Impact Statements
What are Impact Statements?
Impact statements briefly describe the effects of an initiative on certain structures, processes, or outcomes. For AIM, impact statements showcase the effects of state and jurisdiction teams’ AIM patient safety bundle implementation and targeted quality improvement activities on processes of care, patient health outcomes, and other measures of patient safety.
AIM patient safety bundles are frequently implemented by hospital teams as part of state- or jurisdiction-based collaboratives, which are often facilitated by perinatal quality collaboratives. By using collaborative models to implement patient safety bundles, hospital teams can learn from peers and experts while testing changes and making improvements to make a cumulative impact on population health.
Impact Statements By Year
State or District
Patient Safety Bundle
Arizona
In December 2020, the severe maternal morbidity (SMM) rate in Arizona among people with hypertensive disorders of pregnancy was reported to be three times as high as the rate among people without hypertensive disorders of pregnancy. In April 2021, Arizona began implementing the AIM Severe Hypertension in Pregnancy Patient Safety Bundle with 32 of the state’s 42 birthing facilities. After bundle implementation, in participating facilities the percentage of pregnant and postpartum people with persistent severe hypertension who were treated within one hour increased by 38% between 2021 and 2023 (55% in April-June 2021 and 76% in October-December 2023). Among people with persistent severe hypertension who were not treated within one hour, the percentage who were debriefed by their care team increased from 11% to 57% between April-June 2021 and October-December 2023. Arizona continues to support facilities through learning sessions, data support, and opportunities to meet and discuss topics of interest such as health equity and quality improvement.
District of Columbia
In Washington, DC, 16% of birthing patients had gestational or pre-existing hypertension in 2016 through 2019. In August 2021, the District of Columbia Perinatal Quality Collaborative (DCPQC) began implementing AIM’s Severe Hypertension in Pregnancy Patient Safety Bundle in all five of the district’s birthing facilities. The percentage of birthing facilities that have patient education materials on urgent postpartum warning signs increased from 0% in October 2021 to 80% in July 2023. Between October 2021 and October 2023, the proportion of women receiving timely treatment for persistent severe hypertension increased from 36% to 85%. The DCPQC continues to work with birthing facilities to implement AIM patient safety bundles through structured communities of learning that incorporate quality improvement support and sharing of clinical best practices resources.
Hawaii
In June 2021, in response to high rates of severe maternal morbidity (SMM) due to hemorrhage, the Hawaii Perinatal Collaborative, in partnership with the Healthcare Association of Hawaii (HAH), began implementation of the AIM Obstetric Hemorrhage Patient Safety Bundle in 10 of the state’s 12 birthing facilities. Between April 2021 and June 2022, the proportion of patients who had their blood loss measured from birth through the recovery period using quantitative and cumulative techniques increased from 49.0% to 67.0%. Among participating birthing facilities, the rate of SMM among people who experienced an obstetric hemorrhage, excluding those who received blood transfusions alone, decreased from 9.0% in 2019 to 7.1% in 2021, a reduction of 21.1%. HAH continues to assist facilities with quarterly reporting of data, learning opportunities, and quality improvement support.
Hawaii
In July 2021, in response to high rates of severe maternal morbidity (SMM) due to severe hypertension in pregnancy, the Hawaii Perinatal Collaborative, in partnership with the Healthcare Association of Hawaii (HAH), began implementation of the AIM Severe Hypertension in Pregnancy Patient Safety Bundle in 10 of the state’s 12 birthing facilities. Between July 2021 and September 2022, in participating facilities, the percentage of pregnant and postpartum people with persistent severe hypertension who were treated within one hour increased from 46.3% to 63.9%, an increase of 38%. HAH continues to assist facilities with quarterly reporting of data, learning opportunities, and quality improvement support.
