California Maternal Quality Care Collaborative Case Study

CMQCC INITIATIVE: Background

From 1996 to 2006, the MMR for California nearly tripled from 6 to 17 per 100,000 annual births.10 The California Maternal Quality Care Collaborative, also known as the CMQCC, was created through the Perinatal Programs of Stanford University Medical School Division of Neonatal and Developmental Medicine, as a multi-stakeholder organization whose objective was to end preventable maternal mortality and injury while reducing disparities for maternal health services in California. The CMQCC partnered with another Stanford University entity, California Perinatal Quality Care Collaborative, over 250 volunteer clinicians, public health specialists, and community and business organization leaders as stakeholders in order

The Task Force faced several assessment challenges. For example, initially Task Force members were focused on the utilization of high-tech solutions (use of interventional radiology), but the data demonstrated attention to basic care processes such as recognition and responsiveness were more important and allowed the Task Force members to switch to a more universally applicable solution. Also, not all health centers would have access to services such as interventional radiology, therefore would be difficult to implement. Furthermore, due to financial constraints and lack of capacity, the Task Force was limited in the amount of data that could be captured and analyzed. Moreover, some analysis was found to be impractical as they were too detailed and not able to be implemented easily in a state-wide project that involves almost 300 hospitals. Another issue was due to maternal mortality data not including women who had suffered morbidity, as it was limited to only women who died. Lastly, capturing hemorrhage rates was difficult as clinicians had varying definitions for OB hemorrhage, and administrative data had inconsistences in coding, making it difficult to create a standard for benchmarking. Consequently, this pushed the Task Force to identify key points to revolve strategies and tools that can be standardized and utilized in many different

The research gathered through this effort was then drafted and compiled into the “Compendium of Best Practices” and into the OB Hemorrhage Care Guidelines for recognition, response and prevention of OB hemorrhage. The guideline is available in three formats for ease of use including: beside checklist for team care, a table and flowchart to present key points. This also led way to develop a publicly available CMQCC OB Hemorrhage Toolkit for universal application.11 All of these tools allow clinicians act more efficiently in response to OB hemorrhage by defining roles and responsibilities according to the severity of the hemorrhage. Furthermore, key aspects of treatment, such as medication dosing and recommended ratios for replacement of blood products are clearly defined to allow the team to effectively respond to OB