Oral Concurrent Session 4 – Equity, Public Health, and Public Policy

Objective: To evaluate whether implementing a standardized substance use screening program reduced racial disparities in urine toxicology (Utox) testing among delivery admissions. Study Design:We conducted a retrospective cohort study of delivery admissions at a single academic center from June 2019 to June 2025.To address known disparities in Utox testing, a standardized iPad-based screening tool using a modified 4Ps screen was implemented Feb-May 2023, with full rollout after June 2023.Screening responses triggered protocolized Utox testing based on a predefined algorithm (Figure).Clinical and demographic predictors of Utox testing were compared pre-and post-implementation using chi-square and t-tests.Logistic regression with predictor × era interaction terms assessed changes in associations with testing; final models adjusted for age, parity, and insurance.Results: Among 36,656 admissions, 216 (0.59%) underwent Utox testing: 181 (0.80%) pre-implementation and 32 (0.26%) postimplementation (p < 0.001).Pre-implementation, Black patients accounted for 26.8% of tests but only 7.0% of the population (p < 0.001).Post-implementation, Black patients represented 6.3% of tests and 6.5% of the population (p = 0.91).The testing rate for Black patients declined from 3.15% to 0.51% (p < 0.001).The proportion of tested patients with public insurance declined from 65.7% to 53.1%, though not significantly (p = 0.19).In unadjusted models testing for effect modification by implementation period, race (p = 0.02 for Black vs White; interaction OR 0.17, 95% CI 0.05-0.66)and advanced maternal age (p = 0.001; interaction OR 1.14, 95% CI 1.06-1.23)showed significant interactions.In adjusted models, the disparity in testing by race significantly decreased post-implementation (interaction aOR for Black vs White 0.17, 95% CI 0.05-0.66;p = 0.01).Among those tested, positive Utox screens did not differ significantly by period (43.2% vs. 56.3%,p = 0.11).Conclusion: Implementation of a standardized substance use screening tool was associated with a significant reduction in racial disparities in Utox testing at delivery.