AEIX Perinatal Improvement Collaborative Impacting Maternal Health through Clinical Culture and Process Changes

Key takeaways:

• Maternal mortality and morbidity rates remain high in the U.S. and evidence suggests this can be attributed to the lack of both standardized condition management and comprehensive maternal health data to support evidence-based education and guidance.
• Armed with PINC AI™ solutions, the American Excess Insurance Exchange (AEIX) Perinatal Improvement Collaborative (AEIX PIC) provides access to a tech-enabled dashboard that helps pull insights from 150+ national measures from Premier’s QualityAdvisor® platform designed to help support improved outcomes.
• Although the COVID-19 pandemic brought additional challenges and competing priorities to collaborative members’ best practice implementations, AEIX PIC members maintained the priority of their efforts on process reliability in the perinatal setting.
  

Maternal mortality and morbidity rates remain high in the U.S., keeping it a national priority. Multiple factors contribute to these high rates, ranging from a lack of a standardized management of complications and emergencies to a rise in women presenting with chronic and pregnancy-related conditions. There is a lack of comprehensive inpatient, delivery-related maternal health data, which prohibits identifying where the opportunities for improvement exist.

AEIX Perinatal Improvement Collaborative: Closing Gaps Through Collaboration

The AEIX PIC was an initiative to test, adopt, implement and sustain evidenced-based improvement strategies including, but not limited to, the consensus-endorsed national maternal safety care bundles.

The collaborative ran for two years (April 2019 – March 2021), with an overarching aim to help health systems implement and sustain evidence-based process improvements. It was designed to address maternal and infant health challenges by closing the gap between what is known and what is practiced, identifying new solutions that could produce better clinical outcomes by reducing adverse events, engaging patients and families, and enhancing multidisciplinary communication.

During the implementation, the COVID-19 pandemic was declared a public health emergency. Hospital leaders and staff responded to daily changes in practice requiring agility, vigilance and adaptation to rapidly evolving evidence to continually support a safe environment. Despite this disruption, the coaching support and data provided by the collaborative contributed to improvement and sustainment in best practice implementation and influenced patient outcomes.

Collaborative members worked to:

• Increase implementation for evidence-based processes to improve the reliability of care.
• Increase identification of high-risk patients.
• Mitigate and reduce severe outcomes associated with complications.
• Enhance patient and family engagement in their care.
• Focus on learning how they could improve the overall health of women and newborns in the community by understanding who they serve.

The collaborative members’ improvement efforts aligned with certain recommended national strategies such as the work of the Alliance for Innovation on Maternal Health (AIM), state perinatal quality collaboratives and the goals of national maternal health reform.

The AEIX PIC infrastructure included monthly coaching calls with the frontline clinical team, reviewing bundle elements and implementation plans, and monitoring aligned outcome measures over time. Monthly webinars allowed additional opportunities for shared learning from subject matter experts and collaborative-specific sharing. Resources to supplement the published AIM bundles were identified and provided to all AEIX PIC members.

Utilizing Evidence-Based Processes and Tech-Enabled Tools

The AEIX PIC leveraged three tools to help support organizations in their efforts to implement process changes, create a culture of safety, and measure improved maternal and infant health outcomes.

• High Reliability Assessments (HRAs) – The AEIX PIC team performed a baseline and a post-project onsite perinatal high reliability assessment for each organization that qualitatively examined inpatient obstetric and neonatal service areas and whether structure and process elements of care were reliably delivered.
• Tech-Enabled Perinatal Dashboard – Each collaborative member had access to the tech-enabled perinatal dashboard that provided resources, data and analytics to support efforts to improve maternal and infant outcomes.
• Implementation Project Plans – Each collaborative member received an interactive project plan, customized to reflect each facility’s identified areas of focus for implementation, to recognize what structures and processes they had put into place, and identify opportunities for improvement.

Achieving Improved Outcomes

The AEIX PIC members saw improvement in outcomes in the following areas:

This table represents results of 12 hospitals participating in the 2019 Q2 – 2021 Q1 AEIX PIC initiative, through analysis of a pre-initiative High Reliability Assessment and post-initiative High Reliability Assessment, as well as results from outcomes data from PINC AI™ data and QualityAdvisor® platform.

For more on this topic:

• Learn more about Premier’s efforts to improve maternal and infant health by contacting us.

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