California Crosses the Quality Chasm In Maternal Mortality
The last post outlined the California effort that lowered maternal mortality in pregnancy to levels seen in other advanced countries and to one fifth the number of maternal deaths in Arkansas. This is no accident. Women having babies in California are safer because leaders in California followed the National Academy of Medicine playbook for better priority condition management written two decades ago.
Identify a priority condition affecting many people
Bring together stakeholders to solve the problem
Develop evidence-based care processes consistent with best practices.
Pay provider groups for lower maternal mortality
This is a systems problem. It is not hard to improve priority condition management. You just have to follow the steps to success. Take a look inside the Hypertensive Disorders of Pregnancy Toolkit from the California Maternal Quality Care Collaborative. Here is the protocol to identify the patients and the algorithm to manage them.
Improving maternal mortality is important for every American. “The care of pregnant women has national importance beyond infant outcomes, as maternity care is the most frequent overall reason for hospitalization, cesarean section is the most common surgery, and Medicaid is financially responsible for half of all US births.” The mean combined maternal and infant medical care costs in the preeclampsia patients of $41,790 were significantly higher than those for the uncomplicated patients of $13,187. These differences were largely driven by differences in the infant costs. The mean infant cost in the preeclampsia cohort were $28,898, in the uncomplicated cohort $3,669 because mothers with preeclampsia delivered 3 weeks earlier. Black and brown people have higher maternal mortality rates in our country but white American women have a maternal death rate that is twice that of other developed countries.
This is a great example of improving health and lowering cost for common priority conditions by following the National Academy of Medicine playbook. There are other examples. Kaiser Permanente is controlling blood pressure better in northern California. They are reducing mortality and lowering costs for heart artery disease patients in Colorado. Minnesota is tracking optimal medical therapy achievement for patients with diabetes and heart artery disease. We can improve health and reduce costs in the United States now, but we must replicate these successes across the country to do so.