Changing the Tide in Maternal Health Outcomes to Reduce Morbidity and Address Equity

00:00:00:15 - 00:00:27:19
Tom Haederle
The good news is that the rate of maternal mortality in the United States has dropped-slightly-over the past couple of years. The bad news is that improvement still leaves the U.S. with the highest rate of maternal mortality of any high income nation in the world. So, we're doing a little bit better, but not great.

00:00:27:21 - 00:01:05:16
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Most maternal deaths do not occur in the hospital, but happen after discharge, postpartum to one year. And they are not equally or randomly distributed. Three black women die at the rate of every one white woman from complications related to giving birth. In today's podcast hosted by Jackie Hunter, vice president for Health Equity Strategies with the AHA's Institute for Diversity and Health Equity, we learn about what it will take to bring down the maternal mortality rate even more, and the role that health equity must play in achieving that goal.

00:01:05:19 - 00:01:18:25
Tom Haederle
For more resources on maternal and child health, visit AHA's Better Health for Mothers and Babies website at www.aha.org/bhmb

00:01:18:27 - 00:01:24:21
Jackie Hunter
Can you introduce yourself, your role and what you're most passionate about in the world of maternal health?

00:01:24:23 - 00:02:00:27
Veronica Gillispie-Bell, MD
Yes, my name is Dr. Veronica Gillispie-Bell, I'm a board certified OB/GYN. I serve as an associate professor and senior site lead section head of women's services at Ochsner Health, but I also serve as the medical director of the Louisiana Perinatal Quality Collaborative and the Pregnancy Associated Mortality Review. And so I think when I think about maternal health and I think about the roles that I play, I lead the committee that review the maternal deaths and we review them not to just look at the numbers, but just to determine where we can make changes to prevent our maternal mortality outcomes that we're seeing.

00:02:00:29 - 00:02:13:17
Veronica Gillispie-Bell, MD
And so it's very exciting to then lead the committee, the Louisiana Perinatal Quality Collaborative, in partnering with birthing facilities to implement evidence-based practices to change the tide, to turn things around.

00:02:13:19 - 00:02:24:25
Jackie Hunter
Yeah. Thank you for that. You know, we've seen a slight drop in maternal mortality over the past couple of years, which is a good sign. What do you attribute that to? And what will it take to continue that downward trajectory?

00:02:24:27 - 00:03:02:08
Veronica Gillispie-Bell, MD
You know, we had actually a slight increase due to COVID. We saw that actually not play out in 2020, but in 2021. And when we are now seeing those numbers come down, like you said, which is great, but not quite as fast as we would like to see it. We still as the United States are a country that has the highest rate of maternal mortality among all high income countries, and so definitely more work to do. When we look at our maternal mortality data from maternal mortality review committees, like the one that I run, we noticed that the majority of deaths are not happening in the hospital, as some people may think.

00:03:02:14 - 00:03:24:10
Veronica Gillispie-Bell, MD
They actually are happening from the time of discharge up to one year postpartum. And so for me, that says there's a lot that we need to do, not just in the clinical space, but also looking at those social drivers of health and how can we impact economic stability. How do we help with transportation, those barriers to care that we know will affect our outcomes?

00:03:24:12 - 00:03:35:01
Jackie Hunter
Thank you. Let's talk a little bit about perinatal quality improvement and AIM bundles. Can you share with our listeners what AIM bundles are and discuss their importance for improving maternal health outcomes?

00:03:35:03 - 00:04:06:07
Veronica Gillispie-Bell, MD
Sure. So the Alliance for Innovation on Maternal Health, or AIM bundles are patient safety bundles that help with readiness, recognition and prevention response reporting, all with respectful care woven into the other 4R's to implement evidence based practices for those conditions, clinical conditions, that we see leading to maternal morbidity and mortality. So things like obstetric hypertension, obstetric hemorrhage, sepsis, perinatal mental health conditions, perinatal substance use disorder.

00:04:06:09 - 00:04:11:06
Jackie Hunter
And what are some data metrics are now used to show how this approach is making an impact?