Illinois
In ILPQC participating hospitals, the rate of nulliparous, term, singleton, vertex (NTSV) cesarean births was 25% in 2019, higher than the Healthy People 2030 target of 23.6%. In December 2020, ILPQC began implementation of the AIM Safe Reduction of Primary Cesarean Birth Patient Safety Bundle with 94 of the state’s 102 birthing facilities. Between December 2020 and December 2023, the collaborative’s NTSV cesarean birth rate declined from 24.9% to 22.8%. In December of 2023, due to hospital closures and other factors precluding ongoing participation, there were 74 teams actively participating in the bundle. ILPQC plans to continue implementation of the bundle through 2024 to support facility teams who have not yet achieved initiative goals in reducing their NTSV cesarean birth rates and associated racial and ethnic disparities and maintaining systems and cultural changes to promote safe vaginal births through a small group coaching model.
Indiana
The Indiana Department of Health (IDOH), in collaboration with the state’s Maternal Mortality Review Committee, the Indiana Hospital Association, and the Indiana Perinatal Quality Improvement Collaborative, began implementation of the AIM Severe Hypertension in Pregnancy Patient Safety Bundle in March 2021 with seven of Indiana’s birthing facilities. Between January 2021 and June 2023, the percentage of obstetric physicians and midwives who received education on severe hypertension and preeclampsia increased from 54.9% to 82.9% and the percentage of obstetric nurses who received education on severe hypertension and preeclampsia increased from 78.4% to 92.7%. IDOH continues to support bundle implementation at participating facilities through the development of supporting resources and facilitation of webinars and trainings. As of February 2024, all of Indiana’s 77 birthing facilities are participating in implementation of the AIM Severe Hypertension in Pregnancy Patient Safety Bundle. IDOH continues to support bundle implementation at participating facilities.
Indiana
The Indiana Department of Health (IDOH), in collaboration with the state’s Maternal Mortality Review Committee, the Indiana Hospital Association, and the Indiana Perinatal Quality Improvement Collaborative, began implementation of the AIM Obstetric Hemorrhage Patient Safety Bundle in December 2019 with 80 of the state’s birthing facilities. Between July 2022 and June of 2023, the percentage of people who had their blood loss measured through quantitative and cumulative techniques remained high and increased from 86.5% to 89.0%. During the same time, the percentage of patients who received a hemorrhage risk assessment for the duration of their birth hospitalization also remained high and increased from 88.6% to 90.2%. As of April 2024, 99% of the state’s birthing facilities participate in bundle implementation. IDOH continues to support bundle implementation at participating facilities with obstetric services and works to continuously recruit new facilities to engage in implementing the AIM Obstetric Hemorrhage Patient Safety Bundle.
Louisiana
In 2017, Louisiana’s Pregnancy-Associated Mortality Review Report identified substance use as one of the leading causes of pregnancy-associated deaths among pregnant and postpartum people. In September 2021, the Louisiana Perinatal Quality Collaborative (LaPQC) began implementation of the AIM Obstetric Care for Women with Opioid Use Disorder Patient Safety Bundle among 11 of the state’s 47 birthing facilities. Between January and December 2022, universal screening increased from 70% to 72%; referral to treatment for those who screened positive increased from 36% to 48%; and referral to medication for opioid use disorder (MOUD) increased from 29% to 34%. The LaPQC continues to work with participating facilities to provide evidence-informed, respectful care to pregnant and postpartum patients with substance use conditions and their families.
Massachusetts
Maternal deaths due to obstetric hemorrhage are largely preventable in the U.S., including Massachusetts. Alarmingly, Black pregnant and postpartum people who experience obstetric hemorrhage have disparate rates of severe maternal morbidity (SMM). The Perinatal-Neonatal Quality Improvement Network of Massachusetts (PNQIN) began implementation of the AIM Obstetric Hemorrhage Patient Safety Bundle in June 2021 with 21 of the state’s 40 birthing facilities. Between April 2021 and June 2022, the percentage of patients who had their blood loss measured from birth through the recovery period using quantitative and cumulative techniques increased by 33%, from 60% to 80%. During the same time, MA observed a decrease of 8.1% in SMM excluding blood transfusions among birthing people with an obstetric hemorrhage, from 6.2% to 5.7%. SMM decreased for all racial groups with the greatest decrease observed among Black patients. PNQIN continues to collect process and structure measures data for the patient safety bundle, focusing on collecting data disaggregated by race and ethnicity to assess inequities in care and disparities in outcomes.
