The Alliance For Innovation on Maternal Health (AIM): Maternal Mortality Support to States Deidre McDaniel, MSW, LCSW AIM Senior Program Manager
WHAT IS THE ALLIANCE FOR INNOVATION ON MATERNAL HEALTH (AIM)?
AIMs Growth Over The Years 2013 2014 1987 – 2007 2010 2012 • Maternal Deaths • CDC/ACOG explore • SMFM Workgroup • MCHBs National • HRSA/MCHB funds Partnership for the Alliance for Double cases of “near on Putting the “M” Maternal Safety Innovation on misses” NY/CA Back in MFM formed (ACOG, Maternal Health. PQCs report on • IHI coins the SMFM, ACNM, increased concept of complications AWHONN). “Bundles” around time of • AMCHP received (Hemorrhage, delivery HTN, VTE, MEWS) funding to develop state maternal • Council for Patient mortality and Safety in Women’s morbidity review Health Care teams formed by ACOG.
AIM’s Goal • Eliminate Preventable Maternal Mortality and Severe Morbidity in Every U.S. Birthing Facility By: • Promoting safe maternal care for every US birth. • Engaging multidisciplinary partners at the national, state and hospital levels. • Developing and implementing evidence-based maternal safety bundles . • Utilizing data-driven quality improvement strategies. • Aligning existing safety efforts and developing/collecting resources. Funded through HRSA (federal) Maternal and Child Health Bureau with a cooperative agreement.
AIM Partners AIM Partnership Structure American College of Obstetricians and Gynecologists (ACOG) Core Partners Affiliate Partners American College of Nurse American Hospital Association Midwives (ACNM) American Society of Addiction Medicine Association of Maternal and Child (ASAM) Health Programs (AMCHP) American Society of Healthcare Risk Management Association of State and Territorial Black Mama’s Matter Health Officers (ASTHO) Every Mother Counts March of Dimes California Maternal Quality Care Collaboration (CMQCC) National Perinatal Information Center NICHQ Society for Maternal-Fetal Medicine Nurse Practitioners for Women’s Health (SMFM) Preeclampsia Foundation Premier, Inc Association of Women’s Health, Society for Obstetric Anesthesia and Obstetric and Neonatal Nurses Perinatology (SOAP) (AWHONN) Trinity Health Care American Academy of Family WIC Practitioners (AAFP)
AIM Works at National, State, and Facility Levels National PH and Perinatal Collaborative: Hospitals, Providers, Professional DPH, Hospital Assoc., Nurses, Offices Organizations Professional Groups and Patients • Engage/coordinate • Support/coordinate • Create QI team national partners and hospital efforts. • Implement bundles. resources. • Share tools, resources, • Share best practices. • Develop QI tools and best practices. • Collect structure and • Use state data for • Support multi-state process metrics. data platform. outcome metrics. • Review progress. • Share and interpret • Support inter-state collaboration. progress.
Requirements for AIM Enrollment Maternal Mortality Review Committee Ability to collect data A state-based multidisciplinary coordinating body/PQC
AIM IMPLEMENTATION TIMELINE Evaluation & Enrollment Onboarding Data Onboarding Implementation Sustainability 1-3 Months 3-6 Months 6-9 Months 9-12 Months 12-24 Months Completion/Submission of Establish meetings • Establish meetings • Monthly meetings • AIM National Team AIM Enrollment Form. with State Partners. with State Data with AIM Program visit at 18 months. Coordinator, AIM Manager and State Review of AIM Establish monthly Program Manager, Lead Enrollment Form by AIM meeting schedule with and AIM Data Coordinator/Team. Executive Team/Partners. AIM Program Consultant. Manager and State • Submit AIM Acceptance of AIM Lead Coordinator. • Review and Submit Quarterly Progress Enrollment Form. signed DUA to AIM Reports. Review and Submit National Team. signed MOU to AIM • Submit Data National Team. • Review data files, data Quarterly. user manual, SMM Create • Participate in AIM Codes List, and Demo Implementation Monthly Calls. Data Portal. Workplan and Submit • Attend Annual AIM to AIM National • Determine Data Meeting. Team. Reporting Pathway. • Submit State Review/Edit and • Submit Participating Resources to AIM Distribute Baseline hospital list to AIM National Team for Survey to hospitals. Data Consultant. website. Coordinate/Schedule • AIM Data Consultant Kick-off. develops State section in AIM Data Portal.
