Many points of transition present opportunities for communication failure and adverse events
Transitions routinely occur across phases of the maternity cycle, among individual providers and disciplines, between settings with different levels of care, and between maternity care and other types of health care. Lapses in communication and discontinuity of care frequently cause adverse events and decreased quality, and maternity care is characterized by numerous care transitions and weak care coordination processes.
The current model of maternity care does not engage consumers as partners and empower them to take an active role in coordinating their own care
The vision of engaged and empowered childbearing women and families at the ‘‘center’’ of well-coordinated maternity care is largely unrealized at present. The current focus is often facility and provider oriented, with institutional policies that serve the needs of the system taking precedence over woman- and family-centered care, respect for self-determination, and access to care options along with support for informed choice.
Lack of cooperation between maternity care providers and facilities
Competition for maternity clients among facilities and providers within a community is common and may be a key barrier to communication and care coordination. Lack of trust presents a particular barrier to effective coordination of maternity care during intrapartum care transfers from out-of-hospital to hospital settings; this problem negatively impacts safety and continuity of care, and improved processes are needed. (See the Blueprint section on Clinical Controversies.)
Negative or perverse incentives discourage optimal care coordination
The current reimbursement system does not incentivize care coordination activities that foster appropriate use of services, does not reliably cover many beneficial preventive and other services for women and families, and encourages overuse of procedures and duplication of services. There is no mechanism for sharing the overhead and revenue of maternity care across the full episode of care among facilities and providers. Liability pressures may discourage collaboration between midwives and physicians who fear exposure to vicarious liability. (See the Blueprint sections on Payment Reform Aligning Incentives with Quality and Improved Functioning of the Liability System.)
Health IT and other resources and tools for care coordination are poorly developed at present
Health professionals and systems lack tools to foster good coordination, such as interoperable health IT with personal health records, decision tools, and systems for measuring performance and improving the quality of care. (See the Blueprint section on Development and Use of Health Information Technology.)
- The full episode of maternity care is coordinated through a Woman- and Family-Centered Maternity Care Home.
- When moving within the maternity care system, women and families experience seamless transitions throughout the full episode of maternity care.
- Care is coordinated around the needs and preferences of childbearing women and families.