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
New Jersey
Between 2014 and 2016, hypertensive disorders in pregnancy were among the leading causes of severe maternal morbidity and mortality in New Jersey. In January 2017, the New Jersey Perinatal Quality Collaborative (NJPQC) began implementing AIM’s Severe Hypertension in Pregnancy Patient Safety Bundle in 39 of the 48 birthing facilities in New Jersey. Between 2018 and 2019, the first two years data were collected, the proportion of providers who received education on severe hypertension and preeclampsia increased from 46.8% to 64.3%. Between 2016 and 2022, the statewide rate of severe maternal morbidity excluding blood transfusions among people with preeclampsia, eclampsia, and HELLP syndrome declined from 8.5% to 6.0%, a reduction of 29.4%. The NJPQC continues to work with their birthing facilities to fully implement the AIM Severe Hypertension in Pregnancy Patient Safety Bundle through expanded education and other technical assistance opportunities.
New York
In New York, the rate of opioid overdose deaths for women aged 18-44 tripled between 2010 and 2016. In response, the New York State Perinatal Quality Collaborative (NYSPQC) implemented the AIM Obstetric Care for Women with Opioid Use Disorder Patient Safety Bundle through the NYS Opioid Use Disorder in Pregnancy & Neonatal Abstinence Syndrome Project. The NYSPQC provides participating birthing facilities with education, data collection and analysis, and other clinical and quality improvement support. The project began as a pilot in September 2018 with 15 birthing hospitals participating and expanded in December 2020. As of the project close in June 2023, 41 of the state’s 119 birthing facilities were participating. The percentage of birthing facilities that had a unit standard policy to screen every person giving birth for substance use disorder increased from 20% in January 2019 to 93% in May 2023 among the 15 hospitals participating in the pilot phase and from 40% in December 2020 to 96% to in May 2023 among the 26 hospitals participating in the expansion phase. Additionally, the percentage of pregnant and postpartum people with opioid use disorder with existing referral or linkage to medication-assisted treatment or behavioral health treatment on admission increased from 73% to 91% among pilot phase hospitals and from 64% to 100% among expansion phase hospitals, between December 2020 and May 2023.
Ohio
In Ohio, preeclampsia and eclampsia were found to be the leading causes of pregnancy-related death between 2008 and 2016, with 85% of those deaths determined by review to have been preventable. In 2020, Ohio began implementation of the AIM Severe Hypertension in Pregnancy Patient Safety Bundle in 30 of the state’s 91 birthing facilities. Between October 2020 and September 2021, the percentage of pregnant and postpartum people with persistent severe hypertension who were treated within one hour increased from 56.8% to 71.4%, an increase of 25.7%, with no statistically significant differences observed across racial and ethnic groups. As of April 2024, Ohio has reached 81 of its 91 birthing facilities through the AIM Severe Hypertension in Pregnancy bundle. The Ohio Hospital Association and Ohio Department of Health continue to work with birthing facilities to expand the bundle to all hospitals in the state and sustain improvements among those already participating in patient safety bundle implementation.
Rhode Island
In Rhode Island, hemorrhage is a key contributor to maternal morbidity. In July 2020, the Hospital Association of Rhode Island and the National Perinatal Information Center began implementation of the AIM Obstetric Hemorrhage Patient Safety Bundle with four of the five birthing facilities in the state. Between July 2020 and January 2022, the percentage of obstetric physicians and midwives receiving obstetric hemorrhage education increased from 5% to 50%, and the percentage of obstetric nurses receiving the same education increased from 10% to 90%. Rhode Island continues to support participating birthing facilities by providing virtual monthly collaborative meetings, focused hospital coaching calls, and sharing of best practices.
