Making Motherhood Safe in California California Pregnancy-Related and Pregnancy-Associated Mortality Review

1
Making Motherhood Safe in CaliforniaCalifornia
Pregnancy-Related and Pregnancy-Associated
Mortality Review California Maternal Quality
Care Collaborative

• Maternal, Child and Adolescent Health Program
• Center for Family Health
• California Department of Public Health
• California Maternal Quality Care Collaborative
• October 16, 2007
• MCH Federal/State Partnership

2
Presentations and Discussion

• Shabbir Ahmad, Acting Division Chief, California
  Department of Public Health, Maternal, Child and
  Adolescent Health Program
• Welcome and Introductions
• Background
• Amy L. Godecker, California Department of Public
  Health, Maternal, Child and Adolescent Health
  Program
• California Pregnancy-Related and
  Pregnancy-Associated Mortality Review (CA-PAMR)
• Debra Bingham, Project Director, California
  Maternal Quality Care Collaborative
• CA-PAMR Advisory Committee Review Process
  Contributing Factors Analysis
• Elliott K. Main, Principal Investigator,
  California Maternal Quality Care Collaborative
• Maternal Care Quality Improvement Programs in
  California
• Discussion

3
Making Motherhood Safein California

• Shabbir Ahmad, D.V.M., MS, Ph.D.
• California Department of Public Health
• Center for Family Health
• Maternal, Child and Adolescent Health Program

4
California Demographic Characteristics 2006

• State Projected Total Population 37.4 million
• Hispanic 13.2 million (35)
• Non-Hispanic 24.2 million (65)
• White 16.4 million (44)
• Asian 4.3 million (12)
• Pacific Islander 0.1 million (0.4)
• African American 2.3 million (6)
• American Indian 0.2 million (0.6)
• Multi-Race 0.8 million (2.1)
• California Resident Women Births 562,157
• 13.3 of 2005 US Births
• Births to Resident Hispanic Women 52 of total
  births
• Paid by Medi-Cal
• Delivery 47 of total births
• Unintended Births to California Women 43

Data Sources State of California, Department of
Public Health, 2006 Birth Records Hamilton BE,
Martin JA, Ventura SJ. Births Preliminary data
for 2005. Health E-Stats. Released November 21,
2006 State of California, Department of Finance,
Race/Ethnic Population with Age and Sex Detail,
20002050. Sacramento, CA, July 2007. Maternal
and Infant Health Assessment (MIHA) Survey, 2005.
5
Maternal/Pregnancy-Related Mortality Rate,
California Residents United States 1991-2004
HP 2010 Objective 4.3 Deaths per 100,000 Live
Births
SOURCE State of California, Department of Public
Health, California Birth and Death Statistical
Master Files, 1991-2004. Maternal mortality
(deaths 42 days postpartum) calculated
1991-1998 using ICD-9 classification.
Pregnancy-related mortality (deaths 365 days
postpartum) calculated beginning 1999 using
ICD-10 classification. United States data and
HP2010 Objective are for maternal mortality.
Produced by California Department of Public
Health, Maternal, Child and Adolescent Health
Program, October 2007.
6
Pregnancy-Related Mortality Rates by
Race/Ethnicity, California Residents 1990-2004
SOURCE State of California, Department of Public
Health, California Birth and Death Statistical
Master Files, 1990-2004. Maternal mortality
(deaths 42 days postpartum) calculated
1990-1998 using ICD-9 classification.
Pregnancy-related mortality (deaths 365 days
postpartum) calculated beginning 1999 using
ICD-10 classification. Maternal single race code
used 1990-1999 multirace code used beginning
2000. Produced by California Department of
Public Health, Maternal, Child and Adolescent
Health Program, October 2007.
7
California Pregnancy-Related and
Pregnancy-Associated Mortality Review(CA-PAMR)
Making Motherhood Safe

• Amy L. Godecker, MS PhD
• California Department of Public Health Maternal,
  Child and Adolescent Health Program

8
California Pregnancy-Related and
Pregnancy-Associated Mortality Review(CA-PAMR)
Making Motherhood Safe

1. Californias outcomes
2. The challenge of scale
3. Los Angeles prior mortality review
4. Developing CA-PAMR
5. CA-PAMRs 2002 cohort