Michigan
In Michigan, complications from sepsis, hemorrhage, and hypertension are the leading causes of maternal mortality and severe maternal morbidity (SMM). Between November 2015 and September 2023, more than 64% of birthing hospitals in the state participated in the implementation of AIM’s Severe Hypertension in Pregnancy Patient Safety Bundle, with the MI AIM Collaborative providing technical assistance, conducting site visits, facilitating education, and offering data support to collect structure and process data. Between 2011-2015 and 2016-2021, the statewide SMM rate excluding blood transfusions alone among patients with preeclampsia/eclampsia decreased from 7.7% to 6.6%, an overall reduction of 14.3%. The MI AIM Collaborative has a goal of engaging all Michigan birthing hospitals in quality improvement efforts that address drivers of maternal mortality and SMM to improve health outcomes for all.
Montana
Obstetric hemorrhage is a leading cause of severe maternal morbidity in Montana. To strengthen capacity of birthing facility teams to respond to obstetric hemorrhages using evidence-informed practices, the Montana Perinatal Quality Collaborative (MPQC) began implementation of the AIM Obstetric Hemorrhage Patient Safety Bundle in October 2021 with 17 of the state’s 26 birthing facilities. Between July 2021 and September 2022, the percentage of birthing facilities conducting hemorrhage risk assessments increased from 59.0% to 87.2%. During the same period, the percentage of participating birthing facilities who had policies and procedures in place to measure blood loss during the birth admission using quantitative and cumulative techniques increased from 23.5% to 68.9%. The MPQC continues to support hospitals in their quality improvement work and will assess and monitor rates of severe maternal morbidity as data are available.
Nebraska
In July 2019, the Nebraska Perinatal Quality Improvement Collaborative (NPQIC) began implementing the AIM Severe Hypertension in Pregnancy Patient Safety Bundle in 28 of the state’s 52 birthing facilities. Between July 2019 and June 2022, the proportion of obstetric physicians and midwives who completed education on severe hypertension and preeclampsia increased from 51.1% to 93.4%. Nursing education increased from 69.6% to 92.9% during the same period. Between 2019 and April 2021-June 2022, the rate of SMM excluding blood transfusions alone among patients with preeclampsia, eclampsia, and HELLP syndrome decreased by 37.3%, from 5.1% to 3.2% among participating facilities. NPQIC continues to work with participating birthing facilities to implement the patient safety bundle and educate all birthing facilities in the state on implementing best practices for the timely treatment of persistent severe hypertension.
State or District
Patient Safety Bundle
Alaska
Hypertensive disorders in pregnancy are increasing in Alaska, and hypertensive disorders contributed to one third of the pregnancy-related deaths in Alaska between 2012 and 2016. Based on these data and feedback from key stakeholders, the Alaska Perinatal Quality Collaborative (AKPQC) launched its first initiative focused on hypertensive disorders in pregnancy in March 2019. This initiative engaged six hospitals, representing 63% of Alaska births, in implementation of the AIM Severe Hypertension in Pregnancy patient safety bundle. As a result of this initiative and efforts of participating hospitals, the AKPQC exceeded its primary goal and observed a reduction in the statewide percent of severe maternal morbidity (SMM) among people with preeclampsia, excluding blood transfusions alone, from 7.7% in 2018 to 4.1% in 2020, the lowest percentage in the most recent five years. During this period, statewide SMM among people with preeclampsia, excluding blood transfusions alone, decreased from 10.8% to 3.9% for Non-Hispanic White people and from 5.5% to 3.4% for American Indian and Alaska Native people. Additionally, between Q3 2019 and Q4 2020, the percentage of pregnant people with persistent severe hypertension who received treatment within 60 minutes of episode onset at participating birthing facilities increased from 58.0% to 70.8%. The AKPQC continued to support participating hospitals with sustainability planning and data reporting through September 2021. The AKPQC is working to support hospitals in addressing the strain of the COVID-19 pandemic on healthcare systems and overall population health, as well as direct clinical impacts on pregnant patients, in an ongoing manner.