Utah
In Utah, substance use disorder contributed to 35% of maternal deaths between 2015 and 2016. In March 2020, the Utah Women and Newborns Quality Collaborative (UWNQC) began implementing the AIM Opioid Use Disorder (now Substance Use Disorder) Patient Safety Bundle. At the kick-off training, 25 of 46 birthing facilities in Utah and six birthing facilities in Wyoming participated. From March 2020 to October 2022, the percentage of pregnant and postpartum people who were screened for substance use conditions using a validated verbal screening tool in participating hospitals increased from 46% to 87%. UWNQC continues to work with participating hospitals on patient safety bundle implementation strategies.
Washington
The Washington State Maternal Mortality Review Panel findings for 2014 through 2016 showed that over a third of pregnancy-related deaths were due to mental health conditions, including suicide and overdose. In April 2022, the Washington State Hospital Association (WSHA), in partnership with the Department of Health, began implementation of the AIM Opioid Use Disorder Patient Safety Bundle with 47 of the state’s 56 birthing facilities. From April to December of 2022, the percentage of facilities that had a unit standard policy and procedure to universally screen every person giving birth for substance use disorder using a validated verbal screening tool increased from 30% to 50%. WSHA and the Department of Health continue to support participating hospitals by focusing efforts on capturing current data to further evaluate progress within this initiative.
West Virginia
In 2020, the West Virginia Perinatal Partnership began implementation of the AIM Severe Hypertension in Pregnancy Patient Safety Bundle. Between October 2022 and September 2023, the percentage of patients who experienced persistent severe hypertension during their birth admission and had a postpartum blood pressure and symptoms check scheduled before their hospital discharge increased from 17.5% to 36.7%. Additionally, the proportion of nurses who received education on respectful, equitable, and supportive care increased from 67.2% in October 2022 to 79.2% in September 2023. The WV Perinatal Partnership continues to coordinate the implementation of the patient safety bundle, with additional focus on identifying potential disparities through improved data collection and analysis of race, ethnicity, and socioeconomic status, and improving clinician education on respectful, nonjudgmental care.
State or District
Patient Safety Bundle
Maryland
In Maryland, hypertensive disorders of pregnancy are the third leading cause of severe maternal morbidity and account for over 8% of pregnancy-related deaths. In January 2021, the Maryland Perinatal-Neonatal Quality Collaborative (MDPQC) began implementing AIM’s Severe Hypertension in Pregnancy patient safety bundle in all 32 of the state’s birthing hospitals. Since implementation, the percentage of clinicians receiving education on severe hypertension and preeclampsia increased from 61% to 77% in obstetric physicians and midwives and 79% to 85% in obstetric nurses from Q1 2021 to Q4 2021. Treatment of persistent severe hypertension within 60 minutes of episode onset increased from 41% to 54% during this same period. The MDPQC continues to work with birthing hospitals to fully implement the AIM Severe Hypertension in Pregnancy patient safety bundle with an additional focus on improving the rates of severe maternal morbidity (SMM) among patients with preeclampsia and reducing racial and ethnic disparities within SMM.
Michigan
In Michigan, hemorrhage is among the three leading causes of pregnancy-related death. Between November 2016 to December 2020, 56 of the state’s 80 birthing facilities participated in implementation of AIM’s Obstetric Hemorrhage patient safety bundle with Michigan AIM. As part of this collaborative, participating facilities received technical assistance, site visits, education, and data support. From 2011-2015 to 2016-2020, the statewide severe maternal morbidity (SMM) rate among birthing patients who experienced a hemorrhage, excluding those who only received blood transfusions, declined from 11% to 5%, an overall reduction of 55%. MI AIM continues to assist participating facilities in quality improvement efforts addressing drivers of severe maternal morbidity and mortality with the goal of engaging all birthing facilities in the state in their collaborative.
