Health care delivery for maternal-child populations represents a key opportunity for improvement in Missouri.

Addressing the complex health needs of mothers and infants is important to end preventable deaths, while greatly improving health and well-being. The U.S. Department of Health and Human Services and the Surgeon General released a Maternal Health Action Plan and a Call to Action that has three ambitious goals.

1. Reduce the maternal mortality rate by 50% in five years.
2. Reduce the low-risk cesarean delivery rate by 25% in five years.
3. Achieve blood pressure control in 80% of women of reproductive age with hypertension in five years.

The most recent Missouri Pregnancy-Associated Mortality Review Report found that 75% of pregnancy-related deaths were preventable. Mental health conditions, including substance use disorder, were the leading underlying cause of pregnancy-related deaths, followed by cardiovascular conditions.

MO PAMR recommends the implementation of standardized practices and procedures across the health care continuum through evidence-based practices, such as AIM bundles and developing collaborative community referral networks. MHA provides technical support, education and programming to improve the health care experience and outcomes for Missouri pregnant and postpartum people and their babies.

MHA Initiatives

MHA sponsors the Missouri Perinatal Quality Collaborative in association with the Missouri Department of Health and Senior Services. The PQC/Maternal-Child Learning and Action Network, a broad clinical and community network of maternal-child stakeholders, provides guidance and subject matter expertise to improving health and health care.

The MO PQC includes access to evidence-based initiatives, technical support, education and resources to support the reduction of severe maternal and infant morbidity and mortality. QI collaboratives are deployed for more complex topics and are designed to result in highly reliable processes and improved care outcomes. QI collaboratives are offered in active or sustained options. Active collaboratives include monthly engagement, broader data collection, access to topical subject matter experts and personalized coaching support. They typically are deployed for newer EBP not commonly deployed yet across care settings. Sustained collaboratives include EBP updates, streamlined data collection and attestation to the implementation of safety bundle elements.

QI collaboratives align with key MO PAMR findings and recommendations to mitigate causes of mortality in Missouri. Implementing vetted, evidence-based practices and creating clinical-community integration will serve to improve maternal and child health and outcomes, strengthen the health care and community-based workforce, and reduce preventable deaths. Each collaborative’s resources are listed below. If your organization is interested in joining one of the MO PQC efforts, please complete a Registration Form or email Katie Brassfield for more information.

AIM Quality Improvement Collaboratives

In 2018, the Missouri Department of Health and Senior Services and MHA partnered to join the American College of Obstetricians and Gynecologists, as funded by the Health Resources and Services Administration, to join the Alliance for Innovation on Maternal Health — AIM. AIM is a national data-driven maternal safety and quality improvement initiative. Missouri was designated as an AIM state in 2018, and MHA serves as the designated organization responsible for ensuring completion of AIM activities, achievements and outcomes.

Missouri Neonatal Abstinence Syndrome Collaborative

Implementing the Eat, Sleep, Console Model of Care

Because maternal conditions directly affect infant health, we also must bolster our best practices for infants. While maternal mental health conditions, including substance use disorder, are a major cause of maternal death, Missouri has focused efforts on improving infant health through the Neonatal Abstinence Syndrome Collaborative. This work is focused on improving assessment and treatment protocols for infants experiencing NAS and neonatal withdrawal syndrome, and supporting the Mother-Baby Dyad.

The Cuff Kit™ Project

MHA and the Missouri Maternal and Child Learning Action Network are pleased to announce funding from the Missouri Department of Health and Senior Services COVID-19 Statewide Health Disparities Initiative Grant to support The Cuff Kit™ Project through the Preeclampsia Foundation. The Cuff Kit™ Project allows for the distribution of blood pressure cuff kits to vulnerable maternal patients at high risk for or diagnosed with blood pressure-related issues.

Below are the criteria and list of resources for participation in the project. The application period closed, and recipients were notified in November. If your facility does not receive kits through this lottery drawing, you will receive a courtesy email and will be prioritized for any future distribution cycle.

We are excited to offer this additional avenue to assist you in monitoring maternal patients at high risk for or diagnosed with BP-related issues. We believe this project has a unique ability to reach and impact additional lives as we continue to Change Missouri’s Birth Story.

This (project/publication/program/website, etc.) (is/was) supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $35,569,951 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government. The (organizations/projects/program/website, etc.) has received a portion of this funding from the Department of Health and Senior Services, Office of Rural Health and Primary Care to expand efforts to address health disparities caused by COVID-19. 

General QI Resources

• TeamSTEPPS Tools for Patient Safety Communication — PowerPoint | Recording
• MHA: High Reliability Organization Toolkit
• IHI: Improvement Tools
• Life QI: Help Center