Hanley Center For Health Leadership And Education

PERINATAL QUALITY COLLABORATIVE FOR MAINE (PQC4ME) - MAINE IS THE MOST RURAL STATE IN THE NATION, WITH A TOTAL POPULATION OF 1.34 MILLION. POVERTY, RURAL ISOLATION, LACK OF PUBLIC TRANSPORTATION, FOOD INSECURITY AND SUBSTANCE USE ARE SOME OF MAINE’S TOP HEALTH-RELATED CHALLENGES, ALL OF WHICH IMPACT MATERNAL, CHILD AND FAMILY HEALTH STATUS. OVER THE LAST 20 YEARS, EIGHT HOSPITAL OB UNITS HAVE CLOSED, AND ANOTHER OB UNIT CLOSURE IS PENDING IN A SMALL CITY THAT IS HOME TO A GROWING COMMUNITY OF IMMIGRANTS AND REFUGEES. KEY ASSETS OF THE STATE INCLUDE A SHARED COMMITMENT BY HEALTH CARE PROVIDERS, ADVOCATES, PUBLIC HEALTH ORGANIZATIONS, COMMUNITY LEADERS AND MANY OTHERS TO IMPROVING OUTCOMES FOR ALL INFANTS, CHILDREN AND FAMILIES, PARTICULARLY THOSE EXPERIENCING HEALTH INEQUITIES. PQC4ME, MAINE’S STATEWIDE PERINATAL QUALITY COLLABORATIVE, IS ACTIVELY WORKING TO ADDRESS THESE CHALLENGES AND IMPROVE OUTCOMES FOR ALL MOTHERS, INFANTS, AND FAMILIES. BASED AT THE MAINE MEDICAL ASSOCIATION CENTER FOR QUALITY IMPROVEMENT, PQC4ME PLANS, IMPLEMENTS AND EVALUATES PERINATAL QI INITIATIVES IN COLLABORATION WITH ALL MAINE BIRTHING HOSPITALS AND MANY PUBLIC AND PRIVATE SECTOR PARTNERS. STRATEGIES FOR YEAR 1 PROPOSED IN THIS APPLICATION INCLUDE: 1) PLAN, IMPLEMENT, AND EVALUATE THE AIM SEVERE HYPERTENSION IN PREGNANCY BUNDLE BY ENGAGING WITH 100% OF MAINE’S 25 BIRTHING HOSPITALS, WITH PARTICULAR FOCUS ON THOSE THAT SERVE DISPROPORTIONATELY IMPACTED POPULATIONS; 2) ADVANCE HEALTH EQUITY IN THE DIAGNOSIS AND MANAGEMENT OF MATERNAL HYPERTENSION BY ENGAGING VULNERABLE POPULATIONS IN EVALUATING TOOLS AND RESOURCES USED IN BIRTHING FACILITY PATIENT EDUCATION AND DISCHARGE PLANNING; AND 3) ESTABLISH PQC4ME AS MAINE’S CENTER OF EXCELLENCE FOR PERINATAL QUALITY IMPROVEMENT INITIATIVES BY ENHANCING ITS CAPACITY TO MAKE MEASURABLE IMPROVEMENTS IN PERINATAL CARE AND OUTCOMES STATEWIDE. RESULTS OF THE INITIATIVE WILL BE USED TO IMPROVE THE PREVENTION, DIAGNOSIS AND TREATMENT OF MATERNAL HYPERTENSION AND WILL ULTIMATELY LEAD TO R EDUCTIONS IN MATERNAL MORBIDITY AND MORTALITY. IN ADDITION TO THE YEAR 1 QI INITIATIVE, PQC4ME WILL CONTINUE IMPLEMENTATION OF EXISTING QI PROJECTS, IDENTIFY PRIORITIES FOR FUTURE PERINATAL QI INITIATIVES, LEAD THE PQC4ME STEERING COMMITTEE, IMPLEMENT EDUCATION TRAINING AND DISSEMINATION ACTIVITIES AND COLLABORATE WITH STATE, REGIONAL AND NATIONAL PARTNERS, INCLUDING THE NNPQC.

