Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care

Kahwati, Leila C.; Sorensen, Asta; Teixeira-Poit, Stephanie; Jacobs, Sara; Sommerness, Samantha A.; Miller, Kristi; Pleasants, Elizabeth; Clare, Hanna Margaret; Hirt, Charles; Davis, Stephanie; Ivester, Thomas; Caldwell, Donna; Muri, Janet H.; Mistry, Kamila B.

doi:10.1016/j.jcjq.2018.11.002

Cited by 8 publications

(9 citation statements)

References 19 publications

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“…186,187,188 When these bundles have been implemented in hospitals with communication and resolution programs, hospitals, health systems, providers, and patients have observed lower rates of adverse events, lower costs, and improved patient outcomes. 186,187,189 Most cases of maternal mortality and severe maternal morbidity are preventable, and prevention strategies include improving access to and coordination and delivery of quality care. 182,190,191 Recognition is growing of the need to develop, monitor, and improve performance on quality measures in obstetrics care, particularly around disparities.…”

Section: Maternal Morbidity and Mortalitymentioning

confidence: 99%

“…Maternal deaths that occur during hospital stays may provide a window into both system and provider-level factors that can play a role in preventing maternal death. 182,189,190 In-hospital deaths per 100,000 delivery hospitalizations provides a measure of intrapartum maternal mortality or those that occur during delivery through hospital discharge. This measure represents a small portion of the Centers for Disease Control and Prevention definition of pregnancy-related mortality and relates to Healthy People 2020 Maternal, Infant, and Child Health Objective 5 (Reduce the rate of maternal mortality).…”

Section: In-hospital Deaths Per 100000 Delivery Hospitalizationsmentioning

confidence: 99%

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Interventions to Reduce Stereotyping Through Targeting Familiarity Preference

Liu¹

2021

Preprint

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Section: Maternal Morbidity and Mortalitymentioning

confidence: 99%

Section: In-hospital Deaths Per 100000 Delivery Hospitalizationsmentioning

confidence: 99%

Interventions to Reduce Stereotyping Through Targeting Familiarity Preference

Liu¹

2021

Preprint

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“…However, studies of organizational culture in perinatal care have not considered PCC: they have focused on the work environment, [25][26][27][28][29] particularly safety culture. [29][30][31][32][33][34][35] A barrier in evaluating perinatal PCC culture in hospitals is the lack of a comprehensive, validated, and context-specific measure. 36 A systematic review of the literature (prior to January 2019) 36 indicates that no existing PCC measures capture all dimensions of PCC identified in The Picker Institute/The Commonwealth Fund's PCC framework nor can they be readily adapted to assess PCC culture.…”

Section: Introductionmentioning

confidence: 99%

“…In health care, another core aspect of culture is emphasis on patient‐centered care (PCC), defined as the provision of “care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.” 19 PCC has been associated with a decrease in unexpected deaths and complications, 20 increased physical comfort, 21 decreased patient/caregiver anxiety, 22 improved patient/caregiver–provider communication, 22 increased participation in care, 22 and better clinical status 1 year after discharge 23,24 in some hospitalized populations. However, studies of organizational culture in perinatal care have not considered PCC: they have focused on the work environment, 25–29 particularly safety culture 29–35 …”

Section: Introductionmentioning

confidence: 99%

Development and testing of a survey measure of organizational perinatal patient‐centered care culture

