PQCs: Enhancing the quality of care for mothers & babies, one State at a time

Picture of Andrew Lavender

Published on 21 September 2020 at 17:27

by Andrew Lavender

Perinatal Quality Collaboratives
Ensuring quality of care during pregnancy and childbirth is crucial to improving health outcomes and reducing preventable mortality and morbidity among women and their newborns. In recent years, Perinatal Quality Collaboratives have been driving improvements in perinatal care across the United States.
 

Perinatal Care Quality in the United States in 2020

Perinatal mortality is often used as an indicator of the quality of healthcare before, during, and after delivery. Perinatal Mortality in the United States is similar to other comparable countries, at around 6 deaths per 1,000 live births (Gregory et al., 2018). However, variability in the definitions of perinatal care make international comparisons difficult and can lead to rate variance of up to 50% (Richardus et al., 1998).
 
Taking a broader view of the health of mothers and infants, it's important to consider additional measures of population health. Two of the most widely reported measures are Infant Mortality and Maternal Mortality. Infant Mortality is defined as death of an infant within the first year of life. Infant mortality rates in the United States are up to 84% higher, and are declining more slowly, than the average of comparable countries (Gregory et al., 2018). Data from the National Center for Health Statistics show significant variability in infant mortality rates across the US, ranging from 3.6 deaths per 1000 in New Hampshire to over 8 in Mississippi in 2018 (Infant Mortality Rates by State). Clear disparities in mortality rates exist based on race, ethnicity and socio-economics; national data show that infants born to Black mothers are more than twice as likely to die before their first birthday than those born to White or Asian mothers (Gregory et al., 2018).
 
Maternal Mortality (maternal deaths per 100,000 live births) paints an equally troubling picture. The US is the only developed country where the rate has been rising over recent years. Between 1987 and 2014, maternal mortality rate in the US increased from 7.2 to 18, with a slight decline in subsequent years (Centers for Disease Control and Prevention). Even more alarming is that Black women are three to four times more likely to die in childbirth than White women (Centers for Disease Control and Prevention).
 

Perinatal Quality Collaboratives (PQCs)

As part of the drive to improve the standard of care for mothers and babies, Perinatal Quality Collaboratives (PQCs) have been established in many states. PQCs are state or multistate networks of teams working to improve the quality of care for mothers and babies. PQCs do that by advancing evidence-informed clinical practices and processes using quality improvement principles to address gaps in care. PQCs work with clinical teams, experts and stakeholders, including patients and families, to spread best practices, reduce variation and optimize resources to improve perinatal care and outcomes. The goal of PQCs is to achieve improvements in population-level outcomes in maternal and infant health.
 

Some selected PQCs current areas of focus include:

  • Reducing severe pregnancy complications associated with high blood pressure and hemorrhage
  • Reductions in health care-associated bloodstream infections in newborns
  • Improving identification of and care for infants with neonatal abstinence syndrome
  • Reducing racial/ethnic and geographic disparity
  • Reductions in unnecessary cesarean births among low-risk pregnant women
  • Reducing preterm births
 

The PQC approach

There is no universal structure and each of the PQCs has a different structure and addresses problems with healthcare that affect mothers and babies in their state. However, most PQCs follow the same basic agenda:
 

1. Build a network:

Identify a group of hospitals, establish multidisciplinary teams and empower those teams to make improvements.
 

2. Collect data and Track Progress:

Collect, Analyse and share project results with participating hospitals. Track progress to identify areas for improvement and action.
 

3. Facilitate Collaborative Learning:

Educational webinars, learning calls, sharing of best practice.
 

4. Strive for population-based improvements:

Support a large-scale systematic QI process to ensure improvements are seen at the population level, not just within one facility.
 
Robust Quality Improvement methodology is central to the PQC approach. The Center for Disease Control and Prevention (CDC) recommend that PQC’s use the Model for Improvement method and the IHI Breakthrough Series approach.
 
Essential in all of this is engaging and empowering teams from hospitals across the state to drive their own improvements, and to see the effect of that in the measures. That’s where Life QI comes in...
 

