Overview Of Maternal Mortality In Kentucky And Strategies .

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Overview of Maternal Mortality in Kentuckyand Strategies for Change2020 KHA Quality ConferenceConnie Gayle White, MD, MS, FACOGDeputy CommissionerDr. Jeffrey D. Howard, Commissioner

Maternal Mortality 2018 - CDC2

Maternal Mortality Rate, United StatesDeaths per 100,000 live births1000900800700600500400JAMA “proclamation”30020010001900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010“The apparently irreducible minimum of1 maternal death per 1000 live births.”Maternal Deaths—One in a Thousand. JAMA.1950 ;144(13):1096–1097.

U.S. MMR* Compared toIndustrialized Countriesranks last among wealthywith 300,000 births, U.S.countries – even if you limit the2014, using WHO EstimatesU.S. to white U.S. All0246* Maternal Mortality Ratio per 100,000 births8101214.814Source: Maternal Mortality: 1990 to 2015 Estimates by WHO, UNICEF, UNFPA, World Bank Group & UN Population Division. Geneva:2015. U.S. rates estimated based on adjustment to pregnancy-related mortality rates in Creanga et al. Obstet Gynecol 2017.16

KRS 211.684KRS 211.6865

Composition of the Maternal Mortality ReviewCommittee (MMRC) Maternal medicine specialistsNeonatologistsOB AnesthesiologyOB Women’s CardiologyAmerican College of Obstetrics andGynecologyAmerican Academy of PediatricsAssociation of Women’s HealthObstetric and Neonatal NursesDepartment for Community BasedServicesKASPER Certified Nurse MidwifeKentucky Hospital AssociationChief Medical ExaminerDomestic Violence & HumanTrafficking – Office of the AttorneyGeneral Department for Behavioral Health,Developmental and IntellectualDisabilities Kentucky State Police Department for Medicaid Services6

Methodology1 Deaths of women 10 to 55 years of age2 Deaths linked to live birth or stillborn deathcertificates occurring within one year prior todeath3 Deaths identified by the completion of thepregnancy boxed on the death certificate7




CDC: A death is considered preventable, if thecommittee determines that there was at least somechance of the death being avertedPatient Lack of adherence to medications or treatment plans Abusive relationships or unstable housing Lack of social support systems Lack on insight into high risk patterns or warning signs

Preventable FactorsProvider Assessment Lack of screening or incomplete assessment Ineffective treatment Communication Lack of communication between providers More handoffs Lack of communication between provider and familyFacility Inadequate assessment of risk

Preventable FactorsCommunity Lack of services needed in local areaSystemic Factors Inadequate systems of care coordination Inadequate training and support for personnel Inadequate or unavailable personnel Lack of policies and procedures

Completeness of RecordsCOMPLETENESS OF e43%14

Immediate Cause of ication/Overdose 31%Motorvehicleaccident16%Cardiovascular & Coronary 15

Pregnancy RelatednessNot pregnancyrelated orassociated21%Pregnancyassociated,unable cyassociated,not related48%16

Preventable Death?No14%Unknown5%Yes81%17

Substance Use Contributing to DeathUnknown13%Probably5%Yes48%No34%18

Chance to Alter OutcomeUnable toDetermine16%GoodChance24%No Chance8%SomeChance52%19

Kentucky MMRC RecommendationsImprove case coordination throughout awoman’s pregnancy between all healthcare providers addressing morbidities,emergency care, oral health, and mentalhealth.20

Refer to ensure continued care Review KASPER for each new OB patient Inform about best practices forprescribing for opioids Screen and refer for SUD and mentalhealth21

Kentucky MMRC RecommendationsEncourage implementing safetymeasures throughout various clinicaldisciplines associated with the healthcare of pregnant and postpartumwomen.22

Educate all on maternal safety bundles Encourage safety planning among patientsfor prenatal and well women providers23

Council for Patient Safety in Women’s Health Care Funded by the Maternal Child Health Bureau Initial funding for four years (2014-2018) Promote consistent and safe maternity care to: reduce maternal mortality by 1,000 reduce severe maternal mortality by 100,00024

AIM Core Partners American College of Obstetricians and Gynecologists (ACOG) American College of Nurse Midwives (ACNM) Association of Maternal and Child Health Programs (AMCHP) Association of State and Territorial Health Officials (ASTHO) Association of Women’s Health, Obstetric, and NeonatalNurses (AWHONN) California Maternal Quality Care Collaborative (CMQCC) Society for Maternal-Fetal Medicine (SMFM)25

National data-driven maternal safety and quality improvementinitiative based on proven implementation approaches to improvingmaternal safety and outcomes in the U.S. Access Patient Safety Bundles & Tools proven to save lives andreduce maternal morbidity. Join a growing community dedicated to maternal safety and quality. Champion a culture of maternal safety in the U.S.26

October 22, 2019Churchill Downs28


Partnership and CoordinationSource: CDC, Julie Zaharatos

Severe Morbidity Reduction: HemorrhageSevere Maternal Morbidity (SMM)-Hemorrhage(per 100 pMain et al. Am J Obstet Gynecol 2017;216(3):298.e1-298.e11.Main et al. Am J Obstet Gynecol 2017;216(3):298.e1-298.e11. Hospitals thatimplemented hemorrhagesafety bundle as part of alearning collaborative: 20% reduction in SMM-H 28% reduction if priorparticipation 11.7% decrease in SMMamong all obstetricpatients




KASPER Review of Postpartum OpioidPrescribing (2014-2017)35

KASPER Review of Postpartum OpioidPrescribing (2014-2017)36

KASPER Review of Postpartum OpioidPrescribing (2014-2017)37

Attributing Initial (within 7 days of delivery)Opioid Analgesic Prescribing to Hospitals(N 75,998)38






Overview of Maternal Mortality in Kentucky and Strategies for Change 2020 KHA Quality Conference Connie Gayle White, MD, MS, FACOG. Deputy Commissioner. Maternal Mortality 2018 - CDC. 2. Maternal Mortality Rate, United States. . reduce maternal morbidity. .

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