Improving and Maintaining Reductions in Severe Maternal Morbidity Through a Statewide Perinatal Quality Collaborative

Area of Science:

• Maternal Health
• Public Health Initiatives
• Quality Improvement Science

Background:

• Severe maternal morbidity (SMM) from hemorrhage and hypertension remains a critical public health concern.
• Addressing racial disparities in maternal health outcomes is a key objective for quality improvement.
• Statewide collaboratives offer a structured approach to implementing evidence-based practices.

Purpose of the Study:

• To assess the impact of the Louisiana Perinatal Quality Collaborative (LaPQC) on reducing SMM related to hemorrhage and hypertension.
• To determine if SMM reductions were sustained across sequential quality improvement initiatives.
• To evaluate the effect of the LaPQC on narrowing racial disparities in SMM.

Main Methods:

• The Louisiana Perinatal Quality Collaborative (LaPQC) implemented two sequential initiatives using collaborative learning and improvement science.
• Thirty-one hospitals continuously participated, collecting aggregate data on nontransfusion SMM related to hemorrhage and hypertensive disorders.
• Trends were analyzed using Joinpoint regression, with process measures including blood loss quantification and hypertension management.

Main Results:

• Nontransfusion SMM from hemorrhage decreased by 44.0% during the first initiative, with sustained reductions of 39.0% overall and 58.2% among Black individuals.
• The Black/White disparity ratio for hemorrhage-related SMM narrowed from 2.2 to 0.9 during the initial initiative.
• SMM from hypertension decreased by 14.1% and 35.4% over the two initiatives, though a Black/White disparity ratio of 1.94 persisted.

Conclusions:

• Statewide implementation of safety bundles via the LaPQC was associated with significant reductions in SMM and narrowed racial disparities.
• Improvements in maternal morbidity were sustained across sequential initiatives, demonstrating the durability of state-based quality-improvement models.
• Quality improvement collaboratives are effective in improving maternal outcomes and reducing health inequities.