California
Between July 2019 and September 2020, the California Maternal Quality Care Collaborative engaged 27 birthing facilities located in counties with high rates of neonatal abstinence syndrome to participate in its mother & Baby Substance Exposure Initiative (MBSEI) Collaborative based on AIM’s Opioid Use Disorder (OUD) patient safety bundle. These facilities represented 14% of live births in the state. Participating facilities identified and implemented best practices in areas including screening, treatment, transitions in care, and education for OUD. Among the MBSEI Collaborative hospitals, the proportion of pregnant people with OUD who received medication for opioid use disorder or behavioral health treatment increased from 45% in January 2019 to 58% in December 2020, representing a 29% increase. During the same period, the proportion of opioid-exposed newborns ≥35 weeks’ gestation who received any of their parent’s milk at discharge increased from 56% to 65%, representing a 16% increase. Long-term outcomes for birth parents and infants will continue to be assessed through other programs.
Florida
In 2017, Florida’s nulliparous, term, singleton, vertex (NTSV) cesarean birth rate was the highest in the nation at 31%. In 2018, the Florida Perinatal Quality Collaborative (FPQC) began implementing AIM’s Safe Reduction of Primary Cesarean Birth patient safety bundle in 46 of the state’s 113 birthing facilities receiving monthly education, labor support workshops, data reports, and technical assistance. Between January 2018 and June 2019, the NTSV cesarean birth rate decreased from 31% to 29% among participating facilities, while the rate among non-participating facilities did not change. In 2020, FPQC expanded implementation to include 76 birthing facilities representing 80% of births in the state. From Q1 of 2017 to Q3 of 2020, Florida’s statewide NTSV cesarean birth rate decreased from 31% to 29%, a reduction of 6%. Participating facilities will continue to track and benchmark their NTSV cesarean birth rates with support from FPQC.
Georgia
Between 2012 and 2015, obstetric hemorrhage was the third leading cause of pregnancyrelated death in Georgia, with Black pregnant and postpartum people dying at double the frequency of White pregnant and postpartum people experiencing a hemorrhage. In April 2018, the Georgia Perinatal Quality Collaborative (GaPQC) recruited 43 of its 75 birthing hospitals to implement the AIM Obstetric Hemorrhage Patient Safety Bundle. Between April 2018 and September 2021, the proportion of hospitals that have OB hemorrhage carts readily available increased from 49.0% to 96.1%. The proportion of patients who had their blood loss measured from birth through the recovery period using quantitative and cumulative techniques also increased from 33.3% to 85.0%. The obstetric hemorrhage initiative moved to sustainability in September 2021 and the GaPQC continues to support those facilities by sharing resources on clinical best practices and providing other quality improvement support.
Georgia
Between 2012 and 2015, preeclampsia was the fifth leading cause of pregnancy-related deaths in Georgia, and Black people died from preeclampsia at a frequency 10 times greater than their White counterparts. In response, in June 2019 the Georgia Perinatal Quality Collaborative (GaPQC) recruited 34 of the state’s 75 birthing facilities to implement AIM’s Severe Hypertension in Pregnancy patient safety bundle. Between July 2019 and March 2022, the proportion of obstetric physicians and midwives at participating facilities who completed an education program on severe hypertension increased from 34.6% to 70.9%. From July 2019 to July 2021, the proportion of participating facilities that had established unit policies and procedures to respond to hypertensive emergencies increased from 32.7% to 81.6%. GaPQC continues to engage facilities in AIM patient safety bundle implementation by sharing resources on clinical best practices, facilitating maternal health learning series for clinical teams and providing other quality improvement support.