Life QI as a tool for PQCs

The Life QI platform has been used to facilitate hundreds of healthcare collaboratives around
the world. It provides the user-friendly tools for teams to drive their own improvement, whilst
also providing program management and data aggregation ability. You can read more about
using Life QI in improvement collaboratives here.
 

Perinatal Quality Collaboratives use Life QI to provide:

  • A simple solution for teams to contribute data and to aggregate and compare those data between sites.
  • A community for sharing ideas, success and learnings across teams to drive more widespread improvements.
  • A virtual platform to support and interact with hospital teams in testing changes, regardless of where teams are physically located.
  • A way to see the real picture by stratifying population level measures to appreciate disparities based on race, ethnicity and socio-economics.
 
Here’s some information about PQCs being run in Life QI ...
 

Louisiana Perinatal Quality Collaborative (LaPQC)

louisiana logo
The Louisiana Department of Health launched the Louisiana Perinatal Quality Collaborative (LaPQC) in August of 2018, and now works with 40 birthing hospitals across Louisiana, covering 92 percent of births in the state. Louisiana has some of the highest maternal and infant mortality rates in the country, as well as one of the biggest disparities between black and white women. The current focus of the LAPQC is on increasing the number of safe births in Louisiana through the Safe Births Collaborative, which is being run across 40 birthing facilities. The goal of the initiative is to achieve a 20% reduction in severe maternal morbidity (SMM) among pregnant and postpartum women who experience haemorrhage and/or severe hypertension/ preeclampsia in LaPQC participating facilities. This will lead to an increase in safe births and narrow the racial disparity in this outcome. Analysis of the data is ongoing, but initial reports indicate reductions in SMM of 22-39% and reducing disparity gaps based on race/ethnicity. You can read more about the initial findings of the Safer Births Collaborative here.
 
LaPQC are also running programs to increase breastfeeding rates (The Gift program), and to improve care for infants with Neonatal Opioid Withdrawal (NOWs). They are part of the national Alliance for Infant and Maternal Health (AIM).
 
 

Wisconsin Perinatal Quality Collaborative (WisPQC)

WispQC

WisPQC is one of the longest established PQC’s, formed in 2014. Their mission is “to improve perinatal health outcomes and equity across the continuum for all women and infants in Wisconsin”. WisPQC, are leveraging the energy of like-minded local, regional, and statewide organizations to form a lasting structure that will formally and systematically improve the quality of perinatal care and outcomes. WisPQC are supporting initiatives on Maternal Hypertension, Human Milk Feeding, and Opiod use disorder. Find out more about the Wisconsin Perinatal Quality Collaborative (WisPQC).

 

 

References

Centers of Disease Control and prevention, National Center for Health Statistics, Infant Mortality Rates by State (https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_mortality.htm)

 

Delbanco et al., 2019. The Rising U.S. Maternal Mortality Rate Demands Action from Employers. Harvard Buisiness Review

(https://hbr.org/2019/06/the-rising-u-s-maternal-mortality-rate-demands-action-from-employers)

 

Gregory ECW, Drake P, Martin JA. Lack of change in perinatal mortality in the United States, 2014–2016. NCHS Data Brief, no 316. Hyattsville, MD: National Center for Health Statistics. 2018. (https://www.cdc.gov/nchs/products/databriefs/db316.htm)

 

Kamal et al., 2019, What do we know about infant mortality in the U.S. and comparable countries? (https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_mortality.htm)

 

Richardus, Jan H. MD, PhD; Graafmans, Wilco C. PhD; Verloove-Vanhorick, S. Pauline MD, PhD; Mackenbach, Johan P. MD, PhD. The Perinatal Mortality Rate as an Indicator of Quality of Care in International Comparisons, Medical Care: January 1998 - Volume 36 - Issue 1 - p 54-66

(https://journals.lww.com/lww-medicalcare/Abstract/1998/01000/The_Perinatal_Mortality_Rate_as_an_Indicator_of.7.aspx)

 

 

 

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