9
Maternal Mortality Rate, California, 1920-2004
HP 2010 Objective 4.3 Deaths per 100,000 Live
Births
2004 13.6
SOURCE State of California, Department of Public
Health, California Birth and Death Statistical
Master Files, 1930-2004. Produced by California
Department of Public Health, Maternal, Child and
Adolescent Health Program, October, 2007.
10
Maternal Mortality Rate, California, 1970-2004
HP 2010 Objective 4.3 Deaths per 100,000 Live
Births
SOURCE State of California, Department of Public
Health, California Birth and Death Statistical
Master Files, 1970-2004.
Produced
by California Department of Public Health,
Maternal, Child and Adolescent Health Program,
October, 2007.
11
Maternal/Pregnancy-Related Mortality Rate,
California Residents United States 1991-2004
HP 2010 Objective 4.3 Deaths per 100,000 Live
Births
SOURCE State of California, Department of Public
Health, California Birth and Death Statistical
Master Files, 1991-2004. Maternal mortality
(deaths 42 days postpartum) calculated
1991-1998 using ICD-9 classification.
Pregnancy-related mortality (deaths 365 days
postpartum) calculated beginning 1999 using
ICD-10 classification. United States data and
HP2010 Objective are for maternal mortality.
Produced by California Department of Public
Health, Maternal, Child and Adolescent Health
Program, October 2007.
12
Pregnancy-Related Mortality Rates by
Race/Ethnicity, California Residents 1990-2004
SOURCE State of California, Department of Public
Health, California Birth and Death Statistical
Master Files, 1990-2004. Maternal mortality
(deaths 42 days postpartum) calculated
1990-1998 using ICD-9 classification.
Pregnancy-related mortality (deaths 365 days
postpartum) calculated beginning 1999 using
ICD-10 classification. Maternal single race code
used 1990-1999 multirace code used beginning
2000. Asian women had too few deaths during
1996-1998 period to calculate rate. Produced by
California Department of Public Health, Maternal,
Child and Adolescent Health Program, October 2007.
13
African-American Women are Over-represented in
Maternal Deaths
SOURCE State of California, Department of Public
Health, California Birth and Death Certificate
Master Files, 2004. Produced by California
Department of Public Health, Maternal, Child and
Adolescent Health Program, October
2007. Pregnancy-related death determined by
ICD-10 coding of death certificate.
14
Californias Births Are Comparable to Many
Countries
15
A California Region An Average State
Making Motherhood Safe
Regional Perinatal Programs of California Region Regional Perinatal Programs of California Region No. of Births (2005)
01 No. Coast (inc. San Francisco) 23,705
02 NE (inc. Sacramento) 47,321
03 East Bay (inc. Oakland) 23,518
04 Mid-Coast 40,013
05 San Joaquin (Central Valley) 54,721
06 Los Angeles (regions 6.1-6.8) 158,712
07 Inland 48,289
08 Orange 44,506
09 San Diego 47,396
10 Kaiser No. 32,004
11 Kaiser So. 29,957
Total 550,142
State No. of Births (2005)
Hawaii 17,925
Nevada 37,258
Oregon 45,937
Washington 82,592
Arizona 96,231
Connecticut 41,717
Mississippi 42,398
New Mexico 28,834
Oklahoma 51,746
Utah 51,554
10 state total 496,192
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Los Angeles County Maternal Mortality Review

• Review dates 1994-1996 Report 1998
• 3 main causes hemorrhage, embolism, and
  hypertension
• Risk higher for women gt 30 years old,
  African-Americans, inadequate prenatal care, and
  higher parity
• Judged that ¾ of deaths had some chance of being
  prevented
• Provider factors contributed most commonly
• Patient factors often contributed some
• Facility and community factors contributed less

17
Developing CA-PAMR

• MCAH Program concerned about trends
• Assess causes of and factors contributing to
  maternal deaths
• Special concern about racial/ethnic disparities
  in maternal mortality
• Develop public health recommendations
• Identify clinical quality improvement
  opportunities
• Form public and private partnerships

18
Developing CA-PAMR

• Collaboration between
• CDPH MCAH Program
• UC San Francisco
• Public Health Institute
• California Maternal Quality Care Collaborative
  (CMQCC)
• Pilot year begun 2004 for 2002 birth cohort
• Draft report due early 2008
• Funding through November 2010
• Use Title V Block Grant funds

19
Developing CA-PAMR

• Foundational work by MCAH Program/UCSF prior to
  the formation of the Advisory Committee for case
  reviews
• Protocol for IRB review
• Public Health Institute for medical records
  review
• Support from ACOG
• Data linkage to identify cases
• Reviewed death certificates
• Selection of sample of cases
• Requested coroner reports