Mississippi
Between 2013 and 2015, complications related to hypertension and cardiovascular disease were the leading causes of pregnancy-related death in Mississippi. In response, the Mississippi Perinatal Quality Collaborative (MSPQC) began implementation of AIM’s Severe Hypertension in Pregnancy patient safety bundle in October 2019 and recruited 37 of the state’s 41 birthing facilities to participate. Between Q4 2019 and Q1 2022, the percentage of obstetric physicians and midwives who received education on severe hypertension and preeclampsia increased from 48% to 89%, and the percentage of obstetric nurses who received similar education increased from 62% to 93%. During the same time, the percentage of participating birthing facilities that had established unit policies and procedures to respond to hypertensive emergencies increased from 24% to 88%. The MSPQC continues to work with participating facilities on patient safety bundle implementation through quarterly leadership calls and other educational opportunities.
Mississippi
In Mississippi, hemorrhage requiring blood transfusions is the leading cause of severe maternal morbidity (SMM). In response, the Mississippi Perinatal Quality Collaborative (MSPQC) began implementation of AIM’s Obstetric Hemorrhage patient safety bundle in August 2016 and recruited 39 of the state’s 41 birthing facilities to participate. To support implementation, MSPQC developed portable hemorrhage toolkits, assisted in hemorrhage cart development, and provided clinical team training on quantified blood loss. Between Q4 2016 and Q4 2020, the percentage of participating birthing facilities with a hemorrhage cart increased from 32% to 98%. During the same time, the percentage of patients whose blood loss from birth through the recovery period was measured using quantitative and cumulative techniques increased from 12% to 72%. The MSPQC will continue to provide technical assistance, training, and guidance to facilities to fully implement the Obstetric Hemorrhage patient safety bundle.
Missouri
In 2017, preeclampsia/eclampsia was the most common cause of death during pregnancy and up to 42 days postpartum in Missouri. Missouri AIM began implementation of AIM’s Severe Hypertension in Pregnancy patient safety bundle in 36 of the state’s 62 birthing facilities in November 2019. Among the 29 birthing facilities who reported data, treatment of persistent severe hypertension within 60 minutes of episode onset increased from a median of 62% at baseline (November 2019 through January 2020) to a median of 87% post-intervention (July 2020 through December 2021). During the same period, the percentage of participating facilities who established processes for scheduling postpartum follow-up appointments for people with diagnoses of hypertension, preeclampsia, or eclampsia increased from 0% to 31%. Missouri AIM continues to support birthing facilities whose implementation of the Severe Hypertension in Pregnancy patient safety bundle was halted or stalled during the COVID-19 pandemic and provides technical assistance to address health disparities related to hypertension in pregnancy and postpartum.
New Jersey
Between 2014 and 2016, hypertensive disorders of pregnancy were among the leading causes of severe maternal morbidity and mortality in New Jersey. In January 2017, the New Jersey Perinatal Quality Collaborative (NJPQC) began implementing AIM’s Severe Hypertension in Pregnancy patient safety bundle in 36 of the state’s 48 birthing facilities. Between Q1 2018 and Q1 2019, treatment of persistent severe hypertension within 60 minutes of episode onset increased from 53.4% to 64.3% among the participating birthing facilities. During the same time, the percentage of participating facilities who reported having established unit policies and procedures to respond to hypertensive emergencies increased from 51.0% to 63.3%. The New Jersey Perinatal Quality Collaborative continues to work with its birthing facilities to fully implement the AIM Severe Hypertension in Pregnancy patient safety bundle through expanded education opportunities and other technical assistance opportunities.
