Advisory Committee on Maternal Fatalities and Morbidity (MFM) Meeting - PDF document

Advisory Committee on Maternal Fatalities and Morbidity (MFM) Meeting Time and Location: Thursday, October 17, 2019: 8:30AM-12:00PM Arizona Department of Health Services Building 250 N 17th Ave., Phoenix, AZ 250-IGLOO Conference Room (1st Floor) Please join the meeting from your computer, tablet, or smartphone: Join Webex meeting ID: 805137610 Password: itjnQNVu Join by phone +1-415-655-0003 US Toll Access code: 805-137-610 Agenda items: I. Call to Order Committee Chair II. Review and Approval of Minutes Committee Chair III. General Report Feedback Facilitator IV. Roundtable on Recommendations Facilitator V. Additional Discussion on Methodology Facilitator VI. Review Timeline and Next Steps Facilitator VII. Call to the Public Committee Chair VIII.Meeting Adjourned Next Meeting Date: Thursday, November 14 at 8:30AM Call to the Public: This is the time for the public to comment. Members of the Board ​ may not discuss items that are not specifically identified on the agenda. ​ Therefore, pursuant to A.R.S. § 38-431.01(H), action taken as a result of public comment will be limited to directing staff to study the matter, responding to any criticism or scheduling the matter for further consideration and decision at a later date Douglas A. Ducey | Governor Cara M. Christ, MD, MS | Director 150 North 18th Avenue, Suite 500, Phoenix, AZ 85007-3247 P | 602-542-1025 F | 602-542-0883 W | azhealth.gov Health and Wellness for all Arizonans

Maternal Fatalities and Morbidity Advisory Committee Meeting Members Present: ADHS Staff Present: Patricia Tarango Jessica Perfette, ADHS, BWCH Dr. Charlton Wilson Kate Lewandowski, ADHS, BWCH Dr. Michael Madsen Gerilene Haskon, ADHS, BWCH Amy Lebbon Kyle Gardner, ADHS, BWCH Dr. Carl Bronitsky Heidi Christensen, ADHS, BWCH Dr. Robert Johnson Martín ​ Celaya, ADHS, BWCH (via Draft Sandy Severson teleconference) Dr. Eric Tack Mary Ellen Cunningham Public Attendees Present: Dr. Mike Foley Dave Nakashima, Facilitator Breann Westmore Jessie Armendt, MOD Jennifer Carusetta Diana Jolles (via teleconference) Dr. Cynthia Booth (via teleconference) Dr. Guadalupe Herrera-Garcia (via teleconference) Mike Mote (via teleconference) Members Absent: Dr. Satya Sarma 1. Call to Order The Maternal Fatalities and Morbidity Advisory Committee meeting convened at the Arizona Department of Health Services, 150 N 18th Avenue, 540 A (5th Floor) in Phoenix, Arizona and via teleconference on Monday, September 16, 2019. Gerilene Haskon conducted roll call. A quorum being present, Madam Chair Patricia Tarango call the meeting to ord ​ er at 12:06 PM ​ . 2. Review and Approval Of Minutes Madam Chair Patricia Tarango introduced the meeting minutes from the Advisory Committee Meeting held on August 30,2019 for review. Ms. Mary Ellen Cunningham motioned to accept the minutes as written. Dr. Charlton Wilson seconded the motion and the advisory committee voted and approved. Douglas A. Ducey | Governor Cara M. Christ, MD, MS | Director 150 North 18th Avenue, Suite 500, Phoenix, AZ 85007-3247 P | 602-542-1025 F | 602-542-0883 W | azhealth.gov Health and Wellness for all Arizonans

