Focus On: California Maternal Quaity Care Collaborative
The California Maternal Quality Care Collaborative (CMQCC) is an organization devoted to reducing preventable maternal mortality and morbidity and their associated racial disparities through data driven quality improvement (QI) initiatives.
Since 2006, the California Department of Public Health, Maternal, Child and Adolescent Health Division (CDPH/MCAH), with federal Title V block grants, has funded CMQCC to convene the first-ever California state-wide maternal mortality review. In April 2010, the CDPH/MCAH released the California Pregnancy-Associated Mortality Review (CA-PAMR): Report from 2002 and 2003 Maternal Death Reviews. This report shows the rise in maternal mortality in California has more than doubled from 1999 to 2008, and gives the findings of the expert committee convened to review maternal deaths occurring in 2002-2003. Among the 98 pregnancy-related deaths reviewed by the committee, the leading causes of death were due to cardiovascular disease (20%), pre-eclampsia/eclampsia (15%), amniotic fluid embolism (14%), obstetric hemorrhage (10%) and sepsis/infection (8%). Overall, nearly 40% of the deaths were determined to have a good-to-strong chance of being prevented. The data also reveal a stark racial/ethnic disparity, with African-American women having a four-fold greater risk of maternal death than women of other racial/ethnic groups.
The findings from CA-PAMR inform the work of CMQCC in terms of identifying key maternal health issues that can be addressed from a quality improvement or systems-perspective, focusing on hospital-level improvements and clinician education.
CMQCC provides technical assistance to local health jurisdictions (counties) that implement QI projects with hospitals and maternity care providers in their regions. In Los Angeles County, the local MCAH department is helping hospitals implement the CMQCC Obstetric Hemorrhage toolkit, which helps staff improve recognition and response to this very preventable cause of maternal death and injury. Systems level improvements include coordination with blood bank (for data and blood product orders), with pharmacies, to bundle uterotonic drugs for quick release when needed and increased training in estimating blood loss and team training through drills and debriefs. The project in San Bernardino County focused on supporting hospitals and clinicians with data and education to reduce elective inductions at all gestational ages. That project led to the creation of the CMQCC/March of Dimes toolkit to Eliminate Elective (Non-Medically Indicated) Deliveries Before 39 Weeks Gestational Age (ED<39Wks), which has now become a national resource. (Oklahoma recently launched a statewide collaborative, called “Every Week Counts”, using this toolkit.)
Continued funding for the maternal mortality reviews and maternal
quality improvement work depends on Federal Title V Block Grants, as California discontinued all general funds to CDPH/MCAH due to 2009-2010 budget constraints. Because this work is publicly funded, all tools and resources are free and available for the public on the CMQCC website. Our next QI toolkit will be focused on optimal management of preeclampsia, which was a highly preventable cause of death identified in the maternal mortality report.
California has over half a million births each year (more than all of Canada!), with about 280 hospitals with at least 50 births/year. To reach all these women, babies, clinicians and hospitals, CMQCC relies on the amazing volunteer support of expert clinicians (midwives, obstetricians, nurses, anesthesiologists and more) who work on the many Task Forces and Expert Committees that carry the projects forward, in addition to our project staff. We have a lot of work to do, and we welcome additional resources and assistance. Please contact us at firstname.lastname@example.org to learn more about our work and how to get involved.
Posted by: Christine Morton, PhD
Research Sociologist and Program Manager