Maternal and Perinatal Quality Care Collaboratives
The Maternal and Perinatal Quality Care Collaborative
A maternal and perinatal quality care collaborative (MPQCC) is a group of people and/or organizations from a common region, state, or hospital system working on health care system improvement for mothers and newborns.(1) Definitions for the term “perinatal” vary somewhat, but generally it refers to the period immediately before and after birth, beginning at the 20th to 28th week of gestation and ends 1 to 4 weeks after birth.(2) As of November 2012, there were approximately 17 state MPQCCs in the U.S.(1) MPQCCs use a variety of available data and methodologies that help develop health IT and clinical information systems throughout the U.S.(3)
A Vision for Redesigning Maternal & Perinatal Healthcare Using Health IT
In 2002, Donald Berwick described a framework to plan, discuss, and propose health system redesign. (4) The Vision Team for Transforming Maternity Care(1) applied this framework to maternity and perinatal care to create four levels for change:
A. the experience of women, their families, and support networks
B. the clinical microsystems that provide direct maternity care
C. the hospitals and health care organizations that house and support clinical microsystems
D. the environment of policy, payment, regulation, accreditation, litigation, and other macro-level factors that influence the delivery of maternity care(1)
Application of Health Information Technology: Problems and Goals
Problems: (5)
• Limited interoperability between health IT systems
• Data and health IT systems is not seamlessly linked across time, care settings, and providers
• Data needed by various users is not yet available through health IT systems
• Implementing health IT is expensive
Goals: (5)
1. Create a core set of standardized data elements for electronic maternity care records to facilitate interoperability.
• Accomplish this via a transparent multi-stakeholder process.
• Core data elements are aligned with what is needed for high-quality care and performance measurement that can be implemented in electronic health records (EHRs) or by administrative/clinical data sources.
• Create a data dictionary for internal use by facilities to ensure standardization of the core data elements for optimal clinical care, performance measurement, quality improvement, and research. Benchmarking, reporting, and resources can be made available through creation of a geographic data dictionary for external use (e.g., hospital, geographic, demographic).
• Advocate for policies that promote quality improvement for childbearing women and newborns, specifically CHIPRA provisions that develop a core performance measure set and a model EHR for beneficiaries of Medicaid and CHIP.
• Pilot, evaluate, and refine the electronic maternity care record, and make it an available resource widespread use.
• Encourage employer purchasers and payers to exhibit leadership in advocating for accountability in the expansion of health IT.
2. Ensure security and establish interoperability through identification/authentication tools and accurate patient matching functionalities, and policies that protect patient privacy and security.
• Convene various stakeholders to create strategies that meet needs of patients, the public health, and purchasers.
• Develop and implement methodologies to allow external public health entities to extract data for surveillance and tracking of population health data from EHRs.
• Base secondary data use progress on algorithms within states and voluntary agreements regarding standard methodologies across care settings.
3. Explore ways to use health IT incentives to improve clinical care quality, efficiency, and coordination and to enable corresponding performance evaluation.
• Use standardized, routinely collected data in electronic maternity care records to facilitate research and quality improvement initiatives.
• Include maternal and newborn quality measures in P4P programs, public reporting, and feedback to providers and facilities.
• Improve care coordination and maternity care quality for disparate populations through health IT incentives under Medicaid and safety net providers.
• Develop health IT resources, training and clinical decision support for high-risk maternity events that incorporates regional data and capacity.
4. Increase and improve consumer-based uses and platforms for health IT.
• Use health IT platforms (such as mHealth and social media)to develop accessible, affordable educational resources, methods of communication with caregivers, and personal health record for consumers.
• Use health IT platforms to publicly report results of performance measurement that is user-friendly for consumers to make comparisons among care options. (5)
Summary
This vision and framework for using Health IT for the purpose of MPQCC implementation provides a blueprint for action. However, MPQCCs are able to capture and use data beginning with what is already available, such as electronic birth certificates.(6) In using currently available data sets and improving and standardizing data and capture methods as needed, MPQCCs are important and innovative initiatives that help fulfill the greater national Health IT vision.
References
1. Transforming Maternity Care [Internet] 2012 [cited 2012 Nov 24]. Available from: http://transform.childbirthconnection.org/resources/collaboratives/.
2. MedicineNet.com [Internet] 2012 [cited 2012 Nov 22]. Available from: http://www.medterms.com/script/main/art.asp?articlekey=7898.
3. Perinatal Improvement Community [Internet] 2012 [cited 2012 Nov 22]. Available from: http://www.ihi.org/offerings/MembershipsNetworks/collaboratives/PerinatalImprovementCommunity/Pages/default.aspx.
4. Berwick D. A user’s manual for the IOM’s ‘quality chasm’ report. Health Aff. 2002 May;21(3):80-90.
5. Ulmer C, McFadden B, Nerenz DR, editor. Subcommittee on standardized collection of race/ethnicity data for healthcare quality improvement. Race, ethnicity, and language data: Standardization for health care quality improvement Washington, D.C.: National Academies Press; 2009.
6. Katica MA, Roso B. Perinatal Quality Collaboratives 101 [Webcast on the internet]. 2012 [cited 2012 Nov 24]. Available from: http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PQC.htm
Submitted by Katherine Pomeroy, N.D.
