We convened the Transforming Maternity Care (TMC) Project because we believed that transformation is possible, and rapid gains in maternity care quality and value are within our reach. While there’s much work still to be done, we look back at the past year and recognize that the transformation is well underway!
We bring you our year-end list of 11 signs that maternity care is transforming. We are proud of Childbirth Connection’s contributions to many of these, and want to thank our TMC Partners and all stakeholders leading the way to better maternity care.
11 Signs of Maternity Care Transformation in 2011
1. The effort to measure and eliminate elective deliveries before 39 weeks is sweeping the nation. The Leapfrog Group, Childbirth Connection, and the March of Dimes worked together in January to publicize Leapfrog survey results on hospital rates of elective early deliveries and share educational materials for women and professionals. Every month that followed brought a new study or report of hospitals implementing programs to reduce or eliminate the practice. Not only are these efforts having a measurable, immediate impact on maternal-newborn health, they are fostering a culture of maternity care quality within hospitals and health systems – fertile soil for future improvement efforts.
2. Maternity care quality is squarely on the national agenda. After years of inadequate and poorly coordinated attention by policy makers and others, maternity care quality has become a priority in health care reform efforts, and public and private partners are working together more than ever before. In June, several TMC Partners including Childbirth Connection took part in a Centers for Medicare and Medicaid stakeholder meeting to identify priorities for improving perinatal outcomes. In April, obstetric adverse events became one of 10 priority areas for the national patient safety initiative, Partnership for Patients. Multiple bills related to maternity care quality improvement were introduced in the House and Senate, including one that Childbirth Connection and the American Congress of Obstetricians and Gynecologists (ACOG) worked jointly on: the Quality Care for Moms and Babies Act of 2011, (S. 1969 / H.R. 3620) sponsored by Senators Debbie Stabenow and Robert Menendez and Representative Eliot Engel. The bill is supported by the American College of Nurse-Midwives, the American Congress of Obstetricians & Gynecologists, Amnesty International USA, the Association of Women’s, Obstetric & Neonatal Nurses, the Black Women’s Health Imperative, the Center for Healthcare Quality and Payment Reform, Childbirth Connection, the International Center for Traditional Childbirth, the Midwives Alliance of North America, the National Association of Certified Professional Midwives, the National Committee for Quality Assurance, the National Partnership for Women & Families, and The Leapfrog Group.
3. We’ve entered a new era of collaboration between doctors and midwives. ACOG and the American College of Nurse-Midwives (ACNM) released a joint statement on collaborative practice that, for the first time, defined certified nurse-midwives and certified midwives as independent providers with their own scope of practice. The two organizations solicited manuscripts on collaborative practice and jointly published the winning papers in their journals. In October, midwives and doctors, along with women, nurses, payers, and other stakeholders, released a common ground statement on planned home birth calling for better collaboration and integration of care.
4. Some troubling trends are slowing or reversing. Last month, the CDC released data showing that the cesarean section rate dropped for the first time in over a decade by a modest but welcome 0.1%. The preterm birth rate and teen pregnancy rates were also lower, following on recent declines. While it’s too early to know what’s behind these changes or if they will persist, it’s heartening to see some key maternity care outcomes moving in the right direction.
5. Shared decision making and maternity care are together at last. As health care reform efforts go after the triple aim of better health, better health care, and lower costs, shared decision making has emerged as a key strategy to achieve all three. 2011 brought a major announcement from Childbirth Connection and the Foundation for Informed Medical Decision Making that the two organizations were teaming up to produce a suite of evidence-based shared decision making tools for maternity care. Expect to hear much more about this in 2012.
6. The Woman- and Family-Centered Maternity Care Home was born. Although the concept has been gestating for a few years, we saw lots of activity to design and test maternity care adaptations to the Patient-Centered Medical Home. Early efforts in states like North Carolina and Minnesota will help identify opportunities and test feasibility. The Quality Care for Moms and Babies Act, if passed, will fund more demonstration projects.
7. Employers and payers stepped up to the plate. We saw countless examples of payers using their purchasing power to drive better quality and value for maternity care. The Leapfrog Group, the Midwest Business Group on Health, the National Business Coalition on Health, the Pacific Business Group on Health, the Center for Healthcare Quality and Payment Reform, and Catalyst for Payment Reform are just some of the partners we worked with over the past year to focus on quality improvement and payment reform strategies to drive better care for women and babies.
8. Performance measurement gathered momentum. Just a few years ago there was no set of nationally endorsed measures of maternity care quality but this has changed rapidly, with efforts gathering steam in 2011. Through a collaboration of the AMA’s Physician Consortium for Performance Improvement, ACOG, and the National Committee for Quality Assurance, a new set of maternity care performance measures is in the pipeline for release in 2012. Our executive director, Maureen Corry, is a member of the Maternity Care Work Group that is guiding this process. And the National Quality Forum’s Perinatal and Reproductive Healthcare Endorsement Maintenance project is reviewing previously endorsed performance measures and considering new submissions. Our director of programs, Carol Sakala, is co-chairing the Steering Committee that is guiding this work.
9. Clinician and hospital leaders embraced patient safety. The year ended with an historic joint Call to Action from the major maternity professional organizations for inter-professional collaboration to improve safety and quality. This was an exciting cap to a year that also brought us the Partnership for Patients and several major reports of comprehensive patient safety programs like those by the Hospital Corporation of America, Intermountain Health, Michigan Health and Hospital Association Keystone OB Project, Trinity Health, and Weill Cornell Medical Center.
10. Nurses’ leadership in quality improvement became clearer than ever. Nurses are natural leaders in hospital improvement efforts as they are at the front lines of care delivery and have a view of the problems that need solutions. In 2011, we saw more and more quality and safety initiatives in the nursing literature, including a special issue of MCN on nurse-led safety initiatives, a project to tackle tachysystole, and a successful nurse-led intervention to keep moms and babies skin-to-skin in the operating room after cesareans.
11. The improvement toolbox is overflowing. 2011 brought more new data sources, robust toolkits, and several direction-setting reports. Just this month, we were pleased to see a white paper from the California Maternity Quality Care Collaborative setting a public agenda for reducing cesareans in low risk women. We were also inspired by the National Quality Strategy, a new white paper on patient-clinician communication, and new standards for the conduct of systematic reviews and creation of clinical practice guidelines.
The wheels of improvement are turning. Let’s keep up the momentum in 2012 and beyond. To be part of the transformation, visit our Join the Transformation campaign page.