What exactly is a perinatal quality collaborative, or PQC?
It’s a statewide or multistate network of professionals and organizations that employ care quality improvement methods to help mothers and infants have the best possible chance at healthy lives. A PQC works with hospitals, health systems and the community to continuously improve the services mothers and babies receive. Nowhere is its role more vital than in rural and underserved areas, where residents often lack local obstetric care, labor and delivery departments may struggle to survive, and some hospitals deliver babies even after their L&D units are shuttered.
To offer a finer picture of how PQCs accomplish their important work, Kristine Sande of the Rural Health Information Hub and Dr. Kristen Dillon of the Federal Office of Rural Health Policy co-hosted a recent webinar featuring three experts on the subject. Here are some of their thoughts on keeping mothers and babies healthy before, during and after pregnancy.
Combating “persistent and significant” disparities
Dr. Jacqueline Wallace of the CDC’s National Center for Chronic Disease Prevention and Health Promotion spoke about the history of quality improvement efforts in maternal/child health, noting that US pregnancy-related mortality has shown no real improvement in nearly two and a half decades. Wallace pointed out “persistent and significant” racial and geographic disparities that affect maternal health outcomes, with some groups such as Native Hawaiian/Pacific Islanders, non-Hispanic Black patients and individuals from rural areas experiencing higher pregnancy-related mortality than others. What’s particularly striking is that about 84% of pregnancy-related deaths are deemed preventable, Wallace noted.
Wallace explained that in 2022, the CMS created a “birthing-friendly” designation to demonstrate which hospitals are committed to high-quality maternal and infant care so patients can make informed decisions. When applying for the designation, hospitals are specifically asked if they participate in perinatal quality collaboratives and efforts to improve patient safety.
The first perinatal quality collaborative took root in California in 1997, Wallace noted, and there is now one in each state. “PQCs address gaps and reduce variation in care,” Wallace said. “It’s really critical because variation in care is a big driver of health disparities.” PQCs can help move the needle by offering staff training, conducting coaching on quality improvement, and performing facility visits to identify care challenges and opportunities.
Initiatives aim at improving outcomes
Caroline Sedano of the Washington State Department of Health is involved in the state’s PQC. While Washington has fairly low maternal and infant mortality rates overall, it does show persistent disparities in outcomes for patients who are American Indian, Alaska Native, Pacific Islander and Black. “A leading cause of pregnancy-related deaths in Washington [is] behavioral health conditions, and a significant number of those are associated with substance use,” Sedano noted.
The state’s PQC, the Washington State Perinatal Collaborative, serves as a hub for programs and initiatives that improve conditions for mothers and babies. Its current focus areas include creating new clinical guidelines and improving birthing center transfers, Sedano said.
The closure of an obstetric unit that served a large tribal population spurred the community to action, and a Rural Access to Safe Deliveries Work Group was formed, Sedano said. Access data were compiled and analyzed, and a virtual forum on safe deliveries for outlying communities helped elucidate challenges. A landscape assessment gathered hospital staff feedback, and grants were made to rural hospitals needing to update their hemorrhage policies. A regional training center, provider advisory group to help with recruitment and placement, and other key programs are also in the works.
“We know from our maternal mortality data that OB care is vital for safe births and reducing the maternal death rate in our state,” Sedano said.
Fostering inclusion via partnerships, training
Annie Glover of the University of Montana is a key player in her state’s PQC, which also serves adjoining states. Glover is director of the Montana PQC at the Montana Alliance for Innovation of Maternal Health and has been involved in assessing hospitals’ obstetric capabilities. Current initiatives include addressing obstetric sepsis, reducing severe hypertension in pregnancy and improving patient safety.
Over the past two decades, care has been compromised by the closure of nearly half of the state’s critical access obstetric units. “American Indian people in Montana are 20 times more likely to give birth at a facility without an obstetric unit,” Glover said. “The baby comes when the baby comes.”
Glover said the state’s hospital and perinatal nurse associations have been key partners for the PQC, sharing data and supporting quality improvement efforts. The collaborative provides virtual learning sessions for hospital staff, quality improvement coaching for clinicians and training for doctoral students.
“We need to be inclusive of our remote communities and hear what they have to say and what they need,” Glover said. “We need to understand that critical access hospitals, whether or not they have OB units, are part of the maternal health system in states like Montana. Rural obstetric care matters.”
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