20
Authority for CA-PAMR

• General legal authority, no specific
  authorization
• Health and Safety Code Section 100325-100335
• The department may do all of the following
  activitiesMake any additional collection of data
  necessary to describe and analyze factors
  related to population dynamics, public health,
  and the environment.
• The furnishing of this information to the
  departmentshall not subject any person,
  hospitalor other organization furnishing this
  information to any action for damages.
• http//www.leginfo.ca.gov/calaw.html
• Similar to Fetal and Infant Mortality Review
• Office of HIPAA Compliance review of protocol
• HIPAA Waiver by State IRB

21
CA-PAMR Confidentiality Protocols

• Signed confidentiality agreements
• Hospital staff trained in HIPAA-compliance
• Secure storage handling of hard copies
  electronic files
• Advisory Committee reviews de-identified
  materials that are destroyed after meetings
• No identifying information on final database
• Reports publications will not identify any
  person, provider, facility, or small geographic
  area

22
CA-PAMR Uses CDC and ACOG Mortality Definitions

• Pregnancy-related deaths under-reported using
  ICD-10 codes on death certificates
• Pregnancy-related mortality
• Death while pregnant or within 1 year of
  termination of pregnancy from any cause related
  to or aggravated by her pregnancy or its
  management, but not from accidental or incidental
  causes.
• Pregnancy-associated mortality
• The death of a woman while pregnant or within 1
  year of termination of pregnancy, irrespective of
  cause.

23
CA-PAMR Case Identification
2002 Birth Cohort Data (Live birth certificates
fetal deaths gt20 weeks)
Pregnancy-related deaths (ICD-10 code on death
cert.)
Pregnancy-associated deaths
2002 2003 Death Certificates (Maternal deaths
within 365 days of birth or fetal death)
CA-PAMR Sample
Linkage process
Pregnancy-associated deaths
2002 2003 Inpatient discharge data (Prenatal,
labor delivery postpartum up to 365 days)
24
CA-PAMR Case Identification

• Includes women 20 weeks gestation
• Future years will identify women lt20 weeks
  gestation by looking at diagnosis codes in
  discharge data
• Pregnancy check box on death certificate
  beginning with 2003 deaths
• Pregnant within 1 year of death
• Will give additional field to select records

25
CA-PAMR 2002 Cohort
Pregnancy-related deaths
60
CA-PAMR Sample
Pregnancy-associated deaths
39 cases
Pregnancy-associated deaths
60 cases
194 cases
25
Sample includes 24 preg.-related 23
Af.-American 38 42 days 9 fetal deaths
155 cases
26
CA-PAMR 2002 Cohort Selected Causes of Death for
194 Cases Identified
Cause of Death (ICD-10) Cases
Eclampsia/pre-eclampsia/stroke 8
Embolism 7
Hemorrhage 4
Cardiac disease 17
Cancer 23
Transportation accidents 29
Drug overdose 15
Homicide 15
Suicide 6
27
CA-PAMR 2002 Cohort Days from birth or fetal
death to pregnancy-related death
3 additional deaths at 131, 179 220 days
SOURCE State of California, Department of Health
Services, California Birth Cohort/Patient
Discharge Data Linkage File, 2002 cohort. ICD-10
used to classify whether coded pregnancy-related
on death certificate.
28
CA-PAMR Advisory Committee
Pregnancy-related deaths
Pregnancy-related deaths
Possibly pregnancy-related deaths
Pregnancy-associated deaths
CA-PAMR Sample
Advisory Committee Review
Pregnancy-associated deaths
Pregnancy-associated deaths
Quality improvement public health opportunities
CMQCC Translating Data Into Action
29
CA-PAMR Advisory Committee Review Process
Making Motherhood Safe
California Maternal Quality Care Collaborative

• Elliott Main, MD, Principle Investigator
• Debra Bingham, RN MS DrPH student, Program
  Director

30
CA-PAMRAdvisory Committee

• Honoring Womens Lives
• Honoring the Teams
• Each Death Has an Important Story to Tell
• Each Death is a Tragedy
• CMQCC Role
• Extract the Lessons
• Translate the Lessons Learned into Actions

CMQCC A Collaborative to advance maternity
through data-driven quality improvement.
31
CA-PAMR Advisory Committee

• Advisory Committee reviews (de-identified)
• Abstracted medical records
• Autopsy
• Coroner reports
• Selected hospital-level data
• Advisory Committee reviews to determine
• Pregnancy-related
• Cause
• Contributing factors
• QI opportunities

