By Kimberlee McKay and Peter Shamamian Aug. 16, 2021
After languishing in the background for far too long, the shockingly high rate of complications and deaths related to pregnancy and childbirth in the U.S. is beginning to get serious attention. What’s needed to give new proposals and programs on maternal health the traction they need is data.
President Biden’s Covid-19 relief package includes a provision to mitigate maternal mortality by extending Medicaid coverage for women for two years after they’ve given birth. There is also momentum to continue this coverage expansion beyond two years. And the Black Maternal Health Caucus has introduced the Black Maternal Health Momnibus Act of 2021 which, among other items, would address social determinants of maternal health such as housing, transportation, and nutrition, factors known to have a direct impact on the health and well-being of mothers and infants.
From our vantage point as physicians, we know that many of the complications and deaths related to pregnancy and childbirth are likely preventable. Yet a lack of consistent and reliable information about pregnancy and childbirth has created a blind spot, limiting experts’ understanding of what is going on and how to keep mothers and their babies safer.
A new collaboration, led by the Office on Women’s Health at the Department of Health and Human Services, is taking a data-first approach to this urgent problem. Using a system that captures health information for nearly one-third of U.S. births, the initiative draws on this data to understand care delivery and outcomes. A network of 200 hospitals will then use this intelligence to implement and test solutions in real-world hospital settings.
This network targets hospitals caring for underserved populations, including the health systems we work for, Avera Health (K.M.) and Montefiore Health System (P.S.). Avera serves a 72,000-square-mile territory across South Dakota and neighboring states, with one tertiary care center in Sioux Falls and 15 small hospitals in rural settings. Montefiore is the dominant health care provider in the Bronx, a borough of New York City comprising one of the poorest and most diverse communities in the country.
Despite starkly different settings, Avera and Montefiore share similar struggles. Our patients often face a compounded risk to pregnancy due not only to health issues but also to a myriad of hurdles outside of their (and our) control, like food insecurity, lack of transportation, and poverty. Although the effects of these social determinants of health are known within medicine, Covid-19 has given the public an understanding of how devastating social inequities can be on health.
As physicians and clinical directors, we have hypotheses for what’s driving increases in severe complications such as excessive bleeding after childbirth, but we can’t know for sure without reliable data. This initiative will provide public health experts, clinicians, and others with information from across a wide swath of U.S. hospitals to answer important questions around maternity care and the downstream effects on babies. In particular, we look forward to the compilation of evidence for interventions and protocols that mitigate social determinants of health and reverse staggering racial and ethnic disparities.
As documented in a recent Government Accountability Office report, maternity care for rural mothers is particularly worrisome, and more robust data collection is needed for this group. Clinical guidelines tend to be tilted toward care offered in tertiary care centers, which are equipped to provide more advanced treatments. As participants in this cohort, we are eager to augment current best practices and, for instance, collect evidence supporting the best treatment for hemorrhage if platelets — the gold standard — are not available, which is often the case in rural facilities.
HHS, working with Premier, Inc., a health care improvement company that has already done significant work in maternal health, have engineered a data system that integrates standardized information from electronic health records and other data sources with care quality, utilization, and cost information. HHS and Premier automatically pull this data, minimizing error and posing little burden to providers and hospitals, which is essential for meaningful and sustained participation.
Never before have health systems been able to pool information on this scale — and with such ease — and communicate to doctors, nurses, midwives, and other clinicians what’s working best and how they’re doing compared to their peers. The use of benchmarked, facility-specific data illuminates specific practices that are associated with better outcomes. For professionals committed to caring for people and motivated by success, this feedback loop is a powerful and underutilized tool for behavior change.
Combining new data with tested quality-improvement practices works to improve care and curb spending. U.S. hospitals that have previously leveraged this model were able to reduce maternal harm and deaths by 20%, reduce rates of early elective deliveries by 67% and save millions in costs. But what’s profound is the scale of the new efforts by the Office on Women’s Health, which will generate a trove of evidence and bring together an alliance of institutions dedicated to translating millions of data points into effective practices.
The U.S. health care system has been failing families and communities and the nation has been too slow to respond. We applaud HHS’ initiative for infusing needed urgency and momentum to address the ongoing crisis in maternal health and scale solutions for the women, children, and families who need them most.
Kimberlee McKay is a board-certified OB-GYN and the clinical vice president for the OB-GYN service line at Avera Health. Peter Shamamian is the vice president, chief quality officer, and vice chairman for quality improvement and performance at Montefiore Medical Center, and professor of surgery at Albert Einstein College of Medicine