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Taking AIM at Rising Rates of Maternal Morbidity and Mortality

Akshita Singh

There is exciting innovation happening in maternal and child health care. ACT.md recently spoke with with Jeanne Mahoney, Senior Director, Alliance for Innovation on Maternal Health (AIM). Here's a summary of our conversation.

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Maternal morbidity and mortality – commonly caused by conditions such as hemorrhage or severe high blood pressure – are key indicators of women’s health. They are also suggestive of the accessibility of maternal and other health care services. Judging by the statistics, we have work to do: since 1987, the rate of pregnancy-related deaths in the U.S. has more than doubled. We spoke with the Alliance for Innovation on Maternal Health (AIM) to learn about their work to reverse this trend.

AIM is a national alliance to promote consistent and safe maternity care to reduce maternal mortality and severe morbidity. Funded by the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau, AIM continues to work to reduce maternal deaths and complications in pregnancy through maternal safety “bundles” that represent best practices for maternity care. The bundles are developed and sanctioned by multidisciplinary teams from national organizations and include action measures for obstetrical hemorrhage, severe hypertension, peripartum racial disparities, postpartum care, and others.

Jeanne Mahoney, Senior Director of AIM, describes their strategies as mapped to the "four R’s" – Readiness, Recognition, Response, and Reporting and Systems Learning.

ACT.md: How did the AIM program originate and coalesce around these goals?

JM: Well, the maternal mortality rate in the United States started rising 2011-12. In 2012 a group of us had become very concerned about it. This group consisted of medical and public health leaders from the CDC, HRSA’s Maternal and Child Health Bureau, physicians from ACOG, the maternal-fetal medicine physicians, nurses from AWHONN, family medicine physicians, and midwives.

The data was showing that hemorrhage, hypertension, and venous thromboembolism were the three major causes of maternal mortality that were remediable. So this group began work on the bundles on hemorrhage and hypertension before the AIM program officially began.

The director of the Maternal and Child Health Bureau, Dr. Michael Lu, was very involved in that discussion. In 2014, the Health Resources and Services Administration put out a competitive cooperative agreement describing building an alliance for the development and implementation of maternal safety bundles and the AIM program was selected among other applicants. Our goal is to reduce preventable maternal mortality and severe morbidity in every birth facility in the United States.

ACT.md: What is the role of data in achieving program goals and what kind of data does AIM look at?

JM: We are a data-driven program, so we find that when you’re doing quality improvement initiatives - which is what AIM is – it’s important to be able to see what your baseline is and to see if your interventions are making a difference over that baseline.

When we enroll states we look at their baseline hospital discharge data, which includes administrative codes. The CDC has chosen 25 code sets from that data to identify severe maternal morbidity. Those codes might include admission to the ICU, use of a respirator, or other organ failures. We get that data from the states and they get that information from their hospitals - either from a hospital association, from a perinatal collaborative, or just from the state public health department.

We also gather data on what exactly those individual hospitals are doing as far as how they're implementing the bundles and each bundle has different process structure measures.

A structure measure would include having a hemorrhage cart on the unit or completing a risk assessment on every admission. We receive that information from hospitals on a quarterly basis. It takes hospital staff perhaps 10-15 minutes a quarter to put those in our data portal. We want to see if the hospital is actually doing the bundles and then what their outcomes are but it’s more important that the hospital is able to see how they’re doing and be able to use that to improve their teams.

ACT.md: What do you hope to achieve by getting all 50 states to share data with AIM?

JM: We are expecting to have all 50 states involved in AIM. We’re going to be able to show how the bundles are actually improving outcomes for moms. We want to see the numerical improvements – that we have reduced severe maternal morbidity and mortality – and we also want to see patient satisfaction.

One of the things we found, and I think it’s so fascinating, is that it really doesn’t matter what bundle a hospital or state is implementing as much as the fact that they’re doing something because we’re seeing severe maternal morbidity reduced whether they’re doing the hemorrhage bundle or the Cesarean reduction bundle. We are seeing change across the board because hospital teams are working towards a goal of maternal safety.

ACT.md: What are you excited about for the future of AIM?

JM: ACOG has been focused on maternal mortality for about the last 10 years. Women should not die in child birth. We look at so many developing countries where women are dying a lot more frequently and we should be doing a lot better than them. But there are American states and cities where our rates get close to those of some of the third world countries, even though we have the most expensive childbirth in the world. So we need to be doing more than we are.

The other thing that is really important is that we don’t work alone. We now have 30 partners that are working with the AIM staff and our state teams, as well as at the national level and the community level to propagate this work. We love our partners.

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ACT.md expresses our sincerest thanks to Jeanne Mahoney and the whole team at AIM. You can learn more about AIM here.

Disclaimer

This interview was conducted for informational purposes only. AIM does not endorse and is not a customer of ACT.md, and participated voluntarily in this interview and its publication.

 

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