CMQCC A Collaborative to advance maternity
through data-driven quality improvement.
32
CA-PAMR Advisory Committee Members (Clinicians)

• Physician and nursing leaders statewide
• Elliott Main, MD, Chair, CMQCC
• Debra Bingham, MS, RN, CMQCC
• Lisa Bollman, MS, RN, Regional Perinatal Programs
  of California, Perinatal Profiles
• Conrad Chao, MD, UC Fresno
• Sheila Cohen, MD, OB Anesthesia, Stanford
• Patsy Dailey, MD, OB Anesthesia, Mills-Peninsula
  Hosp / CSA
• Maurice Druzin, MD, Stanford
• Michael Fassett, MD, Kaiser So California
• Dodi Gauthier, MEd, RN, Assn. of Womens Health,
  Obstetrics Neonatal Nurses
• Katherine Gregory, MD, MPH, American College of
  Obstetricians and Gynecologists
• Kim Gregory, MD, MPH, UCLA/Cedars Sinai
• Thomas Kelly, MD, UC San Diego
• Barbara Murphy, MS, RN, California Perinatal
  Quality Care Collaborative
• Larry Newman, MD, Kaiser No California
• Carolina Reyes, MD, LA Best Babies
• Linda V. Walsh, CNM, PhD, American College of
  Nurse Midwives
• Lynn Yonekura, MD, USC

33
CA-PAMR Will Report Quantitative and Qualitative
Findings

• Quantitative
• Database of key elements
• Data from medical record, vital record, or
  discharge data
• Best source, sometimes multiple sources
• Contributing factors judgments from Advisory
  Committee review
• Add each successive cohort as it is completed
• Qualitative
• Vignettes for case summaries
• Summary of QI and teaching opportunities

34
CA-PAMR Advisory Committee Contributing Factors
Analysis

• Data Elements and Judgments
• Community Factors
• Patient Factors
• Health Care Facility Factors
• Provider Factors
• Categorized As
• No
• Probably
• Definitely
• Insufficient

• Example
• Obesity - Did the fact that the patient is obese
  contribute to the death?
• Lack of Tubing Did the lack of tubing in the
  LD area contribute to the death?

35
CA-PAMR Advisory Committee Contributing Factors
Analysis

• Pregnancy Related Yes/No/Possibly
• Chance to Alter Outcome None/Some/Good/Strong
• Pre-conception Care Chance to Alter Outcome
  None/Some/Good/Strong
• Cause of Death Based on expert review opinion,
  not death certificate
• QI Opportunities
• Free text
• Will be coded for themes

36
CA-PAMR Quality Improvement Opportunities and
Action Items

• Education
• Collaborative Quality Improvement Projects
• County Public Health Department Projects
• Hospital/Provider Projects
• Regulation, e.g., State, Joint Commission
• Payer Pressure
• Year One of Five Year Process
• CMQCC Develop and Implement Changes

37
CA-PAMR Preliminary Quality Improvement Themes

• Health care professional and facility factors
• Response to obstetric hemorrhage and acute
  emergencies
• Prophylaxis for pulmonary embolism and deep vein
  thrombosis
• Management of heart disease
• Emergency Department teams recognition
  treatment of pregnancy-related conditions
• Examples pre-eclampsia, heart disease
• Under-appreciation of high-risk conditions
• Appropriate level of care facility
• Early recognition of maternal distress, use of
  triggers
• Missing Post-partum Depression

38
CA-PAMR Preliminary Quality Improvement Themes

•  Fragmentation of care
• Chronic care management (pre-conception and post
  delivery)
• Access to high-risk specialists, i.e., payment,
  availability
• Prenatal record availability at delivery hospital
  
• Lack of Public Awareness
• Harmful effects of Inductions
• Importance of pre-conception care
• Post-Partum Depression recognition treatment
• Connection of mortality and morbidity associated
  with cesarean sections

39
CA-PAMR Advisory Committee

• Honoring Womens Lives
• Honoring the Teams
• Each Death Has an Important Story to Tell
• Each Death is a Tragedy
• CMQCC Role
• Extract the Lessons
• Translate the Lessons Learned into Actions

CMQCC A Collaborative to advance maternity
through data-driven quality improvement.
40
Improving Quality of Maternity Care in California
Making Motherhood Safe
California Maternal Quality Care Collaborative

• Elliott Main, MD, Principle Investigator
• Debra Bingham, RN MS DrPH student, Program
  Director