3. Review Gaps and Proposed Solutions Sheets Martín Celaya, Chief of Assessment and Evaluation in the Bureau of Women’s and Children’s Health at the Arizona Department of Health Services gave an overview of the identified challenges and possible solutions for the Maternal Mortality Review process. ​ For more detailed information please refer to meeting handout titled, ​ Maternal Mortality Review Process: Identified Challenges and Recommendations. Draft 4. Panel Discussion with ADHS Staff Kyle Garder, Kate Lewandowski, Jessica Perfette, Gerilene Haskon, and ​ Martín Celaya (via phone) were all present and available to answer questions from the Advisory Committee. Staff answered all the questions posed by the committee; however there was no formal panel discussion. The following are questions submitted prior to the meeting to be answered by the panel: 1. Could someone on the panel explain the MMRC’s four categories of deaths (pregnancy-related death; pregnancy-associated death; not pregnancy related or associated; and unable to determine) and how the determination is made in which category the death is categorized? 2. In the last report on maternal deaths, it was talked about how deaths that were flagged for being a pregnancy related death needed to be confirmed. Could someone discuss that process and what records are being reviewed? 3. On the Arizona death certificate, the certifier has to check one of 5 categories for females: not pregnant within last year; pregnant at the time of death; not pregnant, but pregnant within 42 days of death; not pregnant but pregnant 43 days to 1 year before death; and unknown if pregnant within last year. Has there been any quantification or general sense of what percentage of childbearing age females are certified with “unknown”? One concern I have coming from a medical examiner perspective is that we most often check that as we simple are often do not necessarily have that knowledge. Unless it is very obvious and known that a person was pregnant in the last year, most ME offices would not know as pregnancy history is not routinely screened for and gathered during a death investigation. This probably wouldn’t have a large effect on pregnancy-related deaths, but pregnancy associated deaths could be underestimated as there could be medical examiner cases of suicides, accidents, etc where pregnancy status is just simply unknown. Douglas A. Ducey | Governor Cara M. Christ, MD, MS | Director 150 North 18th Avenue, Suite 500, Phoenix, AZ 85007-3247 P | 602-542-1025 F | 602-542-0883 W | azhealth.gov Health and Wellness for all Arizonans

4. The MMRP identified challenges discussed that finalized vital statistics data is only made available on an annual basis, which prohibits ongoing case identification and review. Can someone discuss the process and timeline of how cases are identified? I have served on other mortality boards in Coconino County and in other states before coming to Coconino County, and it seemed like cases were identified and the review process started soon after death registration or death certification occurred. I’m wondering if there are capabilities to identify these cases in a more real-time sense. 5. When it comes to morbidity data, why are data available only delivery hospitalizations? Draft Is this due to a statute or a different rule? Is there any sort of mechanism to get pregnancy or postpartum related ER visits or hospitalization data? 5. Roundtable Discussions Among Advisory Committee for Recommendation Development The Advisory Committee’s discussion was facilitated by Dave Nakashima and centered around four areas of focus; Data Collection Process, Committee Composition, Maternal Mortality Review Process, and Dissemination and Implementation Of MMRC Findings and Recommendations. Data Collection Process: ● Include all recommendations from the ADHS meeting handout titled, ​ Maternal Mortality Review Process: Identified Challenges and Recommendations ● Develop training for those entities and staff that records are being requested from ○ ​ Understanding of what is being asked and statute requirements ● ​ Increase real time availability of records for pregnancy related deaths ○ ​ Review as soon as possible it increase health outcomes in these hospitals ● Build relationships across the state to decrease cycle time from record release ○ Increase MOU’s with hospital systems and all agencies involved ● Reach out to the CDC for technical assistance ○ February 2019 CDC gave technical assistance to ADHS for the MMR process ○ ADHS was awarded the Maternal Mortality Review Grant that begins on September 30, 2019. This will increase staffing and give ADHS technical assistance from the CDC ● Develop screening questions for Medical Examiners ● Mortality data is pulled from death records from vital records. ○ ​ Available on a yearly basis ○ ​ Look at pulling data from HEI ● Morbidity data is pulled from hospital discharge records Douglas A. Ducey | Governor Cara M. Christ, MD, MS | Director 150 North 18th Avenue, Suite 500, Phoenix, AZ 85007-3247 P | 602-542-1025 F | 602-542-0883 W | azhealth.gov Health and Wellness for all Arizonans