SUPPORTING MAINE'S MATERNAL MORTALITY REVIEW COMMITTEES - PROJECT ABSTRACT THE PURPOSE OF THIS PROPOSAL IS TO ENHANCE THE CAPACITY OF THE EXISTING MAINE MATERNAL, FETAL, AND INFANT MORTALITY REVIEW (MFIMR) PANEL TO IDENTIFY, REVIEW, PROVIDE, AND IMPLEMENT RECOMMENDATIONS FOR PREVENTION OF MATERNAL DEATHS. THIS PROPOSAL CONTINUES RESPONSIBILITY FOR MAINE’S MATERNAL MORTALITY REVIEWS TO THE MAINE MEDICAL EDUCATION TRUST, MAINE MEDICAL ASSOCIATION – CENTER FOR QUALITY IMPROVEMENT (MMA-CQI), WHILE MAINTAINING A STRONG WORKING COLLABORATION WITH THE EXISTING PANEL AND THE MAINE CENTER FOR DISEASE PREVENTION AND CONTROL (MAINE CDC), THE STATE PUBLIC HEALTH AGENCY. THREE STRATEGIES AND RELATED ACTIVITIES ARE PROPOSED: STRATEGY 1: ACTIONS THAT IMPROVE THE AVAILABILITY, QUALITY, AND TIMELINESS OF MMRC DATA. • FULLY OPERATIONALIZE THE MMRIA SYSTEM TO SUPPORT CORE FUNCTIONS. • COMPREHENSIVELY IDENTIFY PREGNANCY-ASSOCIATED DEATHS. • IMPLEMENT APPROACHES FOR IMPROVING QUALITY OF DEATH RECORDS AND FOR TIMELY DEATH RECORD QUALITY ASSURANCE. • APPLY A CONSISTENT PROCESS AND STANDARDIZED CRITERIA FOR SELECTING DEATHS THAT WILL BE FULLY ABSTRACTED FOR COMMITTEE REVIEW. • IMPLEMENT INFORMANT INTERVIEW APPROACHES. • ABSTRACT AND ENTER INFORMATION FROM MEDICAL RECORDS, SOCIAL SERVICE RECORDS, INFORMANT INTERVIEWS, AND OTHER RELEVANT SOURCES ABOUT ALL DEATHS POTENTIALLY RELATED TO PREGNANCY INTO MMRIA WITHIN 18 MONTHS OF THE DEATH. • DOCUMENT COMMITTEE DECISIONS ON THE MMRIA COMMITTEE DECISIONS FORM IN MMRIA. • PERFORM DATA QUALITY ASSURANCE CHECKS ON ALL RELEVANT MMRIA FORMS. STRATEGY 2: ACTIONS THAT IMPROVE MULTI-DISCIPLINARY, POPULATION-LEVEL REVIEW OF PREGNANCY-RELATED DEATHS AND DOCUMENTATION OF RECOMMENDATIONS FOR PREVENTION. • MAINTAIN A MULTIDISCIPLINARY REVIEW COMMITTEE. • MAINTAIN A DIVERSE REVIEW COMMITTEE. STRATEGY 3: ACTIONS THAT IMPROVE DISSEMINATION, ACCESS TO, AND EMPLOYMENT OF QUALITY MMRIA DATA TO DRIVE OPPORTUNITIES FOR PREVENTION. • ESTABLISH AN ANALYTIC PLAN FOR PREGNANCY RELATED MMRIA DATA. • ESTABLISH A DISSEMINATION PLAN FOR INFORMATION ON PREGNANCY-RELATED ANALYSES. • IMPLEMENT DISSEMINATION STRATEGIES FOR DATA PRODUCTS AND RELATED INFORMATION FROM PREGNANCY-RELATED ANALYSES. • DEVELOP AND SUSTAIN BIDIRECTIONAL PARTNERSHIPS WITH COMMUNITIES THAT INCREASE THE UTILIZATION OF MMRC DATA TO INCREASE THE TRANSPARENCY OF MMRC PROCESSES AND DATA. • LEVERAGE COLLABORATIVE PARTNERSHIPS TO SUPPORT ACTION ON MMRC INFORMATION AND INFORM PRACTICE, PROGRAM, AND POLICY CHANGES. ACTIVITIES WILL BE ACCOMPLISHED IN PARTNERSHIP WITH THE MAINE CDC, THE MFIMR PANEL COORDINATOR, AND IN COLLABORATION WITH PROFESSIONAL ASSOCIATIONS AND COMMUNITY ORGANIZATIONS. ANTICIPATED SHORT AND INTERMEDIATE OUTCOMES INCLUDE: - INCREASED TIMELINESS, ACCURACY, AND STANDARDIZATION OF INFORMATION AVAILABLE ABOUT PREGNANCY-RELATED DEATHS, INCLUDING DOCUMENTED OPPORTUNITIES FOR PREVENTION. - INCREASED ENGAGEMENT AND COOPERATION BETWEEN MMRCS, PARTNERS, AND COMMUNITIES TO COMMUNICATE INFORMATION FROM DATA ON PREGNANCY-RELATED DEATHS. - INCREASED AVAILABILITY OF RECOMMENDATIONS OF THE MMRCS AMONG COMMUNITIES, CLINICIANS, PUBLIC HEALTH PRACTITIONERS, AND DECISIONMAKERS - INCREASED ADOPTION OF CLINICAL AND NON-CLINICAL POLICIES AND PROGRAMS THAT REFLECT THE HIGHEST STANDARDS OF CARE. - INCREASED IMPLEMENTATION OF RECOMMENDATIONS THAT REACH OR CONSIDER THE NEEDS OF POPULATIONS DISPROPORTIONATELY AFFECTED BY PREGNANCY-RELATED MORTALITY. EVALUATION WILL FOCUS ON THE EXTENT TO WHICH SHORT AND INTERMEDIATE OUTCOME MEASURES OUTLINED IN THE PERFORMANCE MEASUREMENT PLAN ARE MET OVER THE FIVE-YEAR FUNDING PERIOD.