41
Improving Maternal OutcomesTurning data into
action
Making Motherhood Safe
Current MCAH Programs, CDPH

• California Maternal Quality Care Collaborative
  (CMQCC)
• California Pregnancy-Related and
  Pregnancy-Associated Mortality Review (CA-PAMR)
• (3) Local Maternal Care Quality Improvement
  Project(Local Dept. of Health)
• (4) Under Development Regional Maternal Programs
  of California (Hospital QI)

42
Quality Improvement Challenges
Making Motherhood Safe

• Scale
• 350 Maternity hospitals with 560,000 annual
  births
• Distances, diversity, medical cultures
• Organization and Scope
• Lot of cats to herd
• Not much precedent (Great Britain)
• Budget
• We dont have the budget of 10 states

CMQCC A Collaborative to advance maternity
through data-driven quality improvement.
43
California Maternal Quality Care Collaborative
(CMQCC)
Making Motherhood Safe

• Data-driven Quality Improvement
• Develop and Refine Quality Measures
• Develop a State-wide Effort for Collaborative
  Quality Improvement
• Leverage every existing professional group and
  hospital system
• Examine Approaches to Reduce Disparities in
  Outcomes

CMQCC A Collaborative to advance maternity
through data-driven quality improvement.
44
Call to Action!
Maternal Mortality Rate, California, 1970-2004
HP 2010 Objective 4.3 Deaths per 100,000 Live
Births
SOURCE State of California, Department of Public
Health, California Birth and Death Statistical
Master Files, 1970-2004.
Produced
by California Department of Public Health,
Maternal, Child and Adolescent Health Program,
October, 2007.
45
Call to Action (2)!!
Iceberg View of OB Quality
Mortality 1/10,000
Near Misses 1/1,000
Serious Morbidity 1/100
46
Call to Action (3)!!
Maternal Quality Indicator Project (MQI)

• Based at UCLA/Cedars Sinai (M. Lu, Lead)
• Reviewed California Discharge Diagnosis Data
  (hospital specific) over 3 years
• Two key maternal outcomes that exhibit great
  variability among hospitals
• OB Hemorrhage (range 0.43 to 14.2)
• Maternal Infection (range 0.05 to 1.67)
  (both in adjusted, low-risk populations)
• Large Variation (20x), well beyond what can be
  explained by coding differences

47
N Engl J Med 2003349868-74.
48
Lost in Translation

• Biggest issue in Medicine today is not the lack
  of new cures but turning what we already know
  into action
• There is very poor compliance with specialty
  vetted recommendations and guidelines
• Hospitals/ Clinics/ Labs are very complicated
  organizations
• Complex systems are strongly homeostatic
• Resistant to change
• Rewards for preservation of status quo

49
CMQCC Key Founding Organizations
Making Motherhood Safe

• State of California Maternal, Child and
  Adolescent Health Program, Department of Public
  Health Susann
  Steinberg, MD, Division Chief Shabbir Ahmad,
  DVM, MS, PhD, Acting Division Chief
• California Perinatal Quality Care Collaborative
  (CPQCC) (est. 1996) Jeffrey Gould, MD, MPH,
  Elliott Main, MD,Barbara Murphy, MS, RN,Debra
  Bingham, MS, RN, DrPH Student

CMQCC A Collaborative to advance maternity
through data-driven quality improvement.
50
CMQCC Partner Organizations
Making Motherhood Safe

• State Agencies
• DPH Maternal-Child and Adolescent Health
• OSHPD Healthcare Information Division
• Office of Vital Records (OVR)
• Regional Perinatal Programs of California (RPPC)
• Public Groups
• California Hospital Accountability and Reporting
  Taskforce (CHART)
• March of Dimes (MOD)
• Professional groups
• American College of Obstetrics and Gynecology
  (ACOG)
• Association of Womens Health, Obstetric and
  Neonatal Nurses (AWHONN)
• American College of Nurse Midwives (ACNM)
• Key Medical and Nursing Leaders
• University and Hospital Systems
• Kaisers, Sutter, Sharp, CHW, Scripps, Public
  hospitals

