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Combellick JL, Basile Ibrahim B, Esmaeili A, Phibbs CS, Johnson AM, Patton EW, Manzo L, Haskell SG. Improving the Maternity Care Safety Net: Establishing Maternal Mortality Surveillance for Non-Obstetric Providers and Institutions. Int J Environ Res Public Health 2023; 21:37. [PMID: 38248502 PMCID: PMC10815856 DOI: 10.3390/ijerph21010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024]
Abstract
The siloed nature of maternity care has been noted as a system-level factor negatively impacting maternal outcomes. Veterans Health Administration (VA) provides multi-specialty healthcare before, during, and after pregnancy but purchases obstetric care from community providers. VA providers may be unaware of perinatal complications, while community-based maternity care providers may be unaware of upstream factors affecting the pregnancy. To optimize maternal outcomes, the VA has initiated a system-level surveillance and review process designed to improve non-obstetric care for veterans experiencing a pregnancy. This quality improvement project aimed to describe the VA-based maternal mortality review process and to report maternal mortality (pregnancy-related death up to 42 days postpartum) and pregnancy-associated mortality (death from any cause up to 1 year postpartum) among veterans who use VA maternity care benefits. Pregnancies and pregnancy-associated deaths between fiscal year (FY) 2011-2020 were identified from national VA databases. All deaths underwent individual chart review and abstraction that focused on multi-specialty care received at the VA in the year prior to pregnancy until the time of death. Thirty-two pregnancy-associated deaths were confirmed among 39,720 pregnancies (PAMR = 80.6 per 100,000 live births). Fifty percent of deaths occurred among individuals who had experienced adverse social determinants of health. Mental health conditions affected 81%. Half (n = 16, 50%) of all deaths occurred in the late postpartum period (43-365 days postpartum) after maternity care had ended. More than half of these late postpartum deaths (n = 9, 56.2%) were related to suicide, homicide, or overdose. Integration of care delivered during the perinatal period (pregnancy through postpartum) from primary, mental health, emergency, and specialty care providers may be enhanced through a system-based approach to pregnancy-associated death surveillance and review. This quality improvement project has implications for all healthcare settings where coordination between obstetric and non-obstetric providers is needed.
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Affiliation(s)
- Joan L. Combellick
- Department of Veterans Affairs, Veterans Health Administration, Office of Women’s Health, 810 Vermont Ave NW, Washington, DC 20420, USA; (A.M.J.); (E.W.P.); (S.G.H.)
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA
- School of Nursing, Yale University, 400 West Campus Drive, Orange, CT 06477, USA; (B.B.I.); (L.M.)
| | - Bridget Basile Ibrahim
- School of Nursing, Yale University, 400 West Campus Drive, Orange, CT 06477, USA; (B.B.I.); (L.M.)
| | - Aryan Esmaeili
- Health Economics Resource Center (HERC), Palo Alto VA Medical Center, Menlo Park 795 Willow Road, Palo Alto, CA 94025, USA; (A.E.); (C.S.P.)
| | - Ciaran S. Phibbs
- Health Economics Resource Center (HERC), Palo Alto VA Medical Center, Menlo Park 795 Willow Road, Palo Alto, CA 94025, USA; (A.E.); (C.S.P.)
- Departments of Pediatrics and Health Policy, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304, USA
| | - Amanda M. Johnson
- Department of Veterans Affairs, Veterans Health Administration, Office of Women’s Health, 810 Vermont Ave NW, Washington, DC 20420, USA; (A.M.J.); (E.W.P.); (S.G.H.)
| | - Elizabeth Winston Patton
- Department of Veterans Affairs, Veterans Health Administration, Office of Women’s Health, 810 Vermont Ave NW, Washington, DC 20420, USA; (A.M.J.); (E.W.P.); (S.G.H.)
- VA Boston Health Care System, 150 South Huntington Avenue, Boston, MA 02130, USA
- Department of Obstetrics and Gynecology, Chobanian & Avedisian School of Medicine, Boston University, 771 Albany St, Dowling 4, Boston, MA 02118, USA
| | - Laura Manzo
- School of Nursing, Yale University, 400 West Campus Drive, Orange, CT 06477, USA; (B.B.I.); (L.M.)
- US Army, AMEDD Student Detachment, 187th Medical Battalion, Joint Base San Antonio, San Antonio, TX 78234, USA
| | - Sally G. Haskell
- Department of Veterans Affairs, Veterans Health Administration, Office of Women’s Health, 810 Vermont Ave NW, Washington, DC 20420, USA; (A.M.J.); (E.W.P.); (S.G.H.)
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA
- School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06510, USA
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