New York
In New York, the rate of opioid overdose deaths for women aged 18-44 tripled between 2010 and 2016. In response, the New York State Perinatal Quality Collaborative (NYSPQC) implemented the New York State (NYS) Opioid Use Disorder (OUD) in Pregnancy & Neonatal Abstinence Syndrome (NAS) Project based on the AIM Obstetric Care for Women with OUD patient safety bundle. The project began as a pilot in September 2018 with 14 birthing facilities participating and submitting data. The project has since expanded to include a total of 39 birthing facilities. The percentage of facilities that implemented a universal screening protocol for OUD increased from 21% in January 2019 to 73% in December 2021 among the 14 facilities participating in the pilot phase and from 33% in December 2020 to 86% in December 2021 among the 25 facilities participating in the expansion phase. The percentage of birthing people with OUD who received medication for opioid use disorder or behavioral health treatment during pregnancy increased from 72% to 93%, as reported by pilot phase facilities, and increased from 85% to 94%, as reported by expansion phase facilities. The NYSPQC continues to lead the NYS OUD in Pregnancy & NAS Project with webinars, educational opportunities, data collection and analysis, resource distribution, and clinical and quality improvement support.
Tennessee
Between 2017 and 2020, hypertensive disorders contributed to half of all pregnancy-related deaths due to cardiovascular disease, which is the leading cause of maternal mortality in Tennessee. In response, the Tennessee Initiative for Perinatal Care (TIPQC) recruited 15 of the state’s 59 birthing facilities to implement AIM’s Severe Hypertension in Pregnancy patient safety bundle. Five birthing facilities began a pilot project in November 2020, and 10 additional facilities began participating in March 2021. Between Q3 2020 and Q4 2021, the percentage of patients with persistent severe hypertension who were treated within 60 minutes of episode onset at the five pilot facilities increased from 43% to 67%, a 56% increase. Between Q1 2021 and Q4 2021, the percentage of patients with persistent severe hypertension who were treated within 60 minutes of episode onset at the 10 additional participating facilities increased from 32% to 57%, a 78% increase. The TIPQC continues to support participating facilities by hosting huddles focused on project sustainability as well as data check-ins to further improve timely treatment of persistent severe hypertension.
Washington
In Washington, hemorrhage is one of the leading causes of pregnancy-related death. In response, the Washington State Hospital Association (WSHA) began implementation of AIM’s Obstetric Hemorrhage patient safety bundle with 48 of the state’s 57 birthing facilities. Between Q1 2019 and Q2 2021, the percentage of obstetric physicians and midwives receiving obstetric hemorrhage education increased from 39.8% to 57.4%, and the percentage of obstetric nurses receiving obstetric hemorrhage education increased from 74.2% to 80.9%. Hemorrhage risk assessment also increased from 57.6% to 89.6% during this time. Adapting to the evolving nature of the COVID-19 pandemic, WSHA plans to continue its partnership with birthing facilities to support implementation of elements outlined in the AIM Obstetric Hemorrhage patient safety bundle, focusing on timely data collection to identify progress and areas needing focused attention. Participating birthing facilities will be supported with on-site and virtual meetings incorporating educational webinars, sharing of best practices, assistance with hemorrhage simulation, and focus on site specific metrics.
West Virginia
In 2017, West Virginia’s rate of severe maternal morbidity (SMM) among people with preeclampsia, excluding blood transfusions alone, was 7.6%. In response, the West Virginia Perinatal Partnership recruited all 21 birthing facilities in the state to implement AIM’s Severe Hypertension in Pregnancy patient safety bundle in Q2 of 2020. To support implementation, the West Virginia Perinatal Partnership provided patient education materials to birthing facilities and implemented a home blood pressure monitoring program to encourage early recognition of severe hypertension during pregnancy and postpartum. Between Q4 2020 and Q1 2022, the percentage of facilities that had established unit policies and procedures to respond to hypertensive emergencies increased from 23.8% to 71.4%. Additionally, the statewide rate of SMM among people with preeclampsia decreased from 7.6% in 2017 to 5.4% in 2021, a reduction of 28.9%. The West Virginia Perinatal Partnership continues to support facilities in the state by providing education to rural Emergency Departments and facilitating opportunities for collaborative learning.
