Improving Obstetrical Healthcare Quality and Outcomes
Kimberly Gregory, M.D., M.P.H.
Professor and Vice Chair, Women’s Healthcare Quality and Performance Improvement
Cedars-Sinai Medical Center, Los Angeles, California
“AHRQ funding set the stage for my career and enabled me to participate in regional and national quality improvement activities and be part of advocacy and policy work in women’s and obstetrics health services research.”
Kimberly Gregory, M.D., M.P.H., was 5 years old when she decided she wanted to be doctor. Today, she has an endowed chair (Helping Hand of Los Angeles—The Mariam Jacobs Chair in Maternal Fetal Medicine) and is Professor and Vice Chair of Women’s Healthcare Quality and Performance Improvement in the Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center in Los Angeles, California, where she leads health services research projects on quality of maternity care and pregnancy outcomes.
When she began her fellowship in maternal-fetal medicine, Dr. Gregory recognized that “there were very few people doing health services research in women’s health in general, and none in obstetrics.” In particular, she saw a gap in the use of evidence-supported practices, such as vaginal birth after cesarean (VBAC). With her first AHRQ grant in 2002, Dr. Gregory, who is also the Division and Fellowship Director of Cedars-Sinai’s Division of Maternal-Fetal Medicine, identified patient factors, hospital factors, and clinical policies associated with VBAC success rates and maternal and neonatal complication rates.
One study she led found that conditions such as hypertension, obesity, and urinary tract infection history led to variation in VBAC success rates and neonatal complications.
In 2009, Dr. Gregory received another AHRQ grant to develop indicators specific to pregnancy and childbirth services using the existing AHRQ Quality Indicators™. As a result of her findings, childbirth-related anesthesia complications, childbirth complication and morbidity rates, and childbirth-associated hemorrhage and infection, among others, met AHRQ’s criteria for inclusion in its Patient Safety Indicators. These indicators provide researchers, quality improvement experts, clinicians, and hospitals with insights into systematic ways to track data to improve quality of care and patient safety during pregnancy and childbirth.
Rising cesarean rates and maternal morbidity and mortality rates led Dr. Gregory to use her next AHRQ grant to examine regionalization of maternity care by referring high-risk women to medical centers equipped to manage their unique comorbidities. “Maternity care in the U.S. is not standardized, and disparities persist during childbirth,” said Dr. Gregory. She conducted a study to categorize obstetrical services, resources, patient care activities, and their association with maternal and neonatal safety outcomes in 239 non-military hospitals in California.
Her study found that childbirth services, including the ability to perform a cesarean delivery within 30 minutes and 24-hour pediatrician access, varied widely across California hospitals. “These variations in hospital-level services may provide some basis for variation in the outcomes achieved by childbirth hospitals,” said Dr. Gregory. “Understanding the optimal composition of regional obstetric care is critical to improving maternal and childbirth outcomes.”
Dr. Gregory is a Professor at both the David Geffen School of Medicine’s Department of Obstetrics and Gynecology and the Fielding School of Public Health’s Department of Community Health Sciences at the University of California, Los Angeles. Dr. Gregory is currently Chair of the Women’s Preventive Services Initiative Advisory Board, fellow of the American College of Obstetricians and Gynecologists, and member of the Society of Maternal Fetal Medicine, the American Gynecological and Obstetrics Association, the National Medical Association, the Association of Black Women Physicians, and the American Public Health Association.
Principal Investigator: Kimberly Gregory, M.D., M.P.H.
Institution: Cedars-Sinai Medical Center
Grantee Since: 2002
Type of Grant: Various
Consistent with its mission, AHRQ provides a broad range of extramural research grants and contracts, research training, conference grants, and intramural research activities. AHRQ is committed to fostering the next generation of health services researchers who can focus on some of the most important challenges facing our Nation's health care system.
To learn more about AHRQ's Research Education and Training Programs, please visit https://www.ahrq.gov/training.