Hospitals ramp up efforts to reduce maternal deaths in Michigan
Canton Township obstetrician-gynecologist Dr. Jody Jones wants hospitals in Michigan to continue to work on patient-safety measures to lower Michigan's maternal mortality rate, which is still one of the highest in the nation.
The U.S. ranks 64th in the world for maternal deaths, and Michigan ranks eighth in the nation, despite some recent improvement and dropping from No. 5 in 2010. But because of continued high national rates, the American Congress of Obstetricians and Gynecologists, of which Jones is a member, has created the Alliance for Innovation on Maternal Health, or AIM, with a number of other organizations in an effort to reduce maternal deaths.
The alliance's goal, which Jones told Crain's Detroit Business will be difficult to achieve, is to reduce by 1,000 nationally maternal deaths and cut severe maternal morbidity, or the numbers of patients who nearly die, by 100,000 over four years from 2015 to 2018.
"The U.S. maternal mortality rate, aside from Afghanistan and Sudan, is the only country with a rate on the rise," said Jones, who practices at the IHA Canton Obstetrics & Gynecology clinic and is the Michigan ACOG section chairman.
"In Michigan, there is a racial disparity as well. We are third overall (in the U.S.) for African-Americans. We have to sort out ways to make an impact" to lower rates, Jones said.
Overall, Michigan's pregnancy-related mortality rate was 10.6 deaths per 100,000 live births in 2013, the last year for which the Michigan Department of Health and Human Services has data. Those numbers are down from 16.8 deaths per 100,000 live births in 2007, according to the department's Michigan Mortality Surveillance Committee.
However, black women die at a rate 4.9 times higher than white women in Michigan: 36.1 deaths per 100,000 population for black women compared with 7.4 deaths per 100,000 for white women, according to the MDHHS.
Maternal deaths related to pregnancy or childbirth have declined to 12 women in 2013 from 21 in 2010, according to the MDHHS. It is unclear how accurate those numbers are because reporting had been voluntary.
Earlier this year, Public Act 479 mandated that all maternal deaths at hospitals or other healthcare facilities be reported to the state. The law specified that a maternal death included mothers who died during or within one year of childbirth.
But a more telling statistic is that for every woman who dies in childbirth, 100 more suffer a severe life-threatening injury, infection or disease, which adds up to about 2,500 mothers per year, Jones said.
"For every maternal death, there are probably 100 cases of near-misses, where they almost died," Jones said. Because of the data collected by hospitals and the state, "we are learning about situations where there is severe morbidity" that officials didn't know about before.
Over the past year, AIM began focusing its energy on Michigan and five other states with the nation's highest maternal mortality rates: Oklahoma, Maryland, Florida, Louisiana and Illinois.
Jones said the leading causes of pregnancy-related death are obstetric hemorrhage, hypertension, embolism, amniotic fluid embolism, infection and a worsening of pre-existing chronic conditions.
As a result, ACOG and other women's health professional groups developed several "maternal safety bundles." Many of Michigan's 82 hospitals with maternity wards have implemented at least two of them, but Jones said hospitals need to do more.
Once implemented at hospitals, the safety bundles provide actionable measures to identify, prevent and treat severe maternal complications in pregnancy and childbirth. The bundles include:
- Obstetric hemorrhage
- Severe hypertension/pre-eclampsia
- Maternal prevention of venous thromboembolism
- Safe reduction of primary cesarean section, support for intended vaginal birth
- Postpartum care basics for maternal safety
- Patient, family and staff support after a severe maternal event
"This is when women deliver a baby, and depending on the circumstances, women can bleed to death," Jones said. "There can be multiple reasons. It could be a pre-existing condition for the mother (or) a pregnancy-related condition (such as a) placenta implanted incorrectly."
Other reasons could be multiple births or rapid delivery, she said.
"AIM identified these reasons and created these safety bundles for what every obstetrician should do to become safe," Jones said. "It is a very simple process. Readiness has to do with predicting the risk of women's hemorrhage, recognizing it and preventing it."
Jones said AIM has been trying to collect data from hospitals to determine best practices that can be shared.
Groups involved in the AIM effort include ACOG, the MDHHS, the Michigan Health and Hospital Association, the Michigan Medical Society, and local chapters of the American College of Nurse Midwives, the Association of Maternal and Child Health Programs and the Association of Women's Health, Obstetric, and Neonatal Nurses.
"We started this in 2015 and made some headway. Everybody wanted to be on board and part of the AIM program, but as we have moved on with this, hospitals lose staff, lose resources, lose momentum for the program. Other quality initiatives take precedent. As a result we don't get the data back," Jones said.
At the last AIM meeting, Jones said of the 82 hospitals, 50 have implemented the hemorrhage bundle, but 32 have not provided information of whether they have started the bundle or not. Another 45 are doing the hypertension bundle, she said.
"Only four hospitals have shared all data we need to affect knowledge about bundles and to evaluate whether we are affecting the outcomes," Jones said.
Sam Watson, the MHA's senior vice president of patient safety and quality, said the association has been working on issues related to reducing infant mortality since 2009. Because it had a data collection system in place already, Watson said the MHA agreed with AIM to collect hospital data for the project.
Watson said most hospitals are aware of the patient-safety bundles and are in the process of implementing them.
"We are collecting data on postpartum hemorrhage, where the mom bleeds substantially, and pre-eclampsia (convulsions) hypertension," Watson said.
"The AIM national team has six bundles, and the first two have been implemented in Michigan," he said. "When you think about the effort that goes into a package of interventions, it takes substantial amount of work and time to capture the data."
In 2018, Watson said he expects the local improvement teams, led by Jones and others, to visit more hospitals and share best practices with them.
"Hospitals ramp up efforts to reduce maternal deaths in Michigan" originally appeared in Crain's Detroit Business.
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