In 2017 the NJHA/HRET Institute for Quality and Patient Safety applied for and was awarded funding from the Center for Disease Control and Prevention as a Perinatal Quality Collaborative (PQC), one of only 13 in the country. The Institute is partnering with stakeholders, including payers, in a more structured format to improve the quality of care and safety that New Jersey mothers and infants deserve.
WHY NJ AIM?
The Alliance for Innovation in Maternal Health (AIM) program was founded by the Council for Patient Safety in Women’s Health Care – led by the American College of Obstetricians and Gynecologists and using tools developed by the California Maternal Quality Care Collaborative – as a solution to help improve maternal outcomes across the United States. AIM is a national data-driven quality improvement initiative based on proven approaches to improving maternal safety. The importance of culture, teamwork, communication and a focus on patient-centric care has been demonstrated in improving patient safety.
According to Deadly Delivery, The Maternal Health Care Crisis in the USA, New Jersey ranks 35 out of 51 states and the District of Columbia with a maternal mortality rate of 11.2 deaths per 100,000 live births.
- 2016 Severe Maternal Morbidity by Hospital
- 2016 Severe Maternal Morbidity Hemorrhage Cases
- 2016 Severe Maternal Morbidity Hypertension Cases
Research has shown that maternal deaths from obstetric hemorrhage are often associated with adjustable provider and system level factors such as gaps in communication, delays in care and ineffective treatment strategies. Obstetric hemorrhage is the leading cause of maternal morbidity and mortality in the United States and affected 2.9 percent of all women who gave birth in 2006. Most deaths associated with hemorrhage are preventable.
Severe hypertension is also a leading cause of maternal morbidity and mortality in the United States and New Jersey. Indeed, maternal mortality reviews have consistently revealed problems with recognition, communication and effective application of interventions as contributory factors in deaths from maternal hemorrhage and severe hypertension.
Disparities in maternal morbidity and mortality occur across language, race, ethnicity, age and payer. The NJPQC will address these disparities as part of the AIM project and all other areas of work.
- 2016 Severe Maternal Morbidity by Race/Ethnicity
- 2016 Severe Maternal Morbidity by Age, Language Preference and Payer
Birth facilities and health systems that have implemented systematic protocols for recognizing and responding to hemorrhage and hypertension have demonstrated improved outcomes such as decreased use of both blood products and higher-level interventions, such as uterine artery embolization and hysterectomy.
The AIM program is funded through a cooperative agreement with the Maternal and Child Health Bureau/Health Resource Services Administration. The American College of Obstetricians and Gynecologists is the lead partner in the AIM program under the auspices of the Council for Patient Safety in Women’s Health Care. See the AIM section of the Council website for a detailed overview.
The NJ AIM Initiative
As an AIM participant, NJPQC will be supporting New Jersey birthing hospitals to reduce maternal morbidity and mortality through the implementation of the Obstetric Hemorrhage and Severe Hypertension bundles. This initiative will assist participating hospitals with the adoption of the safety bundles by developing systems that promote readiness, recognition and response to obstetric hemorrhage and hypertension.
The overall goals of the NJPQC NJ AIM Initiative are:
- To reduce severe maternal morbidity and mortality related to obstetric hemorrhage and hypertension among women who give birth in New Jersey, and
- To guide and support obstetric care providers and birthing facilities in New Jersey in implementing evidence-based, collaborative, patient-centered practices to prevent and manage obstetric hemorrhage and hypertension.
Participation with the NJ AIM project is voluntary. Hospitals are open to focus on either hemorrhage, hypertension, or both. Participating hospitals will receive expert guidance, tools and resources.
Participating hospitals will be asked to:
- Complete the AIM baseline survey
- Establish a team to lead the obstetric hemorrhage/hypertension bundle implementation
- Engage in webinars, calls for education, feedback and collaboration, and
- Actively work to implement the obstetric hemorrhage/hypertension bundle during the project period.
About the Bundles
Maternal safety bundles represent best practices for maternity care and are developed and endorsed by national multidisciplinary organizations.
See full list of bundles here: http://safehealthcareforeverywoman.org/patient-safety-bundles/
NJ AIM Approach
The NJ AIM team will offer bi-monthly content webinars covering different elements of each safety bundle. As a data-driven initiative, the team will track structure, process and outcome measures to assess this initiative’s progress. As an important benefit, NJ AIM participants will have the opportunity to learn and share best implementation practices during bi-monthly webinars, via the NJPQC initiative’s listserv and at annual state conferences.
The goal of the data collection plan is to reduce burden wherever possible and still have enough data to track performance. We will be tracking:
- Structure Measures – collected only once
- Process Measures – collected quarterly
- Outcome Measures – not collected from hospitals (NJHA has access to this data through the New Jersey Discharge Data Collection System).
Data Feedback Reports
Data will be shared back with participating hospitals through quarterly hospital severe maternal morbidity reports and periodic state-wide data comparisons. Process measure data reports will be available in real-time through the NJPQC data portal.
Getting Involved with NJ AIM
To participate in NJ AIM:
complete the baseline survey at the following link: https://www.surveymonkey.com/r/W9929YB
NJ AIM Contacts:
Kathy Mahoney, PhD, MSN, RNC-OB, APN, C. email@example.com
Robyn D'Oria, MA, RNC, APN firstname.lastname@example.org
Angela Centellas, MPH email@example.com