MATERNAL MORTALITY REVIEW IN NEW JERSEY

1
MATERNAL MORTALITY REVIEW IN NEW JERSEY

• Sandra M. Schwarz, RNC, MS
• Program Manager
• Perinatal Health Services
• New Jersey Department of Health Senior
  Services
  
• Maternal, Infant, and Child Health Epidemiology
  Workshop
  
• December 8-9, 1999

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BACKGROUND

• NJDHSS in cooperation with the Medical Society of
  New Jersey has investigated and reviewed maternal
  deaths since the 1970s
  
• Currently, the death of a women within 90 days of
  pregnancy is considered a maternal death (death
  certificate checkbox)
  
• NJDHSS staff compile needed information
• Maternal Mortality Review (MMR) Committee reviews
  cases once a year
  
• Summary report is developed and discussed by
  Medical Society at its annual meeting

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BACKGROUNDMATERNAL AND CHILD HEALTH CONSORTIA

• Seven regional central service facilities
  licensed by the Department
  
• Members include providers, hospitals, consumers,
  community based agencies and other interested
  parties
  
• Primary functions include prevention activities,
  education, continuous quality improvement, data
  analysis, coordination of transport systems, and
  the development of comprehensive
  perinatal/pediatric regional plans

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ISSUES WITH CURRENT SYSTEM

• Process has remained essentially unchanged for
  the past twenty years.
  
• Voluntary reporting of deaths and supporting
  documents
  
• Time delay in review caused by reliance on Death
  Certificates
  
• Inconsistent method of medical record
  abstraction
  
• Lack of trend analysis
• Single discipline case review team (medical model)

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MODEL MMR PROCESS

• Based on Florida Pregnancy Associated Mortality
  Review (PAMR) model
  
• Identification of cases through check off box on
  death certificates
  
• Select case summaries abstracted in the Florida
  PAMR model
  
• Multidisciplinary team utilized in case review

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OBJECTIVES OF REVISIONS

• Expand case review team to include multiple
  disciplines
  
• Institute a consistent medical record abstraction
  tool
  
• Incorporate the CDC definition of pregnancy
  related mortality surveillance utilized in FL
  model by June 2000
  
• Review all maternal deaths utilizing an
  abstracted record
  
• Develop a plan for CQI activities for MCH
  Consortia based on review
  
• Implement CQI activities including professional
  and consumer education statewide through the
  regional MCH Consortia

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CURRENT ACTIVITIES

• Issued a request for Proposal Notice to MCH
  Consortia for the following
  
• Data abstraction
• Distribution of abstracts to members of Review
  Committee
  
• Analysis of trend data on an annual basis
• States proposal presented to the Medical Society
  committee for approval at the May 1999 annual
  meeting
  
• States proposal presented to the New Jersey
  Obstetric/Gynecologic Society at the September
  1999 annual meeting

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ACTIVITIES IN YEAR 1

• By July 1999, the MCH Consortium (MCHC) will
  coordinate transition activities with the
  existing MMR
  
• By September 1999, the Department of Health and
  Senior Services will receive Institutional Review
  Board approval
  
• By October 1999, the MCHC will establish a
  mechanism to analyze individual and aggregate
  trend data

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ACTIVITIES IN YEAR 2

• By December 1999, the MCHC will ensure membership
  expanded to include multidisciplinary
  representation
  
• By June 2000, the contractor MCHC will provide
  technical assistance to remaining MCHC to develop
  CQI plans
  
• By June 2000, the NJDHSS, MMR Committee MCHC
  will consider expanding the review to include
  deaths of pregnant women within 12 months
  
• By June 2000, each MCHC will incorporate any
  identifiable trend data into educational programs

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REVIEW OF GOALS

• Improved identification of cases
• Improved review of cases
• Better understanding of ways to decrease maternal
  deaths
  
• Strengthen and improve the system of care for
  childbearing women
  

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CONTACT INFORMATION

• Sandra M. Schwarz, RNC, MS
• Program Manager
• Perinatal Health Services
• New Jersey Department of Health and Senior
  Services
  
• PO Box 364
• Trenton, NJ 08625-0364
• [phone]
• sschwarz_at_doh.state.nj.us