Illinois
In 2016 and 2017, mental health conditions, including substance use disorder, were the leading causes of pregnancy-related deaths in the state. The Illinois Perinatal Quality Collaborative (ILPQC) launched the Mothers and Newborns affected by Opioids – Obstetric (MNO-OB) Initiative in May 2018 based on AIM’s Obstetric Care for Women with Opioid Use Disorder (OUD) patient safety bundle with all 101 of the state’s birthing facilities. Over the course of the initiative, the percentage of sampled pregnant patient records with documentation of a validated screening tool used on Labor & Delivery increased from 3% in Q4 of 2017 to 85% in Q4 of 2020. During the same period, the percentage of patients with OUD who were connected to medication for opioid use disorder by delivery discharge and linked to recovery treatment services increased from 41% to 76% and 48% to 70%, respectively, and the percentage of patients with OUD who received Narcan counseling increased from 2% to 63%. The MNO-OB sustainability phase began in January 2021, where participating facilities worked to track compliance and develop plans for missed quality improvement opportunities. ILPQC continues to support the implementation of strategies for continuing quality improvement, new hire education, and the maintenance of up-to-date maps of community resources.
Indiana
The Indiana Department of Health (IDOH) joined the Alliance for Innovation on Maternal Health (AIM) in 2019 and collaborated with the state’s Maternal Mortality Review Committee (MMRC), the Indiana Hospital Association (IHA), and the Indiana Perinatal Quality Improvement Collaborative (IPQIC) to implement the AIM Obstetric Hemorrhage patient safety bundle. As of February 2022, Indiana has engaged 80 of the state’s 84 birthing facilities in implementation of the Obstetric Hemorrhage patient safety bundle. To support participating birthing facilities in quality improvement work, IDOH designed a Maternal Hemorrhage Toolkit and facilitated webinars and in-person trainings. Between December 2019 and December 2020, the percentage of participating facilities with a hemorrhage cart increased from 93.8% to 96.3%. Additionally, during the same time, the percentage of obstetric physicians and midwives who received education on obstetric hemorrhage increased from 66.1.4% to 74.1% and the percentage of obstetric nurses who received education increased from 88.1% to 92.2%. IDOH continues to support bundle implementation at participating facilities and works to continuously recruit new facilities to engage in quality improvement work.
Indiana
The Indiana Department of Health (IDOH) joined the Alliance for Innovation on Maternal Health (AIM) in 2019 and collaborated with the state’s Maternal Mortality Review Committee, the Indiana Hospital Association and the Indiana Perinatal Quality Improvement Collaborative to implement AIM’s Severe Hypertension in Pregnancy patient safety bundle. As of February 2022, Indiana has engaged 77 of the state’s 84 birthing facilities in implementation of the Severe Hypertension in Pregnancy patient safety bundle. To support participating birthing facilities in quality improvement work, IDOH designed a Maternal Hypertension Toolkit and facilitated webinars and trainings. Between Q1 2021 and Q4 2021, the percentage of participating facilities with unit policies and procedures to respond to hypertensive emergencies increased from 74.4% to 91.0%. During the same period, the percentage of obstetric physicians and midwives who received education on severe hypertension and preeclampsia increased from 55.7% to 69.2% and the percentage of obstetric nurses who received education on severe hypertension and preeclampsia increased from 79.7% to 90.6%. IDOH continues to support bundle implementation at participating facilities and works to continuously recruit new facilities to engage in quality improvement work.
Iowa
Due to Iowa’s nulliparous, term, singleton, vertex (NTSV) cesarean birth rate exceeding the Healthy People 2030 target rate of 23.6%, the Iowa Maternal Quality Care Collaborative (IMQCC) began implementation of AIM’s Safe Reduction of Primary Cesarean Birth patient safety bundle in 43 of the state’s 56 birthing facilities. Since the start of implementation in May 2021, participating facilities have received monthly education on evidence-based practices, quality improvement, and family-centered care. Provisional data show a 16% reduction in the statewide rate of NTSV cesarean births from 25.0% in Q1 2021 to 21.1% in Q1 2022. During the same time, non-participating facilities experienced an increased rate of low-risk (NTSV) cesarean births. IMQCC continues to sponsor labor support workshops, provide one-on-one and small group coaching, and support birthing facilities in collecting and interpreting institutional data to advance AIM patient safety bundle implementation work.