00:04:11:08 - 00:04:33:06
Veronica Gillispie-Bell, MD
So a lot of us talk about maternal mortality, but we know that that's actually the tip of the iceberg. For every case of maternal mortality, there are hundreds of cases of maternal morbidity. And so that's really the outcome measure that we're looking at when we implement those AIM bundles. Looking at severe maternal morbidity related to those conditions that I just mentioned.

00:04:33:13 - 00:04:36:29
Veronica Gillispie-Bell, MD
And so looking to see that those numbers are starting to improve.

00:04:36:29 - 00:04:41:16
Jackie Hunter
Thank you. And how are quality improvement effort impacting equity?

00:04:41:19 - 00:05:02:19
Veronica Gillispie-Bell, MD
That's a great question. And so I always say and I 100% believe you cannot have quality without equity. You have to implement any changes that you're making through a lens of equity. If we don't, then we see our disparity gap get wider and we know that we have disparities. Three black women die at a rate of every one white woman.

00:05:02:19 - 00:05:34:06
Veronica Gillispie-Bell, MD
Two American Indian Alaska Native women die at the rate of every one white woman. So we have those disparities. And so it's so important when we're doing quality improvement - if we're thinking about a process that we're implementing, we have to think about it again through a lens of equity. Thinking about the other social drivers of health. So for example, we know that one of the things in the AIM bundle is that for women that have severe hypertension when they're discharged from the hospital, they need to be saved three days after discharge for a blood pressure check.

00:05:34:08 - 00:05:55:06
Veronica Gillispie-Bell, MD
It's not enough to just say everybody needs to be saved for a blood pressure check. You have to also consider social determinants of health. Does that individual have transportation? Do they have child care? And so when we talk about implementing with the lens of equity, it means considering all those things to make sure that everybody can have the same optimal outcome.

00:05:55:11 - 00:06:00:18
Jackie Hunter
And when you think about what are some key factors for successfully implementing AIM bundles?

00:06:00:20 - 00:06:27:17
Veronica Gillispie-Bell, MD
So I have a lot of insight, not only as being the medical director of our Perinatal Quality Collaborative, but I'm the medical director of quality in my health system and have been doing quality improvement since 2015. It's one thing to know what to do. It's an entirely different thing to know how to do it. And so with quality improvement it's using improvement science to understand how do you change workflow?

00:06:27:17 - 00:06:51:09
Veronica Gillispie-Bell, MD
How do you change workload? How do you go from unfreezing something that you're doing? How do you then manage the emotions that come around when you ask somebody to change? And then how do you freeze a new way of doing things? And it really is intentional. It involves a measurement. This is a statement I've heard many times. First, I heard it from the IHI, but

00:06:51:09 - 00:07:11:17
Veronica Gillispie-Bell, MD
all improvement is change, but not all change is improvement. So really important to also measure doing those small tests of change and doing those plan-do-study-act cycles. Change is not one change. It's a series of changes. And so understanding how you do that to implement those evidence-based practices.

00:07:11:18 - 00:07:21:21
Jackie Hunter
Right. And my last question for you is if you looked into your ideal world crystal ball, what does the future of high quality, equitable maternal care look like?

00:07:21:24 - 00:07:50:15
Veronica Gillispie-Bell, MD
So if I look into my crystal ball, this is interesting because I was actually just asked the same question on a panel that I was on during Essence Fest. If I looked into my crystal ball, I would have no more young black women coming to me telling me that they have decided they're not going to have children because they're afraid that they're going to die. Because of the maternal mortality rate that we have in this country, and especially how it's impacting our black women.

00:07:50:21 - 00:07:58:21
Veronica Gillispie-Bell, MD
And so in my crystal ball, everybody will experience a safe, equitable and dignified birth.

00:07:58:22 - 00:08:21:10
Jackie Hunter
Great, thank you for that. You know, I want to thank you for your time and for sharing information about what you're doing and this great work. We appreciate your dedication to this vital work, and we look forward to your continued positive impact. And as I close for our listeners, thank you for listening. For more information from the Institute of Diversity and Health Equity, please visit our website at ifdhe.aha.org

00:08:21:13 - 00:08:24:01
Jackie Hunter
Thank you so much.

00:08:24:03 - 00:08:32:14
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.