State Quality Initiative Can Reduce Maternal Morbidity

A statewide quality initiative can improve severe maternal morbidity (SMM) and reduce the incidence of maternal morbidity and mortality from postpartum hemorrhage (PPH), a modeling analysis found. Such measures could potentially provide savings to birthing hospitals, according to the California cost-effectiveness study, published in Obstetrics & Gynecology.

A team led by Eric C. Wiesehan, MHA, MBA, a PhD candidate in health policy at Stanford (Calif.) University, examined the effects of the safety initiative of the California Maternal Quality Care Collaborative (CMQCC) in a theoretical cohort of 480,000 births across a mix of hospital settings and sizes. The CMQCC developed a PPH toolkit and quality-improvement protocol to increase recognition, measurement, and timely response to PPH.

Drawing retrospectively on a large 2017 California implementation study, the simulation estimated that collaborative implementation of the CMQCC added 182 quality-adjusted life-years (0.000379 per birth) by averting 913 cases of SMM, 28 emergency hysterectomies, and one maternal mortality. Additionally, it saved $9 million ($17.78 per birth) owing to avoided SMM costs.

According to the Centers for Disease Control and Prevention, pregnancy-related maternal deaths in the United States have increased from 7.2 per 100,000 live births to 16.9 per 100,000 live births over the past 20 years, making it the only country in the Organization for Economic Cooperation and Development with rising rates of maternal mortality. PPH accounts for 11% of maternal deaths.

As to the study’s broader applicability, Dr. Wiesehan said in an interview, “findings of effectiveness in terms of reducing PPH-related SMM are well known outside of California. In terms of costs, however, it is more of an unknown how much is generalizable. It would go a long way if another state quality care collaborative implementing such a project recorded costs prospectively. Prospective costing, particularly microcosting, would be optimal to precisely place where the most, or least, value of this quality improvement project is achieved.”

Studies of PPH safety programs in other U.S. jurisdictions showing reductions in blood transfusions and maternal morbidities suggest the current findings are relevant to a range of hospital settings and regions. “With state perinatal collaboratives already in 47 states, examination of implementation of the PPH-SMM reduction initiative within additional collaboratives would add further robustness to our findings,” the authors wrote.

In 2022, a New York City hospital study reported that learning collaboratives that optimize practice and raise staff awareness could be important tools for improving maternal outcomes.

Still to be answered, said Dr. Wiesehan, are questions about the long-term effectiveness and sustainability of the quality initiative project beyond the early pre/post periods.

The authors indicated no specific funding for the study and had no conflicts of interest to disclose.

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This article originally appeared on, part of the Medscape Professional Network.

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