Louisiana
In 2018, hemorrhage accounted for one-third of all pregnancy-related deaths in Louisiana, and Black people were 3 times more likely to experience a pregnancy-related death compared to White people. In response, the Louisiana Perinatal Quality Collaborative (LaPQC) was established to address the state’s leading causes of morbidity and mortality, and in August 2018 LaPQC began implementation of AIM’s Obstetric Hemorrhage patient safety bundle, eventually recruiting 43 of the state’s 49 birthing facilities. Between August 2018 and January 2022, the percentage of facilities with standard processes to measure patients’ blood loss using quantitative and cumulative techniques from birth through the recovery period increased from 28.6% to 93.4%. During the same time, the percentage of facilities who established a standardized process to complete a hemorrhage risk assessment at the time of admission for birth increased from 85.2% to 100%. The LaPQC continues to work with participating AIM facilities to refine readiness and response structures through the provision of support focused on drills, staff education and competencies, and debriefs.
Louisiana
Louisiana’s nulliparous, term, singleton, vertex (NTSV) cesarean birth rate was 33.2% in Q3 of 2020, and some individual facilities had NTSV cesarean birth rates exceeding 50% during that time. In January 2021, the Louisiana Perinatal Quality Collaborative (LaPQC) began implementing AIM’s Safe Reduction of Primary Cesarean Birth patient safety bundle in 42 of the state’s 49 birthing facilities. The LaPQC completed the Labor Culture Survey with all participating facilities and is now working to implement and stabilize processes to make labor cultures more supportive of vaginal birth. Between January 2021 and January 2022, the NTSV cesarean birth rate declined from 30.3% to 27.5% among participating facilities. The LaPQC continues to host regular data reviews and QI planning sessions with the now 44 participating facilities and host clinical trainings to support the safe reduction of low-risk cesarean births.
Louisiana
In 2018, cardiovascular concerns and conditions related to hypertension accounted for one-fourth of pregnancy-related deaths in Louisiana, and Black people were three times more likely to experience a pregnancy-related death compared to White people. In response, the Louisiana Perinatal Quality Collaborative (LaPQC) was established to address the state’s leading causes of morbidity and mortality, and in August 2018 LaPQC began implementation of AIM’s Severe Hypertension in Pregnancy patient safety bundle, eventually recruiting 43 of the state’s 49 birthing facilities. Between August 2018 and January 2022, the percentage of participating birthing facilities that had established unit policies and procedures to respond to hypertensive emergencies increased from 21% to 100%. The LaPQC continues to work with facilities to refine and improve identification of and response to severe hypertension, including assuring appropriate integration of treatment algorithms into emergency department settings.
State or District
Patient Safety Bundle
California
Many states, including California, have low-risk cesarean birth rates well above the national Healthy People 2020 target of 23.6%. In California between July 2016 and June 2018, 91 birthing facilities with high cesarean birth rates participated in a California Maternal Quality Care Collaborative (CMQCC) initiative to implement the AIM Safe Reduction of Primary Cesarean Birth patient safety bundle. During the same time period, all 251 birthing facilities in California participated in at least one cesarean reduction initiative. The statewide rate of lowrisk cesarean births declined from 26.0% in June 2016 to 22.7% by the end of 2019, an overall reduction of 14%. Analyses of the reductions have attributed this change to both statewide efforts and participation in the collaborative.
California
Obstetric hemorrhage accounts for nearly half of all instances of severe maternal morbidity (SMM) in the US. In California between January 2015 and December 2016, 99 of 251 birthing facilities participated in a California Maternal Quality Care Collaborative (CMQCC) initiative to implement the AIM Obstetric Hemorrhage patient safety bundle. Nearly 200,000 births were represented in this initiative. Between the baseline (2011-2014) and post-intervention (October 2015-December 2016) periods, the rate of SMM decreased among all groups of birthing patients with a hemorrhage: 13% among White patients, 17% among Hispanic patients, and 24% among Black patients. After excluding blood transfusions, the SMM rate decreased among Black birthing patients even further, by 38%.
