of community-health system partnerships.

1) Strong leadership, time, and commitment are essential to building a fruitful partnership between a health system and a community-based program.

Building a strong partnership with effective communication took time, and several specific strategies helped create a trusting foundation for giving and receiving feedback. This included incorporating HBI staff into Providence committees, having them participate in meetings and regularly interact with leadership, and including them as valued members of the care team. The ongoing collaboration contributed to the formalization of birth and racial equity as strategic objectives in the Providence Maternal Health division.

“HBI is seen as a partner in care… they come to charge nurse meetings, regularly interact with the director over patient care issues, regularly have contact with the social workers. They’re what I would consider part of the extended care team.” – Providence Staff

2) Advancing recognition and understanding of the structural and historical context of racism in the healthcare system and its impacts takes intention and effort.

The Providence-HBI partnership helped Providence leadership and staff build capacity to recognize negative Black patient experiences as part of trends and systems rather than one-off exceptions. HBI providers are well versed in applying a systemic lens to individual cases and were able to offer insights and re-framings as informal training to Providence staff.

I feel like more advocacy has started to happen around that and trying to understand individual contexts and making clinically informed decisions about each situation. – Providence Staff  

3) The partnership fostered a more culturally responsive environment, additional shared power within the healthcare system, and an improved dynamic between providers and patients.

The partnership enhanced providers' understanding of the importance of culturally specific considerations in care. For example, HBI raised awareness of how practices like automatic drug testing or mandatory DHS reporting can be harmful or perceived as threatening, resulting in changes to these practices. Furthermore, giving HBI a seat in spaces typically reserved for health system leaders drove meaningful changes and helped validate the importance of culturally specific perinatal care. Providers are now better equipped to serve Black patients through collaborative decision-making that prioritizes patient autonomy and respect.

“I’ve had clients [say], ‘even though I had this C-section, it was one of the best experiences because it’s not about having a C-section, it’s how people made me a part of what was happening to me’.” – HBI Staff

4) In addition to the lessons learned above, the researchers identified several areas for improvement, including:

Opportunities to improve care coordination between community programs and health systems through a systematic referral process and shared access to patient information.
A need to recognize, value, and leverage the unique skills, perspectives, and resources that each organization brings to the partnership.
The importance of recognizing that such partnerships are people-dependent and finding ways to secure, formalize, and integrate these partnerships to ensure their sustainability

Moving forward

This research has revealed valuable insights. Dr. Hunte and CORE presented findings to leadership at HBI, to Providence’s Birth Equity Council, and at the CityMatCH conference. However, there’s much more to learn. With new funding from the Housman Foundation for Medical Research, our team will expand its analysis by conducting qualitative interviews with Providence patients who have also been clients of HBI to understand the impact of the partnership on these individuals.

These findings will inform recommendations for improving care coordination and building more sustainable, culturally responsive partnerships. Ultimately, this research aims to guide similar collaborations nationwide, helping to close health equity gaps for Black women and birthing people and their families.

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