Siddhi Nadkarni, Simileoluwa Falako, Adwoa D Antwi, Katherine H Campbell, Oluwatosin O Adeyemo
Through correlating interview responses with EMR documentation, we identified four themes: (1) Incomplete representation of positive and negative experiences in EMR documentation, (2) Concerns with acknowledgement of pain and pain management, (3) Perceived coercion and stereotyping with contraception counseling, and (4) Counseling around delivery planning: balancing autonomy and provider recommendations. While participants' described experiences were correlated to EMR documentation for some instances, we noted differences in patient and provider perspectives that impacted patients' perceived quality of care received.
BACKGROUND: The electronic medical record (EMR) is a mainstay of medical documentation but can be limited in its representation of patient perspectives. Given significant disparities in quality of care and health outcomes for Black pregnant individuals, we sought to correlate patient-provider perspectives in the care of Black pregnant individuals with diabetes and/or hypertension to identify opportunities for quality improvement.
METHODS: We conducted a convergent mixed methods study, which correlated findings from in-depth qualitative interviews exploring participants' pregnancy, delivery, and postpartum experiences with providers' medical documentation in the EMR through retrospective chart review. Participants self-identified as Black (N = 9), were on average 10.6 weeks postpartum, and had confirmed diagnoses of diabetes and/or hypertension during pregnancy or postpartum.
RESULTS: Through correlating interview responses with EMR documentation, we identified four themes: (1) Incomplete representation of positive and negative experiences in EMR documentation, (2) Concerns with acknowledgement of pain and pain management, (3) Perceived coercion and stereotyping with contraception counseling, and (4) Counseling around delivery planning: balancing autonomy and provider recommendations. While participants' described experiences were correlated to EMR documentation for some instances, we noted differences in patient and provider perspectives that impacted patients' perceived quality of care received.
DISCUSSION: We highlight limitations of using EMR alone as a tool to assess the quality of care for Black pregnant patients and propose a novel informed care model that encourages providers to center patient voices, assess personal biases, and consider patients' historical, personal, and community contexts while counseling patients with high-risk pregnancies.