Colorado
In Colorado, the Nulliparous, Term, Singleton, Vertex (NTSV) cesarean birth rate is below the national average, but it is above the national Healthy People 2020 target in many birthing facilities. In response, the Colorado Perinatal Care Quality Collaborative recruited five specific birthing facilities with high NTSV cesarean birth rates to implement the AIM Safe Reduction of Primary Cesarean Birth patient safety bundle. Comparing quarterly NTSV cesarean birth rates from April – June 2018 to April – June 2020, the quarterly NTSV cesarean birth rate among participating facilities declined from 25.3% to 22.9%, representing an 11% decrease. The NTSV cesarean birth rate for participating hospitals is now lower than the national Healthy People 2020 target of 23.6%.
Florida
Florida has the second highest cesarean birth rate in the nation. To address this, the Florida Perinatal Quality Collaborative (FPQC) began the PROVIDE initiative in January 2018 to promote safe vaginal births and reduce unnecessary cesarean births. Participating facilities worked to implement the AIM Safe Reduction of Primary Cesarean Birth patient safety bundle and received monthly education, labor support workshops, data reports, and technical assistance. Between January 2018 and June 2019, 46 birthing facilities participated in the initial phase of this initiative to address the Nulliparous, Term, Singleton, Vertex (NTSV) cesarean births. The participating facilities experienced a rate decreased of 8%, while rates for non-participating facilities did not change during this period. In January 2020, FPQC expanded its initiative and commenced PROVIDE 2.0 to include 76 of the 113 birthing hospitals, which accounts for 80% of births in the state.
Georgia
Between 2012 and 2015, obstetric hemorrhage was the third leading cause of pregnancyrelated death in Georgia. In April 2018, the Georgia Perinatal Quality Collaborative (GaPQC) recruited 80% of the state’s 83 birthing facilities to implement the AIM Obstetric Hemorrhage patient safety bundle in collaboration with many key stakeholders and maternal and child health partners. Between 2018 and 2019, the rate of severe maternal morbidity among birthing patients who experienced obstetric hemorrhage reflected an overall reduction of 38% (i.e., a decline from 8% to 5%), excluding those who only received blood transfusions. GaPQC continues to engage and support facilities in AIM patient safety bundle implementation by sharing resources on clinical best practices, facilitating maternal health learning series for clinical teams and providing other quality improvement support.
Illinois
In Illinois, opioid overdose is the leading cause of pregnancy-associated deaths. In response, the Illinois Perinatal Quality Collaborative (ILPQC) initiated the Mothers and Newborns affected by Opioids (MNO)-Obstetric Initiative based on the AIM Obstetric Care for Women with Opioid Use Disorder patient safety bundle. Between October 2017 and June 2020, the percentage of birthing patients, on a labor and delivery unit, who received a validated screening for opioid use disorder (OUD) increased from 3% to 85%, based on a representative sample of birthing patients in the 43 targeted birthing facilities. During the same time period, the percentage of birthing patients with OUD who were connected to medication-assisted treatment by the time of delivery discharge increased from 41% to 67%. Those who were linked to recovery treatment services increased from 48% to 71%. ILPQC continues to assist facilities with sustainability planning, monthly review and reporting of data, quarterly webinars, and quality improvement support
Illinois
In response to rising rates of severe pregnancy complications associated with hypertension, the Illinois Perinatal Quality Collaborative (ILPQC) began the Severe Maternal Hypertension Initiative based on the AIM Severe Hypertension in Pregnancy patient safety bundle. Between January 2016 and December 2017, ILPQC engaged clinical teams and public health leaders from 108 of 120 birthing facilities that were operational as of January 2016. The goal was to improve care for pregnant and postpartum patients with hypertensive conditions. During the time period, the percentage of patients with sustained, new-onset severe hypertension who received treatment within 60 minutes of an elevated reading increased from 41% to 89%, and the statewide rate of severe maternal morbidity among patients with hypertension at delivery decreased by 40%. Since completing this initiative, ILPQC continues to assist birthing facilities with sustainability planning, monthly review and reporting of data, quarterly webinars, and quality improvement support.
