The Louisiana Department of Health and the Louisiana Perinatal Quality Collaborative (LaPQC) have met their goal of reducing maternal morbidity among hemorrhage and severe hypertension connected to pregnancy by 20 percent, according to a new report.
Launched in August 2018, the goal was part of the Reducing Maternal Morbidity Initiative, a central focus of Louisiana's commitment to reduce maternal mortality. This initiative focused on reducing maternal morbidity, which means an unplanned outcome or injury from childbirth that negatively affects the health of the mother.
The Reducing Maternal Morbidity Initiative set a goal to reduce the occurrence of two recognized contributors to maternal morbidity and mortality: preventable hypertension and/or hemorrhage, while also reducing racial disparities in outcomes. The goal was to show measurable progress by Mother's Day 2020. This LaPQC report is the first time the Department has reported on maternal morbidity; previous reports covered maternal mortality (the death of a mother).
Maternal mortality has occurred in Louisiana at unacceptably high rates, and the LaPQC and the Louisiana Commission on Perinatal Care and Prevention of Infant Mortality has committed to adopting best practices to stop preventable death and injury.
Goal 1: Reduce maternal morbidity among hemorrhage through the implementation of best practices, including hemorrhage risk assessment and measuring blood loss rather than estimating.
Result: Severe maternal morbidity among hemorrhage was reduced by 39.3%.
Goal 2: Reduce maternal morbidity among severe hypertension through timely treatment of severe hypertension.
Result: Severe maternal morbidity among hypertension was reduced by 22%.
Goal 3: Reduce racial disparities. Black mothers in Louisiana die as a result of childbirth at unacceptable rates in comparison to white mothers.
Result: There were incremental improvements in severe maternal morbidity among black patients who experienced hypertension and hemorrhage. However, those same improvements grew at a faster rate for white mothers, indicating continued disparities. Because systemic inequities are a major contributor to disparities, systems-level work will need to continue for many years to see a consistent and constant change.
The work of the LaPQC is carried out by the 41 hospitals and birthing centers that have volunteered to work with the Department to improve outcomes, and meeting these goals could not have been done without their hard work. Because of the collaboration, 9 out of 10 births are now occurring in LaPQC-affiliated facilities.
These 41 facilities also worked with the Department to improve internal processes that helped assure families that even if an unplanned event occurs during childbirth, facilities are prepared to respond. The 41 LaPQC facilities reported the following progress in improving outcomes:
LaPQC hospitals focused on three key goals in improving internal processes: timely treatment of hypertension, risk assessment at admission and quantification of blood loss.
Result: Timely treatment of hypertension: +30%
Result: Risk assessment: +20%
Result: Quantification of blood loss +30%
"This report shows that we have made important progress, particularly in preventing unplanned maternal outcomes that could lead to death," said Louisiana Department of Health Secretary Dr. Courtney N. Phillips. "We recognize we have more work to do, especially around reducing disparities. We are proud to continue this work alongside our healthcare partners and are grateful for the work of countless advocates, doctors, nurses and families who helped highlight the importance of maternal health."
While these numbers are considered preliminary, it was the goal of the LaPQC to issue a progress report by Mother's Day 2020. Final results are slated for 2021.
In September 2020, the LaPQC will launch the Safe Births Initiative that will continue improvement work on hemorrhage and hypertension and serve as a vehicle for a new focus on reducing Louisiana's primary cesarean section rate.
To view the LaPQC report in full, click here.
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