51
CMQCC Spheres of Activity
Executive Committee
Analysis
Data
Qual Improv
Partners
Commun-ications
CMQCC A Collaborative to advance maternity
through data-driven quality improvement.
52
Analysis Sphere
Pregnancy Associated Mortality Review
Maternal Quality Indicators
MQI
PAMR
-ID/Valid of measures-Analysis oflarge
admindata sets
-Review of Mat Mort-ID of improv
opportunities-Pub Health
Other
-Systems
53
Data Sphere
California Maternal Quality Care Collaborative
California PerinatalQuality Care Collaborative
CMQCC
CPQCC
-All births-Vital Recs-MC Dx Diagnoses
-lt1500gm-Big babies
MIT
MaternalInformationTechnologyWorkgroup
Other
-Systems
-Other State data sources
54
Quality Improvement Sphere
MQIP
CHART
California Hospital Accountability Reporting
Taskforce
MaternalQuality ImprovementProject
-Tool kits-Regional-Capacity-Diffusion-Sustain
- ability
-Public release measures
Other
-Conferences-Collaboration-Web
55
Public Release Measures
56
Confidential Release Measures

• Perinatal Profiles
• Hospital level FMR, NMR, PMR
• Delivery of VLBW infants at hospitals without
  appropriate level of care
• Neonatal outcomes
• CPQCC (VONN)
• Maternal outcomes
• Based on yearly combined BC/DxDx data set(both
  mother and infants)

57
Maternal Quality Improvement Panel (MQIP)Direct
to Hospitals

• State-wide Collaborative (provider-driven)
• Identify key quality topics
• Develop Tool-Kits and intervention strategies
• Increase Quality Improvement Capacity
• Expand and regionalize QI efforts (diffusion)
• Maintain gains (sustainability)
• Coordinate with measures
• Develop Partnerships!

58
What are Quality Priorities?Variation of Opinion

• Maternal Mortality Reviews
• OB hemorrhage
• Critical care support
• Venous Thrombosis prevention
• Lack of recognition of severe maternal illness
• Prior Cesarean birth
• Maternal obesity
• Lack of access to specialists
• Lack of recognition/care for Postpartum depression

• Provider Interviews
• Labor inductions
• OB hemorrhage
• Early labor admissions
• Lack of access to specialists
• Lack of standardization for oxytocin use

• Payers/Public Interviews
• Labor Cesarean births rate
• Poor term baby outcomes
• 3rd and 4th degree lacs
• VBAC accessibility
• Preterm birth, particularly 34-37 weeks

59
(3) Engaging Local Public Health Departments in
Maternal QI

• Maternal Care Quality Improvement Project
• Three-year quality improvement project with 2-5
  Local Health Jurisdictions (LHJ)
• Focus on the role of LHJs to reduce maternal
  mortality and morbidity thereby improving
  pregnancy and birth outcomes
• Provide technical assistance to LHJs for quality
  improvement interventions.
• Build Partnerships
• Implementation Phase State FY 2008/2009

CMQCC A Collaborative to advance maternity
through data-driven quality improvement.
60
(4) Regional Maternal Programs of California (In
Development Phase)
Teach and Implement Rapid-Cycle Change Approach
to Quality Improvement

• MAP-IT
• Mobilize Groups
• Assess data
• Plan Standards Changes
• Implement Changes
• Track Progress
• Sustain and continue to improve (upward spiral)

Making Motherhood Safe
Regional Hospital-Based QI Six-year projects for
4 of the 11 existing regional perinatal programs
61
Communications Sphere
Web
Partners
-Information-Push News-Meetings-Community
-Newsletters-Agendas-Links
Other
-Conferences-Speakers
62
Partners Sphere
Strategic
Other
-Govt-Prof Org-Systems-Payers
-Qual Org-Other States -National Prof
Org-CDC
63
CMQCC Spheres
Data
Analysis
CM-
CP-
MQI
PAMR
MIT
Qual Improv
Partners
Web
Strategic
MQIP
Partners
Other
CHART
Commun-ications
CMQCC A Collaborative to advance maternity
through data-driven quality improvement.
64
Interactions
Analysis
Data
Qual Improv
Partners
Commun-ications
CMQCC A Collaborative to advance maternity
through data-driven quality improvement.
65
8 Cell Embryo
give us another 9 months!
66
CMQCC---Summary

• Analysis of maternal death cases and
  administrative data sets have identified
  significant improvement opportunities
• We have developed a large-scale evidence-based
  data-driven quality improvement collaborative and
  are off and running
• The scale of California remains a daunting
  challenge

CMQCC A Collaborative to advance maternity
through data-driven quality improvement.
67
2005 Live Births by State
gt13 of US births are in California
gt38 of US births are in 5 states
Births Preliminary Data for 2005 (NCHS)