Last month, Pennsylvania took this significant first step forward in fighting the unsettling growing maternal mortality rate through the establishment of a statewide Maternal Mortality Review Committee (MMRC). On May 9, 2018, Governor Tom Wolf signed Pennsylvania HB 1869, Maternal Mortality Review Act now Act 24, into law, creating a formalized, multidisciplinary committee to review maternal deaths and develop prevention strategies. Pennsylvania became the 33rd state to officially commission a Maternal Mortality Review Committee.
Maternal mortality review is a standard and comprehensive system that here in the United States primarily operates at the state level. MMRCs’ role is to identify, review, and analyze maternal deaths, and disseminate their findings. The PA MMRC is currently recruiting its 15 member committee, but how review committees are comprised and structured will be critical to its success. Learning from leading international models will help build an effective system here to begin lowering our maternal mortality rates.
The United Kingdom (UK) has the longest running system to review maternal deaths, and their methodology is considered by many as the gold standard. The UK uses a national collaboration known as Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries (MBRRACE-UK) to run their national Maternal, Newborn and Infant Clinical Outcome Review Programme (MNI-CORP) which conducts surveillance and investigates the causes of maternal deaths, stillbirths and infant deaths. MBRRACE-UK reports on an annual basis an analysis of all maternal deaths and produces an annual study with a different topic each year focusing on women who survived severe pregnancy problems.
One the important parts of the UK’s program is their use of unpaid health professionals to conduct the inquiries. These assessors are recruited from relevant Royal Colleges and provided with specialty-specific training and resource-packs. This reduces the cost of implementing the review process. In addition to determining preventability of all reviewed cases, assessors compare care with guidelines and quality standards and assign a quality of care category to each case. This allows for identification of quality improvement efforts and tracking changes in quality of care.
In the UK, as is also seen in the US, near-miss maternal morbidities are more common than maternal deaths. (According to the CDC, approximately 700 women die each year due to pregnancy complications, while over 50,000 women experience severe maternal morbidity.) This informed the decision for the UK committee to also conduct inquiries into annually selected topic-specific serious morbidity. Topics are chosen based on morbidity burden, availability of national standards against which to evaluate the quality of care, and ease of identifying cases. The committee conducts topic-specific serious morbidity inquiries in association with a Topic Expert Group that identifies key standards for the chosen topic.
New Zealand, also a model of MMRCs, has a Perinatal and Maternal Mortality Review Committee (PMMRC) with a clearly defined Terms of Reference (attached below) defining the function, scope, expected activities, and composition of their MMRC. Notably, one of the committee members must have relevant consumer experience with an excellent network to consumer groups, and provide consumer perspective.
In both countries, the review committee also collects and assesses perinatal deaths. Also, for both countries, a healthcare quality organization plays a vital role. The Healthcare Quality Improvement Partnership (HQIP) in the UK commissioned MBRRACE to oversee MNI-CORP. In New Zealand, the Health Quality and Safety Commission appoints members of the PMMRC.
Although this step in creating a MMRC is an improvement, Pennsylvania is still only one of six states without a perinatal quality collaborative (PQC), which provides a mechanism to not only measure the quality of maternity care, but to take the recommendations of the MMRC and act on the findings. Now that we will be able to track the data of maternal deaths, Pennsylvania must continue this momentum by using the data we’ll learn to improve the outcomes for the mothers and babies by applying best practices.
[The following post was originally published on the WHAMglobal blog.]
Click To View or Download: pmmrctermsofreferenceapr2015newzealand