DALLAS (FRONTLINE MEDICAL NEWS) – A statewide quality improvement initiative to address treatment strategies for women with severe maternal hypertension resulted in a 41% reduction in severe maternal morbidity, from 15% before the initiative to 9% after the suite of interventions was fully implemented.

A total of 102 Illinois hospitals participated in the quality improvement (QI) initiative, which eventually included 12,718 women with severe maternal hypertension, defined as blood pressure greater than 160/110 mm Hg.

“All project aims were achieved,” said the study’s first author Patricia Lee King, PhD . The proportion of severe maternal hypertension cases treated within 60 minutes in accordance with national guidelines doubled, from 41% at baseline to 82%. Discharge education more than doubled, from 38% to 87%.

The number of patients who were scheduled for follow-up appointments within 10 days of discharge increased from 53% to 83% after the QI initiative was implemented. The proportion of cases of severe maternal hypertension that were subject to a provider-nurse debrief analyzing time to treatment went from 2% before the intervention to 53%.

Dr. Lee King presented the findings to a receptive audience at a plenary session of the meeting sponsored by the Society for Maternal-Fetal Medicine. “We had a philosophy of ‘leave no hospital behind,’ and of ‘leave no patient behind,’ ” she said, to wide applause.

“The key prevention of maternal morbidity and mortality associated with severe maternal hypertension is timely treatment; the primary cause of maternal death associated with hypertensive disorders of pregnancy is maternal hemorrhagic stroke,” said Dr. Lee King.

The multidisciplinary, multistakeholder project was coordinated by the Illinois Perinatal Quality Collaborative (ILPQC), housed at Northwestern University, Chicago. The participating hospitals account for over 95% of the births in the state of Illinois, said Dr. Lee King, ILPQC state project director.

The approach used for implementation of the hypertension QI initiative included collaborative learning and the use of rapid response data to give near–real time feedback on how institutions were faring in meeting national guidelines to treat severe maternal hypertension.

Specific clinical interventions included both “system changes and culture changes,” said Dr. Lee King. They included adopting facility-wide protocols for timely identification and treatment of women with severe maternal hypertension; standardizing patient education and discharge planning; increasing provider and nurse education about severe maternal hypertension protocols; and creating rapid access to medication and standardized treatment order sets.

The ILPQC facilitated collaboration between hospitals in meeting these aims, including monthly web-based updates and seminars and construction of the database that gave institutions rapid access to data for ongoing QI efforts. Newsletters, website updates, and QI support were also part of the ILPQC package.

The proportion of participating hospitals meeting time-to-treatment goals for severe maternal hypertension went from 13% at baseline to 71% at the end of data collection, said Dr. Lee King.

In looking at hospital characteristics such as rurality, size, and patient mix, Dr. Lee King and her collaborators found no significant differences in time to treatment, patient education, and number of cases that were debriefed.

“These strategies helped hospitals achieve initiative goals, regardless of hospital characteristics,” said Dr. Lee King. The only significant association the research team found was that hospitals with fewer than 500 deliveries per year were less likely to reach the goal of early follow-up appointments (P less than .02).

“Participation in a statewide perinatal quality collaborative increases hospitals’ QI capacity. A statewide QI initiative can achieve significant population-level improvements in care for women with severe maternal hypertension and – more importantly – a reduction in severe maternal morbidity,” Dr. Lee King said.

The QI initiative and the follow-up study were conducted by the Illinois Perinatal Quality Collaborative , and the work was funded by the Centers for Disease Control and Prevention, the Illinois Department of Health, and the Alliance for Intervention on Maternal Health . Materials related to the maternal hypertension initiative are available at . Dr. Lee King reported no conflicts of interest.

SOURCE: Lee King P et al. Am J Obstet Gynecol. 2018 Jan;218:S4 .


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