Around the world and within the United States, pregnancy and childbirth still carry grave, often avoidable risks for mothers and newborns. According to the World Health Organization (WHO), 810 women die worldwide daily from preventable causes related to pregnancy and childbirth. In the U.S., approximately 6,700 newborns die each day, comprising 47 percent of all deaths under the age of five, and two million babies are stillborn each year, with 40 percent occurring during labor.
For World Health Day 2021 (September 17), the WHO is calling for action around “safe and respectful childbirth.” Individual health systems can contribute to childbirth safety improvement by leveraging their data and analytics to better understand risks to mothers and newborns within their populations and identify ways to avoid preventable harm.
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The World Health Organization (WHO) reports that 810 women die worldwide every day from preventable causes related to pregnancy and childbirth. In addition, approximately 6,700 newborns die each day, comprising 47 percent of all deaths under the age of five, and two million babies are stillborn each year, with 40 percent occurring during labor.
In the United States, the maternal mortality ratio—the number of maternal deaths during a given time per 100,000 live births—is higher than comparable countries. Plus, there are significant racial disparities in maternal health outcomes. The most recent U.S. mortality ratio is 17.4 per 100,000 pregnancies, placing the U.S. last among other industrialized countries. The Organization of Economic Cooperation and Development ranks the U.S. 33 out of 36 for infant mortality.
I’ve been involved in patient safety improvement work for more than 20 years but didn’t have personal experience with pregnancy-related complications until my second pregnancy, when doctors informed me that my baby’s umbilical cord only had two vessels—one artery and one vein. Normally, umbilical cords have three vessels—two arteries and one vein. The two arteries provide the neonate the oxygen-rich blood required for growth and development.
Doctors don’t know exactly why 1 percent of pregnancies result in a two-vessel cord. They know the condition increases the risk for high blood pressure for the woman at the end of pregnancy and increases the baby's risk for complications, including decreased neonatal growth, trisomy 18, cardiovascular abnormalities, gastrointestinal problems, kidney problems, and infant death.
I received effective prenatal care throughout my pregnancy, and my health and my baby's health were closely monitored. At 34-weeks’ gestation, my baby’s slow growth appeared to stop, and at week 35 my blood pressure was dangerously high. My doctor decided to induce delivery. I delivered a healthy, bigger-than-expected baby girl, and then hemorrhaged, losing approximately half of my total blood volume, requiring emergency surgery and blood product transfusion.
On this 2021 World Patient Safety Day, I join WHO in urging all stakeholders to “act now for safe and respectful childbirth.” Data and analytics can play a powerful role in supporting the objectives of World Patient Safety Day 2021 in two critical ways:
The following success stories show the power of data-informed best practices to improve the safety of childbirth:
Improving the safety of childbirth starts with ensuring access to effective prenatal care. Allina Health’s Minnesota Perinatal Physicians provides comprehensive diagnostic services and medical/surgical care for a full range of fetal abnormalities, maternal health concerns, and complications of pregnancy.
The organization’s data indicated it had the opportunity to improve access to care and patient satisfaction. Using utilization and access data, Allina Health optimized the scheduling framework to reduce patient wait times, reduce and manage no-shows, and increase the number of available ultrasound appointments—improvements resulting in more than 2,200 additional ultrasounds performed annually.
The California Maternal Quality Care Collaborative (CMQCC) used data and analytics to conduct an in-depth analysis of the causes and contributing factors of pregnancy-related deaths. The organization used these insights to develop evidence-based quality improvement toolkits/best practices that address leading causes of preventable pregnancy-related death such as early elective deliveries, preeclampsia, obstetric hemorrhage, vaginal birth (decreasing cesarean deliveries), and venous thromboembolism.
CMQCC successfully reduced the pregnancy mortality rate in California by 55 percent over seven years. The best practices have been adopted nationwide, and implementation and refinement of these best practices continue to impact patient outcomes positively.
MultiCare Health System worked with its clinicians to improve clinical care and patient outcomes for women’s services systemwide, implementing best practices and using its data platform and analytics to measure and communicate performance. The organization achieved a nulliparous, term, singleton, vertex (NTSV, a low-risk, first-time mother) cesarean section rate 9 percent less than the national average; a 63 percent reduction in episiotomy rates; and an 11 percent reduction in surgical-site infection rate—all while increasing market share.
With the help of analytics, Gunnison Valley Hospital gained insight into its labor and delivery practices, implementing best practices and achieving an 87 percent relating reduction in elective inductions of labor before 39-weeks’ gestation and a 61.1 percent relative reduction in the number of NTSV cesarean deliveries.
In addition to risks associated with pregnancy and birth, mothers and infants have not been spared from the opioid epidemic, and substance use disorders can result in many adverse outcomes for both. Infants exposed to opiates during pregnancy can be born with substantial breathing and feeding problems. In response to this risk, Community Health Network (CHNw) leverages its data platform to understand the needs of its patient populations, adjust and improve care, and evaluate outcomes and communicate performance.
CHNw identified that 42 percent of babies born at its Community Hospital East location were exposed to illicit substances. The data also demonstrated that the number of newborns diagnosed with neonatal abstinence syndrome (NAS), a group of problems occurring in newborns withdrawing from exposure to opiates, was increasing. CHNw developed and implemented an innovative program for pregnant women with substance use disorders, offering medication in combination with counseling and behavioral therapy to treat substance use disorders. The health system takes a non-punitive, data-driven, evidence-based approach to toxicology testing, referring patients with positive results for behavioral health consult and referral to its medication-assisted treatment program.
The CHNw program is transforming lives and improving maternal and newborn safety. Newborns whose mothers participated in medication-assisted treatment using buprenorphine had a 25 percent lower incidence of NAS, and 20 percent more mothers on buprenorphine tested negative for opiates at the time of delivery.
Healthcare providers have ample opportunity to use data and analytics to improve maternal and newborn safety, and there are some exciting future use cases:
The MITRE Corporation is using CDC Wonder, Institute for Health Metrics and Evaluation, and Healthcare Cost and Utilization Project data to develop a tool to enable policymakers to determine program costs to reduce maternal mortality and maternal mortality racial disparities. The federal government approved $12 million in funding, directing the Department of Health and Human Services to build a program supporting state efforts to reduce maternal mortality and create data standards to enable performance analysis nationwide. This work should generate new insights for improvement.
Integration of products like the new Healthcare.AI™ suite unlocks even more potential improvement opportunities. Organizations can use Healthcare.AI to embed statistical and machine learning techniques into business intelligence tools and analytics applications, then can leverage data to forecast outcomes. Organizations can use augmented-intelligence-enhanced technology to identify differences in quality associated with personal characteristics, such as race, ethnicity, primary spoken language, geographic location, sexual orientation, and socioeconomic status, and can set goals, expectations, and targets to improve maternal and newborn safety.
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