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Severe Maternal Morbidity, A Tale of 2 States Using Data for Action—Ohio and Massachusetts

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Abstract

Purpose Describe how Ohio and Massachusetts explored severe maternal morbidity (SMM) data, and used these data for increasing awareness and driving practice changes to reduce maternal morbidity and mortality. Description For 2008–2013, Ohio used de-identified hospital discharge records and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to identify delivery hospitalizations. Massachusetts used existing linked data system infrastructure to identify delivery hospitalizations from birth certificates linked to hospital discharge records. To identify delivery hospitalizations complicated by one or more of 25 SMMs, both states applied an algorithm of ICD-9-CM diagnosis and procedure codes. Ohio calculated a 2013 SMM rate of 144 per 10,000 delivery hospitalizations; Massachusetts calculated a rate of 162. Ohio observed no increase in the SMM rate from 2008 to 2013; Massachusetts observed a 33% increase. Both identified disparities in SMM rates by maternal race, age, and insurance type. Assessment Ohio and Massachusetts engaged stakeholders, including perinatal quality collaboratives and maternal mortality review committees, to share results and raise awareness about the SMM rates and identified high-risk populations. Both states are applying findings to inform strategies for improving perinatal outcomes, such as simulation training for obstetrical emergencies, licensure rules for maternity units, and a focus on health equity. Conclusion Despite data access differences, examination of SMM data informed public health practice in both states. Ohio and Massachusetts maximized available state data for SMM investigation, which other states might similarly use to understand trends, identify high risk populations, and suggest clinical or population level interventions to improve maternal morbidity and mortality.

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References

  • American College of Obstetricians and Gynecologists. (2015). Obstetric care consensus No. 2: Levels of maternal care. Obstetrics and Gynecology, 125, 502–515.

    Article  Google Scholar 

  • American College of Obstetricians and Gynecologists. (2016). Obstetric care consensus no. 5: Severe maternal morbidity: Screening and review. Obstetrics and Gynecology, 128(3), e54–e60.

    Article  Google Scholar 

  • Bateman, B. T., Mhyre, J. M., Hernandez-Diaz, S., et al. (2013). Development of a comorbidity index for use in obstetric patients. Obstetrics and Gynecology, 122(5), 957–965.

    Article  PubMed  Google Scholar 

  • Brown, H. L., Small, M., Taylor, Y. J., Chireau, M., & Howard, D. L. (2011). Near miss mortality in a multi-ethnic population. Annals of Epidemiology, 21(2), 73–77.

    Article  PubMed  Google Scholar 

  • Building U.S. Capacity to Review and Prevent Maternal Deaths. (2018). Report from nine maternal mortality review committees. Retrieved from http://reviewtoaction.org/Report_from_Nine_MMRCs.

  • Callaghan, W. M. (2014). State-based maternal death reviews: Assessing opportunities to alter outcomes. American Journal of Obstetrics and Gynecology, 211(6), 581–582.

    Article  PubMed  PubMed Central  Google Scholar 

  • Callaghan, W. M., Creanga, A. A., & Kuklina, E. K. (2012). Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstetrics and Gynecology, 120(5), 1029–1036.

    PubMed  Google Scholar 

  • Callaghan, W. M., Grobman, W. A., Kilpatrick, S. J., Main, E. K., & D’Alton, M. (2014). Facility-based identification of women with severe maternal morbidity: it is time to start. Obstetrics and Gynecology, 123(5), 978–981.

    Article  PubMed  PubMed Central  Google Scholar 

  • Callaghan, W. M., MacKay, A. P., & Berg, C. J. (2008). Identification of severe maternal morbidity during delivery hospitalizations, United States, 1991–2003. American Journal of Obstetrics and Gynecology, 199(2), 133.e1–133.e8.

    Article  Google Scholar 

  • Creanga, A. A., Bateman, B. T., Kuklina, E. V., & Callaghan, W. M. (2014). Racial and ethnic disparities in severe maternal morbidity: A multi-state analysis, 2008–2010. American Journal of Obstetrics and Gynecology, 210(5), 435.e1–435.e8.

    Article  Google Scholar 

  • Geller, S. E., Cox, S. M., Callaghan, W. M., & Berg, C. J. (2006). Morbidity and mortality in pregnancy: Laying the groundwork for safe motherhood. Women’s Health Issues, 16(4), 176–188.

    Article  PubMed  Google Scholar 

  • Geller, S. E., Rosenberg, D., Cox, S., Brown, M., Simonson, L., & Kilpatrick, S. (2004). A scoring system identified near-miss maternal morbidity during pregnancy. Journal of Clinical Epidemiology, 57(7), 716–720.

    Article  PubMed  Google Scholar 

  • Goodman, D., Stampfel, C., Creanga, A. A., Callaghan, W. M., Callahan, T., Bonzon, E., et al. (2013). Revival of a core public health function: State- and urban-based maternal death review processes. Journal of Women’s Health, 22(5), 1–4.

