The California Maternal Quality Care Collaborative is organization committed to ending preventable morbidity, mortality and racial disparities in California maternity care.
Since CMQCC’s inception, California has seen maternal mortality decline by 55 percent between 2006 to 2013, while the national maternal mortality rate continued to rise.
CMQCC has developed evidence-based quality improvement toolkits for the leading causes of preventable death and complications for mothers and infants, including toolkits on: Cardiovascular Disease, Early Elective Delivery, Hemorrhage, Maternal Venous Thromboembolism, Preeclampsia, and Supporting Vaginal Birth and Reducing Primary Cesareans.
To help California hospitals implement the evidence-based care presented in the toolkits, CMQCC launched large-scale outreach collaboratives. State-wide collaboratives for hemorrhage and preeclampsia were launched individually and then a second time together in 2013 to help CA hospitals implement both obstetric hemorrhage and preeclampsia patient safety bundles. Maternal morbidity was reduced by 20.8% between 2014 – 2016 among the 126 hospitals participating in the California Partnership for Maternal Safety, the joint hemorrhage and preeclampsia collaborative.
A six-month pilot Collaborative to Support Vaginal Birth and Reduce Primary Cesareans was launched in 2014, and the first-birth cesarean rate decreased by greater than 20 percent between the three hospitals participating. Close to 100 hospitals are now participating in the current full-scale collaborative.
Camden Delivers
Camden Delivers is a targeted chronic disease management program for women of childbearing age in Camden, NJ. In Camden, nearly 35% of women are admitted to the hospital or visit the emergency department within a year of giving birth, often because of untreated chronic illness.
Camden Delivers is designed to decrease maternal morbidity and mortality in two ways:
Connect all women of childbearing age in our Medicaid Accountable Care Organization (ACO) to what the CDC calls “interconception care”: primary care, including chronic disease management, after a pregnancy and before they may become pregnant again.
Provide intensive community-based care management to women with complex health and social needs, including chronic disease, homelessness, and addiction. We tailor our care management intervention to the unique needs of women of reproductive age to include reproductive life planning and conversations about healthy pregnancy spacing.
Camden Delivers is a project of the Camden Coalition ACO, which is supported by the Nicholson Foundation
New Jersey Specific Initiatives (https://www.njspotlight.com/2020/01/first-lady-spearheading-plan-to-reduce-njs-high-maternal-mortality-rate/)
NJ DOH has invested in training community-based and culturally sensitive health providers (31 local health workers and 79 doulas) to help improve birth outcomes
DOH also created an interactive public data center and issued its first Maternal Health Report Card in 2019
Medicaid has expanded coverage to include doula care, breastfeeding support services and peer groups that improve outcomes called "centering pregnancy programs"
Governor Murphy has also approved changes to prohibit Medicaid from paying for early-elective deliveries, or c-sections done before 39 weeks, unless there is a specific medical reason
This serves to reduce unnecessary C-sections
Compiled from "Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions"
1) Integrating multidisciplinary care for women with high-risk comorbidities during preconception care, pregnancy, postpartum, and beyond
2) Addressing structural racism and the social determinants of health
3) implementing hospital-wide safety bundles with team training and simulation
4) Providing Patient education on early warning signs for medical complications of pregnancy
5) Regionalizing maternal levels of care so that women with risk factors are supported when delivering at facilities with specialized care teams
Others
Implementation of disparities dashboards - "which stratifies quality metrics by race and ethnicity, is a useful tool which allows healthcare systems to become aware of disparities within their hospitals and to monitor their performance on quality metrics for groups with higher risks of poor outcome"