Alliance for Innovation on Maternal Helth
AIM Safety/Quality Improvement Bundles Severe Obstetric Safety Obstetric Care of Hypertension Hemorrhage Women with Opioid in Pregnancy Bundles Dependence s Maternal Safe Reduction The tan bundles have VTE of Primary Prevention Cesarean Births elements that need to be integrated into the Core Safety Bundles Maternal For Reducing Early Warning Postpartum Care Safety Disparities in Every Criteria Basics Maternity Care Tools Mother SMM Case Review Forms Transition from Maternal Mental Maternity to Well Health Patient, Family Woman Care and Staff Support 12
Maternal Safety Bundles Uniform Structure: • R eadiness Every unit—prepare and educate • R ecognition & Prevention Every patient—before event • R esponse Every Event—team approach • R eporting/Systems Learning Every unit—systems improvement Available at: safehealthcareforeverywoman.org with resource links .
Why an AIM Data Center? • Data-driven / Data-supported Quality Improvement • You can follow your own progress and compare to other “like” facilities in your state and other states (all de-identified) • The State Collaborative leaders can track how you are doing and provide help and nudges where appropriate • Everyone can track overall progress towards the state and national goals 14
Three Audiences • Participating Hospitals • Track measure results and progress • Benchmark against peers (both in-state and across state collaboratives) • Collaborative-wide Leads • Track collaborative progress • Track data submission progress • Benchmark against peer collaboratives • AIM National • Understand which interventions have the biggest impact • Assess state support needs • Evaluate program 15
Data Sharing Policies • All hospital data is de-identified • Hospital names are not revealed to other collaborative members or to national leads • Hospital can be bucketed for comparison purposes by volume (or other criteria) into 4 large groupings • Only exception: State collaborative leads have access to all information submitted 16
Data Portal Overview Combines Data from several sources: • Outcome Measures • Submitted to portal by, sourced from existing data collection processes • Based on administrative data (ICD-9/10 coding) • Structure and Process Measures • Submitted to portal by collaborative hospitals • Based on direct data collection at the hospital • Data from other AIM collaboratives • Allowing for improved benchmarking 17
Data Submission: Outcome Measures • Outcome Measures • No action needed by collaborative hospitals Big Win—keeps hospital burden low and provides uniform data • All are collected from state-wide sources: --All-payer hospital discharge diagnosis files (SMM rate) --State Department of Health (Maternal Mortality rate) --Vital Records (NTSV Cesarean rate) 18
Data Submission: Structure and Process Measures • Option 1: Hospitals submit directly to AIM Data portal • Does not require collaborative to have robust data collection capabilities and allows participating hospitals to view trends and comparisons directly • Option 2: Hospitals Process and structure measures sent to collaborative; collaborative then submits to AIM data portal • Allows for collection of additional measures, or measures structured differently. Collaborative leads can still see graphs and comparisons to other collaboratives. An still generate hospital-specific reports to share with hospitals 19
Structure Measures Supporting Vaginal Birth/ Severe Preeclampsia Obstetric Hemorrhage Reducing Primary CS 1 Unit Policy and Procedure Unit Policy and Procedure Unit Policy and Procedure 2 Multidisciplinary Case Reviews Multidisciplinary Case Reviews Multidisciplinary Case Reviews 3 EHR Integration EHR Integration EHR Integration 4 Patient, Family & Staff Support Patient, Family & Staff Support Patient, Family & Staff Support 5 Debriefs Debriefs Hemorrhage Cart 6 Date completed is reported by the Unit Director
Process Measures Supporting Vaginal Birth/ Severe Preeclampsia Obstetric Hemorrhage Reducing Primary CS Consistency with ACOG/SMFM 1 Unit Drills (#) Unit Drills (#) Guidelines (Bundle Compliance)* (%) 2 Provider Education (%) Provider Education (%) Provider Education (%) 3 Nursing Education (%) Nursing Education (%) Nursing Education (%) Timely Treatment of Severe 4 Risk Assessment (%) HTN* (%) 5 Quantified Blood Loss (%) Based on Unit Director estimates except ones marked with * require chart review
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