OBJECTIVE: To evaluate the role of a statewide Perinatal Quality Collaborative in reducing severe maternal morbidity (SMM) related to hemorrhage and hypertension, and to assess whether the improvements were maintained across sequential initiatives and whether racial disparities decreased over time. METHODS: Using collaborative learning, rapid response to data, and improvement science, the Louisiana Perinatal Quality Collaborative (LaPQC) implemented two sequential quality-improvement initiatives: the Reducing Maternal Morbidity Initiative (August 2018–May 2020) and the Safe Births Initiative (January 2021–September 2022). Thirty-one birthing hospitals participated continuously in both initiatives. Hospital-level aggregate data on nontransfusion SMM related to hemorrhage and hypertensive disorders were obtained from the Louisiana Hospital Inpatient Discharge Database. Rates per 10,000 delivery hospitalizations were calculated quarterly. Percent change and Joinpoint regression assessed trends. Process measures included quantification of blood loss, hemorrhage risk assessment, and timely treatment of hypertension. RESULTS: During the Reducing Maternal Morbidity Initiative, the overall rate for nontransfusion SMM related to hemorrhage decreased by 44.0%, from 1,162.4 per 10,000 deliveries to 650.8 per 10,000 deliveries by Q2 2020. Among non-Hispanic Black individuals, nontransfusion SMM related to hemorrhage declined by 54.7% (1,630.0 per 10,000 deliveries to 737.7 per 10,000 deliveries) through Q2 2020, narrowing the Black/White disparity ratio from 2.2 to 0.9. Reductions in nontransfusion SMM related to hemorrhage achieved during the Reducing Maternal Morbidity Initiative were maintained throughout the implementation of the Safe Births Initiative, resulting in overall rates that were 39.0% lower than baseline and 58.2% lower among Black individuals. The nontransfusion SMM related to hypertension decreased by 14.1%, from 847.5 per 10,000 deliveries to 727.6 per 10,000 deliveries through Q2 2020, with continued improvement during the Safe Births Initiative implementation and a 35.4% reduction by Q3 2022. However, there was still a Black/White disparity ratio of 1.94 by Q3 2022. CONCLUSION: Statewide implementation of evidence-based safety bundles through the LaPQC was associated with reductions in SMM and the narrowing of racial disparities. These improvements were sustained during the implementation of a subsequent initiative, demonstrating the effectiveness and durability of state-based quality-improvement models.
Gillispie-Bell et al. (Thu,) studied this question.