State or District
Patient Safety Bundle
New Jersey
In response to increasing severe maternal morbidity (SMM) rates due to hemorrhage, the New Jersey Perinatal Safety Collaborative (NJPSC) recruited all 44 birthing facilities in the state to implement the AIM Obstetric Hemorrhage patient safety bundle. Between January 2018 and June 2020, the percentage of hospitals that had obstetric hemorrhage supplies readily available in a cart or mobile box increased from 63% to 88%. Additionally, the statewide SMM rate among birthing patients who experienced a hemorrhage, excluding those who only received blood transfusions, declined from 8% during the baseline period (2016-2017) to 7% in the intervention period (2018-2019), an overall reduction of 13%. NJPSC continues to assist facilities with quarterly reporting of data, on-demand learning opportunities and quality improvement support.
New York
In New York, the rate of opioid overdose deaths for women aged 18-44 tripled between 2010 and 2016. In response, the New York State Perinatal Quality Collaborative (NYSPQC) piloted its New York State Opioid Use Disorder (NYS OUD) in Pregnancy & NAS Project among 17 birthing facilities. This initiative is based on the AIM Obstetric Care for Women with Opioid Use Disorder patient safety bundle. Between January 2019 and June 2020, the percentage of participating facilities that implemented a universal screening protocol for OUD increased from 21% to 64%. The percentage of women with OUD who received medication-assisted treatment (MAT) or behavioral health treatment during pregnancy increased from 72% to 81%. NYSPQC continues to assist the NYS OUD in Pregnancy & NAS Project with increased birthing facility enrollment, webinars, podcasts and quality improvement support.
Oklahoma
Obstetric hemorrhage is a leading cause of pregnancy-related death, and death from hemorrhage has been shown to be largely preventable with appropriate care. In 2015, the Oklahoma Perinatal Quality Improvement Collaborative (OPQIC) launched its Every Mother Counts collaborative and implemented the AIM Obstetric Hemorrhage patient safety bundle in 34 of the state’s 47 birthing facilities. By 2016, the percentage of participating facilities with a hemorrhage cart increased from 72% to 100%. Between 2015 and 2020, the percentage of birthing patients who received a formal risk assessment for hemorrhage increased from 66% to 93%. OPQIC is continuing its Every Mother Counts collaborative, providing individualized support and collaborative learning opportunities to participating facilities.
Tennessee
The prevalence of opioid use disorder among birthing patients in Tennessee is among the highest in the United States. To address this issue, in 2019, the Tennessee Initiative for Perinatal Quality Care (TIPQC) launched the Tennessee AIM project with 15 birthing facilities implementing the AIM Obstetric Care for Women with Opioid Use Disorder patient safety bundle. Between 2019 and September 2020, the percentage of birthing patients with opioid use disorder (OUD) who received medication-assisted treatment (MAT) at discharge increased from 45% to 72% in the participating facilities. Additionally, by September 2020, 46% of participating facilities had implemented a universal screening protocol for OUD, and 23% had implemented post-delivery and discharge pain management prescribing practices to safely limit opioid prescriptions. At baseline, there were no facilities implementing the prescribing practices. TIPQC continues to work with participating facilities to establish evidence-based best practices and monitor processes and outcomes via toolkits, podcasts and individualized support.
West Virginia
In response to high rates of severe maternal morbidity (SMM) due to hemorrhage, in 2018, the West Virginia Perinatal Partnership began implementation of the AIM Obstetric Hemorrhage patient safety bundle in 22 of the State’s 23 birthing facilities. Between January 2018 and June 2020, the percentage of participating facilities who reported having a hemorrhage cart increased from 76% to 95%. Additionally, the statewide rate of SMM among birthing patients who experienced obstetric hemorrhage, excluding those who only received blood transfusions, decreased from 7% during the baseline period (2016-2017) to 6% in 2018, a reduction of 14%. The West Virginia Perinatal Partnership continues to work with participating facilities to fully implement the patient safety bundle checklist and has expanded obstetric hemorrhage education to rural emergency departments in facilities without labor and delivery units.