    Article  Google Scholar 

  • Grobman, W. A., Bailit, J. L., Rice, M. M., Wapner, R. J., Reddy, U. M., Varner, M. W., et al. (2015). Racial and ethnic disparities in maternal morbidity and obstetric care. Obstetrics and Gynecology, 125(6), 1460–1467.

    Article  PubMed  PubMed Central  Google Scholar 

  • Healthy People 2020 Objective/Title V National Outcome Measure 2. Accessed on 12/15/2015 at http://mchb.hrsa.gov/programs/titlevgrants/blockgrantguidanceappendix.pdf.

  • Hinkle, S. N., Sharma, A. J., Kim, S. Y., et al. (2012). Prepregnancy obesity trends among low-income women, United States, 1999–2008. Maternal and Child Health Journal, 16(7), 1339–1348.

    Article  PubMed  Google Scholar 

  • Howell, E. A., & Zeitlin, J. (2017). Improving hospital quality to reduce disparities in severe maternal morbidity and mortality. Seminars in Perinatology, https://doi.org/10.1053/j.semperi.2017.04.002.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kilpatrick, S. J., Berg, C., Bernstein, P., Bingham, D., Delgado, A., Callaghan, W. M., et al. (2014). Standardized severe maternal morbidity review: Rationale and process. Obstetrics and Gynecology, 124(2), 361–366.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kilpatrick, S. J., Prentice, P., Jones, R. L., & Geller, S. (2012). Reducing maternal deaths through state maternal mortality review. Journal of Women’s Health, 21(9), 905–909.

    Article  PubMed  Google Scholar 

  • Kuklina, E. V., Whiteman, M. K., Hillis, S., Jamieson, D. J., Meikle, S. F., Posner, S. F., et al. (2008). An enhanced method for identifying obstetric deliveries: implications for estimating maternal morbidity. Maternal and Child Health Journal, 12(4), 469–477.

    Article  PubMed  Google Scholar 

  • Main, E. K. (2012). Decisions required for operating a maternal mortality review committee: The California experience. Seminars in Perinatology, 36(1), 37–41.

    Article  PubMed  Google Scholar 

  • Main, E. K., Abreo, A., McNulty, J., Gilbert, W., McNally, C., Poeltler, D., et al. (2015). Measuring severe maternal morbidity: validation of potential measures. American Journal of Obstetrics and Gynecology, 214(5), 643.e1–643.e10.

    Google Scholar 

  • Main, E. K., Cape, V., Abreo, A., Vasher, J., Woods, A., Carpenter, A., et al. (2017). Reduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative. Am Journal of Obstetrics and Gynecology, 216, 298.e1–298.e11.

    Article  Google Scholar 

  • Pettker, C. M., & Grobman, W. A. (2015). Obstetric safety and quality. Obstetrics & Gynecology, 126(1), 196–206.

    Article  Google Scholar 

  • Shellhaas, C., & Conrey, E. (2018). State-based review of maternal deaths: The Ohio experience. Clinical Obstetrics and Gynecology, 61(2), 332–339.

    PubMed  Google Scholar 

  • The Joint Commission. (2017). Sentinel Events (SE). https://www.jointcommission.org/assets/1/6/CAMH_SE_0717.pdf. Accessed 2 Jan 2018.

Download references

Acknowledgements

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors declare that they have no conflicts of interest. The authors would like to acknowledge Don Reed and Ayana Birhanu from the Ohio Department of Health for assistance with data analysis; Ron Benham, Karin Downs, Emily Lu, Tim Nielsen, and Xiaohui Cui from the Massachusetts Department of Public Health; the Ohio Hospital Association for access to data and review of findings, the CDC/MCHEP, UIC, CSTE, CDC/EIS.

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Authors and Affiliations

  1. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Elizabeth J. Conrey, Susan E. Manning & Dave Goodman

  2. Ohio Department of Health, Columbus, OH, USA

    Elizabeth J. Conrey & Cynthia Shellhaas

  3. U.S. Public Health Service Commissioned Corps, Atlanta, GA, USA

    Susan E. Manning

  4. Massachusetts Department of Public Health, Boston, MA, USA

    Susan E. Manning, Nicholas J. Somerville, Sarah L. Stone & Hafsatou Diop

  5. The Ohio State University, Columbus, OH, USA

    Cynthia Shellhaas

  6. Epidemic Intelligence Service, Division of Applied Sciences, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Nicholas J. Somerville

  7. CDC/CSTE Applied Epidemiology Fellowship Program, Atlanta, GA, USA

    Sarah L. Stone

  8. University of Illinois, Chicago, IL, USA

    Kristin Rankin

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  1. Elizabeth J. Conrey
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Correspondence to Elizabeth J. Conrey.

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Conrey, E.J., Manning, S.E., Shellhaas, C. et al. Severe Maternal Morbidity, A Tale of 2 States Using Data for Action—Ohio and Massachusetts. Matern Child Health J 23, 989–995 (2019). https://doi.org/10.1007/s10995-019-02744-1

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  • DOI: https://doi.org/10.1007/s10995-019-02744-1

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