Reduction in racial disparities in severe maternal morbidity from hemorrhage in a large-scale quality improvement collaborative

Main, Elliott K.; Chang, Shen-Chih; Ravi, Dhurjati; Cape, Valerie; Profit, Jochen; Gould, Jeffrey B.

doi:10.1016/j.ajog.2020.01.026

Cited by 54 publications

(54 citation statements)

References 37 publications

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“…There are excellent examples of interdisciplinary efforts to improve maternity care in the United States. These include the California Maternal Quality Care Collaborative , which has shown how a statewide collective effort in data collection, and reviews can contribute to evidence‐based care bundles to decrease morbidity and mortality and decreasing cesarean delivery rates compared to the rest of the United States 104–108 . The National Partnership for Women &Families Blueprint for Advancing High‐Value Maternity Care Through Physiologic Childbearing is a roadmap to improve maternity services and outcomes in the United States and reflects much of what we found in the four countries we examined 109 .…”

Section: Discussionmentioning

confidence: 84%

“…These include the California Maternal Quality Care Collaborative, which has shown how a statewide collective effort in data collection, and reviews can contribute to evidence-based care bundles to decrease morbidity and mortality and decreasing cesarean delivery rates compared to the rest of the United States. [104][105][106][107][108] The National Partnership for Women &Families Blueprint for Advancing High-Value Maternity Care Through Physiologic Childbearing is a roadmap to improve maternity services and e. Recommend a national registry of midwives to achieve licensing consistency and improved access across state boundaries. 113 3.…”

Section: Discussionmentioning

confidence: 99%

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The role of midwifery and other international insights for maternity care in the United States: An analysis of four countries

Kennedy

Balaam

Dahlen

et al. 2020

Birth

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Background: The United States (US) spends more on health care than any other high-resource country. Despite this, their maternal and newborn outcomes are worse than all other countries with similar levels of economic development. Our purpose was to describe maternal and newborn outcomes and organization of care in four high-resource countries (Australia, Canada, the Netherlands, and United Kingdom) with consistently better outcomes and lower health care costs, and to identify opportunities for emulation and improvement in the United States. Method: We examined resources that described health care organization and financing, provider types, birth settings, national, clinical guidelines, health care policies, surveillance data, and information for consumers. We conducted interviews with country stakeholders representing the disciplines of obstetrics, midwifery, pediatrics, neonatology, epidemiology, sociology, political science, public health, and health services. The results of the analysis were compared and contrasted with the US maternity system. Results: The four countries had lower rates of maternal mortality, low birthweight, and newborn and infant death than the United States. Five commonalities were identified as follows: (1) affordable/ accessible health care, (2) a maternity workforce that emphasized midwifery care and interprofessional collaboration, (3) respectful care and maternal autonomy, (4) evidence-based guidelines on place of birth, and (5) national data collections systems. Conclusions: The findings reveal marked differences in the other countries compared to the United States. It is critical to consider the evidence for improved maternal and newborn outcomes with different models of care and to examine US cultural and structural failures that are leading to unacceptable and substandard maternal and infant outcomes.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

The role of midwifery and other international insights for maternity care in the United States: An analysis of four countries

Kennedy

Balaam

Dahlen

et al. 2020

Birth

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“…The authors concluded that reducing variation in clinical care via safety bundles improved outcomes overall and reduced racial/ethnic disparities. 24 The PPH bundles have overall promising results in reducing MMM. The improvement rates noted in some hospitals or states appear to be highly related to bundle component compliance and the adoption of such factors as mentorship, support from quality team members, and simulation.…”

Section: Obstetric Hemorrhage Bundlesmentioning

confidence: 98%

“…Reversing racial and ethnic disparities remains another critical component for any maternal safety bundle. 24 The CMQCC evaluated its PPH bundle on outcomes stratified by race and ethnicity in a population that was 42% Hispanic, 29% White, 15% Asian, 5% Black, and 7% classified as ''other.'' All populations experienced an overall reduction in SMM during the 6-month period; however, Black women were 23% less likely to experience SMM compared with their baseline rates, which was a larger difference than the overall population after controlling for maternal clinical and sociodemographic factors.…”

Section: Obstetric Hemorrhage Bundlesmentioning

confidence: 99%

Enhancing Obstetric Safety Through Best Practices

Eppes

Han

Haddock

et al. 2021

Journal of Women's Health

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The pregnancy-related mortality rate in the US exceeds that of other developed nations and is marked by significant disparities in outcome by race. This article reviews the evidence supporting the implementation of a variety of best practices designed to reduce maternal mortality. Evidence from maternal mortality review committees suggests that delays in diagnosis, delays in initiation of treatment and use of ineffective treatments contribute to preventable cases of maternal death. We review several protocols for maternal warning signs that have been used successfully to facilitate early identification and intervention. Care bundles, a collection of best practices, have been developed and implemented to address several maternal emergencies. We review the evidence that supports reduction in adverse outcomes with consistent implementation of obstetric hemorrhage and severe hypertension bundles in a collaborative, team-based setting. The article concludes with suggestions for the future.

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“…They demonstrate reduced rates of severe maternal morbidity due to hemorrhage, as well as a reduction in the racial disparity in this outcome. 52 Yet, more could be done to understand the findings. Is measurement of quantitative blood loss acceptable to providers?…”

Section: Obstetric Hemorrhage: An Example Of the Intersection Of Implmentioning

confidence: 99%

Implementation Science is Imperative to the Optimization of Obstetric Care

2020

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In an effort aimed at improving outcomes, obstetric teams have enacted comprehensive care bundles and other clinical tools. Yet, these practices have had limited degrees of success on a national scale. Implementation science aims to bridge the divide between the development of evidence-based interventions and their real-world utilization. This emerging field takes into account key stakeholders at the clinician, institution, and health policy levels. Implementation science evaluates how well an intervention is or can be delivered, to whom, in which context, and how it may be up-scaled and sustained. Other medical disciplines have embraced these concepts with success. The frameworks and theories of implementation science can and should be incorporated into both obstetric research and practice. By doing so, we can increase widespread and timely adoption of evidence and further our common goal of decreasing maternal morbidity and mortality. Key Points

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Reduction in racial disparities in severe maternal morbidity from hemorrhage in a large-scale quality improvement collaborative

Cited by 54 publications

References 37 publications

The role of midwifery and other international insights for maternity care in the United States: An analysis of four countries

The role of midwifery and other international insights for maternity care in the United States: An analysis of four countries

Enhancing Obstetric Safety Through Best Practices

Implementation Science is Imperative to the Optimization of Obstetric Care

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