Louisiana
In Louisiana, hypertension was a leading cause, or underlying cause, of death in pregnancy-related deaths, between 2011 and 2016. During this same time period, racial disparities were noted, with Black women more likely than White women to experience a pregnancy-related death. In response to these findings, the LaPQC implemented the AIM Severe Hypertension in Pregnancy patient safety bundle in 42 of its 52 birthing facilities, engaging in monthly collaborative calls, in-person learning sessions, and in-person site visits. At each stage of this work, the LaPQC sought to incorporate health equity throughout bundle implementation. Between 2016 and 2019, the severe maternal morbidity rate among birthing persons with hypertension decreased by 8% among non-Hispanic Black women and 45% among non-Hispanic White women, leading to an overall reduction of 23%. The LaPQC continues to work on improving equity in care to close the increasing Black-White disparity gap in SMM.
Louisiana
In Louisiana, hemorrhage was the leading cause of pregnancy-related death between 2011 and 2016., Black women were exponentially more likely to experience a pregnancy-related death than White women. In August 2016, the Louisiana Perinatal Quality Collaborative (LaPQC) launched the Reducing Maternal Morbidity Initiative (RMMI) in 42 of 52 birthing facilities. The RMMI addressed preventable maternal mortality and morbidity related to hemorrhage, while focusing their work on reducing racial disparities. Through the LaPQC, participating facilities worked to implement the AIM Obstetric Hemorrhage patient safety bundle engaging in monthly collaborative calls, in-person Learning Sessions, and in-person site visits. At each stage of this work, the LaPQC sought to incorporate health equity throughout. Between 2016 and 2019, the severe maternal morbidity (SMM) rate among birthing persons with hemorrhage decreased 35% for non-Hispanic Black women and 40% for non-Hispanic White women, leading to an overall reduction of 39%. While reductions in SMM were seen among both non-Hispanic Black and non-Hispanic White women, the racial disparity did not decrease. The LaPQC continues to work on improving equity in care to address racial disparities in SMM.
Maryland
In response to Maryland’s rising overall cesarean birth rate, the Perinatal/Neonatal Quality Collaborative (PNQC) initiated a two-year collaborative to reduce the Nulliparous, Term, Singleton, Vertex (NTSV) cesarean birth rate. Beginning in 2016, Maryland’s PNQC recruited 31 of its 32 birthing facilities to participate in the collaborative and implement elements of the AIM Safe Reduction of Primary Cesarean Birth patient safety bundle. Between 2016 and 2018, the NTSV cesarean birth rate decreased by 5.3% from 30.1% to 28.5%. Maryland’s PNQC continued to monitor the effects of its collaborative once it ended in 2018. By the end of 2019 the NTSV cesarean birth rate had further declined to 27.8%, demonstrating a total reduction of 7.6% from the 2016 baseline period.
Michigan
In Michigan, complications from sepsis, hemorrhage and hypertension are the leading causes of maternal mortality and severe maternal morbidity (SMM). Between November 2015 and September 2020, more than 60% of birthing facilities in the state participated in Michigan’s Alliance for Innovation on Maternal Health (MI AIM) collaborative to reduce SMM due to hypertension, which included receiving technical assistance, site visits, education and data support to implement the AIM Severe Hypertension in Pregnancy patient safety bundle. Between the baseline period (2011-2015) and the post-intervention period (2016-2018), the statewide SMM rate among patients with hypertensive disorders declined from 12% to 10%, an overall reduction of 17%.
Mississippi
In Mississippi, hemorrhage is the leading cause of severe maternal morbidity (SMM). A review of hospital practices revealed that only 15% of birthing facilities had established standardized emergency protocols for obstetric hemorrhage and less than 30% of birthing facilities had hemorrhage carts. In response, the Mississippi Perinatal Quality Collaborative (MSPQC) began implementing the AIM Obstetric Hemorrhage patient safety bundle in 2016, with 39 of the 42 birthing facilities in the state participating in the collaborative. With the support of AIM, the MSPQC team developed portable hemorrhage toolkits, assisted in hemorrhage cart development, and provided hands-on simulation training and emergency drills. As part of bundle implementation, the percentage of participating birthing facilities with a hemorrhage cart increased from 28% in 2016 to 95% in 2020. During the same time period, the percentage of birthing facilities with a unit policy and procedure for an obstetric hemorrhage emergency increased from 15% to 90%.
