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Implementation Outcomes of 36 CDC-funded Statewide Perinatal Quality Collaboratives, 2023-2024
Allison S Guarino1, Jacqueline Wallace, Angela M Rohan
1Author Affiliations: Non-Infectious Disease, Program and Innovation Office, CDC Foundation, Atlanta, Georgia (Ms. Guarino); Maternal and Infant Health Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs. Wallace, Rohan, and Kroelinger).
Context:
Maternal and infant morbidity and mortality remain high in the United States, and improving quality of clinical care is one strategy to improve outcomes. Perinatal Quality Collaboratives (PQCs) are statewide networks of teams working to improve maternal and infant health by supporting quality improvement (QI) initiatives. PQCs execute deliberate activities to support implementation of QI; implementation outcomes can be used to measure the execution of these activities.
Objective:
To examine PQC implementation outcomes to better understand implementation achievements.
Design:
We adapted Proctor et al.'s implementation outcomes framework to measure implementation outcomes using standardized annual PQC performance measures.
Setting:
US, October 2023 through September 2024.
Participants:
Thirty-six Centers for Disease Control and Prevention-supported PQCs.
Intervention:
Developed implementation outcome definitions relevant for the standard PQC programmatic model and mapped outcomes to performance measures, assessing the execution of PQC activities. Descriptive PQC-reported data were summarized as counts and percentages.
Main Outcome Measure:
Implementation outcomes (adoption, appropriateness, feasibility, fidelity, penetration, and sustainability).
Results:
PQCs reported moderate adoption, with an average of 67% of births in a state occurring in birthing hospitals that participated in PQC QI initiatives. PQCs also reported moderate appropriateness; among birthing hospitals serving populations most likely to experience adverse health outcomes, 67% participated with their PQC. An average of 85% of participating birthing hospitals submitted data to their PQC as required for QI initiatives (feasibility), and PQCs averaged 75% or higher on all fidelity measures (trainings, webinars, learning products, and convenings). For penetration, fewer than 50% of PQCs engaged in activities with community-based organizations, although 56% engaged with community members and 83% with patients/families. Most (78%) participating hospitals made lasting system changes (sustainability).
Conclusions:
Findings suggest that PQCs implement QI initiatives with high feasibility, fidelity, and sustainability, moderate adoption and appropriateness, and varied penetration. Understanding PQC implementation outcomes can highlight areas of success and identify areas for PQC improvement.
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