SUPPORTING MAINE'S MATERNAL MORTALITY REVIEW COMMITTEES - THE PURPOSE OF THIS PROPOSAL IS TO ENHANCE THE CAPACITY OF THE EXISTING MAINE MATERNAL, FETAL AND INFANT MORTALITY REVIEW (MFIMR) PANEL TO IDENTIFY, REVIEW, PROVIDE AND IMPLEMENT RECOMMENDATIONS FOR PREVENTION OF MATERNAL DEATHS. THIS PROPOSAL MOVES RESPONSIBILITY FOR MAINE’S MATERNAL MORTALITY REVIEWS TO THE MAINE MEDICAL EDUCATION TRUST, MAINE MEDICAL ASSOCIATION - CENTER FOR QUALITY IMPROVEMENT (MMA-CQI), WHILE MAINTAINING A STRONG WORKING COLLABORATION WITH THE EXISTING PANEL AND THE MAINE CENTERS FOR DISEASE PREVENTION AND CONTROL (MAINE CDC), THE STATE PUBLIC HEALTH AGENCY. FOUR FACTORS CONTRIBUTE TO THE RATIONALE FOR THIS APPROACH:1) CURRENT PANEL COORDINATOR CAPACITY IN THE MAINE CDC IS INSUFFICIENT TO CONDUCT COMPREHENSIVE MATERNAL MORTALITY REVIEWS AND RELATED WORK; 2) EXPANDING OR ADDING POSITIONS TO STATE GOVERNMENT, EVEN WITH FUNDING FROM EXTERNAL SOURCES, IS CHALLENGING AND OFTEN REQUIRES YEARS TO OBTAIN APPROVAL; 3) MMA-CQI HAS THE CAPACITY AND EXPERTISE TO ACTIVELY SUPPORT DISSEMINATION AND ACTION ON RECOMMENDATIONS RELATED TO MATERNAL MORTALITY PREVENTION THROUGH THE PQC4ME, THE STATEWIDE PERINATAL QUALITY IMPROVEMENT COLLABORATIVE BASED AT MMA-CQI AND OTHER STRATEGIES; AND 4) THE MAINE CDC MCH PROGRAM STRONGLY SUPPORTS EXPANDING CURRENT CAPACITY FOR MATERNAL MORTALITY REVIEW THROUGH THIS COLLABORATION AND WILL ASSURE ACCOUNTABILITY TO THE MAINE CDC AND THE U.S. CDC. TWO STRATEGIES AND RELATED ACTIVITIES ARE PROPOSED: STRATEGY 1: IMPROVE THE AVAILABILITY, QUALITY, AND TIMELINESS OF MAINE MMRC DATA. - ESTABLISH A MAINE MATERNAL REVIEW COMMITTEE TO FOCUS ON MATERNAL MORTALITY AS PART OF THE MAINE MFIMR PANEL - REVIEW ALL PREGNANCY-ASSOCIATED DEATHS WITHIN ONE YEAR OF DEATH - ABSTRACT RECORDS AND ENTER INFORMATION FROM MEDICAL RECORDS, SOCIAL SERVICES, AND OTHER RELEVANT SOURCES INTO MMRIA (MATERNAL MORTALITY REVIEW INFORMATION APPLICATION) WITHIN 18 MONTHS OF EACH DEATH - IMPLEMENT INFORMANT INTERVIEWS, CONSISTENT WITH U.S. CDC GUIDANCE STRATEGY 2: IMPROVE MULTI-DISCIPLINARY, POPULATION-LEVEL REVIEW OF POTENTIAL PREGNANCY-RELATED DEATHS AND DOCUMENTATION AND DISSEMINATION OF RECOMMENDATIONS FOR PREVENTION. - PERFORM A GAP ANALYSIS TO IDENTIFY AND ENGAGE COMMUNITIES AND DISCIPLINES CURRENTLY UNDERREPRESENTED ON THE MFIMR PANEL - PARTNER WITH MMA-CQI, PQC4ME, AND THE MAINE CDC TO IMPLEMENT QUALITY IMPROVEMENT AND OTHER INITIATIVES WITH COMMUNITIES, CLINICIANS, AND POLICYMAKERS - DISSEMINATE FINDINGS AND RECOMMENDATIONS FOR ACTION THROUGH CONFERENCES, WEBINARS, NEWSLETTERS, PRESENTATIONS AND WEBSITES ACTIVITIES WILL BE ACCOMPLISHED IN PARTNERSHIP WITH THE MAINE CDC, THE MFIMR PANEL COORDINATOR AND IN COLLABORATION WITH PROFESSIONAL ASSOCIATIONS AND COMMUNITY ORGANIZATIONS. EVALUATION WILL FOCUS ON THE EXTENT TO WHICH SHORT, INTERMEDIATE AND LONG-TERM OUTCOMES OUTLINED IN THE PERFORMANCE MEASUREMENT PLAN ARE MET OVER THE TWO-YEAR FUNDING PERIOD.