Handley

Passarella

Martin

et al. 2022

Health Services Research

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Objective: To develop and test a measure of patient-centered care (PCC) culture in hospital-based perinatal care. Data Sources: Data were obtained from US perinatal hospitals: one provided survey development data and 14 contributed data for survey testing. Study Design: We used qualitative and quantitative methods to develop the mother-infant centered care (MICC) culture survey. Qualitative methods included observation, focus group, interviews, and expert consultations to adapt items from other settings and create new items capturing dimensions of PCC articulated by The Commonwealth Fund. We quantitatively assessed survey psychometric properties using reliability (Cronbach's α and Pearson correlation coefficients) and validity (exploratory and confirmatory factor analysis [CFA]) statistics, and refined the survey. After confirming aggregation suitability (ICCs), we calculated "MICC culture scores" at the individual, unit, and hospital level and assessed associations between scores and survey-collected, staff-reported outcomes to evaluate concurrent validity. Data Collection: Survey development included 12 site-visit observations, one semistructured focus group (five participants), two semi-structured interviews, five cognitive interviews, and three expert consultations. Survey testing used online surveys administered to obstetric and neonatal unit staff (N = 316). Principal Findings: Using responses from 10 hospitals with ≥4 responses from both units (n = 240), the 20-item MICC culture survey demonstrated reliability (Cronbach's α = 0.95) while capturing all PCC dimensions (subscale Cronbach's α = 0.72-0.87). CFA showed validity through goodness-of-fit (overall chisquare = 214 [p-value = 0.012], SRMR = 0.056, RMSEA = 0.041, CFI = 0.97, and TLI = 0.96). Aggregation statistics (ICCs < 0.05) justify unit-and hospital-level aggregation. Demonstrating preliminary validity, individual-, unit-, and hospital-level MICC culture scores were associated with all outcomes (satisfaction with care provided, within-unit team effectiveness, and relational coordination [RC] between units) (pvalues < 0.05), except for neonatal unit scores and RC (p-value = 0.11). Conclusions:The MICC culture survey is a psychometrically sound measure of PCC culture for hospital-based perinatal care. Survey scores are associated with staff-

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“…Effective teamwork and communication are also critical to patient safety. [24][25][26] Another QI strategy builds on the Agency for Healthcare Research and Quality's (AHRQ) Comprehensive Unit-based Safety Program and TeamSTEPPS, an evidence-based teamwork system proven to improve communication, teamwork, and patient safety in health care settings. 27,28 The AHRQ's Toolkit for Improving Perinatal Safety applies these evidence-based practices to address adverse events resulting from communication and system failures in obstetric units (Table 1).…”

mentioning

confidence: 99%

Statewide Perinatal Quality Improvement, Teamwork, and Communication Activities in Oklahoma and Texas

Stierman

O'Brien

Stagg

et al. 2023

Quality Management in Health Care

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Background and Objective: The purpose of this study was to describe statewide perinatal quality improvement (QI) activities, specifically implementation of Alliance for Innovation on Maternal Health (AIM) patient safety bundles and use of teamwork and communication tools in obstetric units in Oklahoma and Texas. Methods: In January-February 2020, we conducted a survey of AIM-enrolled hospitals in Oklahoma (n = 35) and Texas (n = 120) to gather data on obstetric unit organization and QI processes. Data were linked to hospital characteristics information from the 2019 American Hospital Association survey and hospitals' maternity levels of care from state agencies. We generated descriptive statistics for each state and created an index to summarize adoption of QI processes. We fitted linear regression models to examine how this index varied by hospital characteristics and self-reported ratings for patient safety and AIM bundle implementation. Results: Most obstetric units had standardized clinical processes for obstetric hemorrhage (94% Oklahoma; 97% Texas), massive transfusion (94% Oklahoma; 97% Texas), and severe hypertension in pregnancy (97% Oklahoma; 80% Texas); regularly conducted simulation drills for obstetric emergencies (89% Oklahoma; 92% Texas); had multidisciplinary QI committees (61% Oklahoma; 83% Texas); and conducted debriefs after major obstetric complications (45% Oklahoma; 86% Texas). Few obstetric units offered recent staff training on teamwork and communication to their staff (6% Oklahoma; 22% Texas); those who did were more likely to employ specific strategies to facilitate communication, escalate concerns, and manage staff conflicts. Overall, adoption of QI processes was significantly higher in hospitals in urban than rural areas, teaching than nonteaching, offering higher levels of maternity care, with more staff per shift, and greater delivery volume (all P < .05). The QI adoption index scores were strongly associated with respondents' ratings for patient safety and implementation of maternal safety bundles (both P < .001). Conclusions: Adoption of QI processes varies across obstetric units in Oklahoma and Texas, with implications for implementing future perinatal QI initiatives. Notably, findings highlight the need to reinforce support for rural obstetric units, which often face greater barriers to implementing patient safety and QI processes than urban units.

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Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care

Cited by 8 publications

References 19 publications

Interventions to Reduce Stereotyping Through Targeting Familiarity Preference

Interventions to Reduce Stereotyping Through Targeting Familiarity Preference

Development and testing of a survey measure of organizational perinatal patient‐centered care culture

Statewide Perinatal Quality Improvement, Teamwork, and Communication Activities in Oklahoma and Texas

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