Reducing severe maternal morbidity for birthing persons with severe hypertension through a statewide quality improvement initiative - 14/06/24
, Lauren Keenan-Devlin, PhD, MPH a, Elissa H. Oh, MA b, c, Danielle Young, MPH b, c, William Grobman, MD, MBA b, c, d, Patricia Lee King, PhD, MSW a, b, cAbstract |
Background |
Hypertensive disorders of pregnancy are a leading preventable cause of severe maternal morbidity and maternal mortality worldwide.
Objective |
To assess the improvement in hospital care processes and patient outcomes associated with hypertensive disorders of pregnancy after introduction of a statewide Severe Maternal Hypertension Quality Improvement Initiative.
Study Design |
A prospective cohort design comparing outcomes before and after introduction of the Illinois Perinatal Quality Collaborative statewide hypertension quality improvement initiative among 108 hospitals across Illinois. Participating hospitals recorded data for all cases of new-onset severe hypertension (>160 mm Hg systolic or >110 mm Hg diastolic) during pregnancy through 6 weeks postpartum from May 2016 to December 2017. Introduction of the statewide quality improvement initiative included implementation of severe maternal hypertension protocols, standardized patient education and discharge planning, rapid access to medications and standardized treatment order sets, and provider and nurse education. The main outcome measure was the reduction of severe maternal morbidity for pregnant/postpartum patients with severe hypertension. Key process measures include time to treatment of severe hypertension, frequency of provider/nurse debriefs, appropriate patient education, and early postpartum follow-up.
Results |
Data were reported for 8073 cases of severe maternal hypertension. The frequency of patients with new-onset severe hypertension treated within 60 minutes increased from 41% baseline to 87% (P<.001) at the end of the initiative. The initiative was associated with increased proportion of patients receiving preeclampsia education at discharge (41% to 89%; P<.001), scheduling follow-up appointments within 10 days of discharge (68% to 83%; P<.001), and having a care team debrief after severe hypertension was diagnosed (17% to 59%; P<.001). Conversely, severe maternal morbidity was reduced from 11.5% baseline to 8.4% (P<.002) at the end of the study period. Illinois hospitals have achieved time to treatment goal regardless of hospital characteristics including geography, birth volume, and patient mix.
Conclusion |
Introduction of a statewide quality improvement effort was associated with improved time to treatment of severe hypertension and increased frequency of provider/nurse debriefs, appropriate patient education, and early postpartum follow-up scheduled at discharge, and reduced severe maternal morbidity.
Le texte complet de cet article est disponible en PDF.Video |
(8.2 Mo)
Key words : early postpartum follow-up, Illinois Perinatal Quality Collaborative, improvement science, patient education, perinatal quality, preeclampsia, preeclampsia education, quality improvement, team debrief, time to treatment
Plan
| The authors report no conflict of interest. |
|
| An earlier version of this study, “Reducing time to treatment for severe maternal HTN through statewide quality improvement,” was presented at the Society for Maternal-Fetal Medicine 38th Annual Meeting, Dallas, TX, from January 29 through February 3, 2018. |
|
| This study was funded by the Centers for Disease Control and Prevention, the Illinois Department of Public Health, and the Alliance for Innovation on Maternal Health. |
|
| Cite this article as: Borders A, Keenan-Devlin L, Oh EH, et al. Reducing severe maternal morbidity for birthing persons with severe hypertension through a statewide quality improvement initiative. Am J Obstet Gynecol 2024;XX:x.ex–x.ex. |
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?