Improving Outcomes of Preeclampsia in California: From Review of Maternal Death to Quality Care Collaboratives

Abstract

Childbearing Poster Presentation Objective To describe characteristics of women in California who died from preeclampsia/eclampsia in 2002 to 2004, identify contributing factors and quality improvement opportunities, and report on process and outcome measures from a multihospital, statewide learning collaborative that implemented a Maternity Care Improvement Preeclampsia Toolkit. Design In 2004, the California Maternal, Child and Adolescent Health Division developed an enhanced surveillance method to identify maternal deaths from administrative data; women's abstracted medical records were reviewed by an expert committee to determine causes of death and opportunities for prevention. Setting Data were collected as part of the California Pregnancy-Associated Mortality Review (CA-PAMR) and from CA-PAMR committee determination after case review. Data collection included classification of pregnancy-relatedness, contributing factors, and quality improvement opportunities. Learning Collaborative participants submitted process and outcomes measures related to the implementation of the Preeclampsia Toolkit. Sample Cases of pregnancy-related deaths (145) from preeclampsia/eclampsia in California between 2002 and 2004 from 26 hospitals in a statewide learning collaborative. Methods Mixed methods analysis was conducted of the CA-PAMR data; Learning Collaborative data were analyzed using frequency and trend charts. Results After case review, 145 maternal deaths from 2002 to 2004 were determined to be pregnancy-related. Preeclampsia was the second leading cause of death accounting for 17% of all pregnancy-related deaths in 2002 to 2004. The women who died from preeclampsia in California from 2002 to 2004 were more likely to be Hispanic, multiparous, and have normal body mass index (BMI) compared to women who died of other pregnancy-related causes. Nearly all ( n = 24/25) of these deaths were determined to have some degree of preventability, with half having a good-to-strong chance. Analysis of the opportunities to improve quality and reduce preventable maternal deaths revealed themes related to the need for recognition and response to clinical triggers (i.e., warning signs) in clinical status and care coordination. Learning collaborative participants reported increased levels of awareness and education regarding the importance of treating severe hypertension in pregnant women as a result of debriefing activity. Sites improved methods for medical chart documentation and coding, and overall data quality improvements as they apply to women with hypertensive disorders, including preeclampsia. Conclusion/Implications for Nursing Practice Implementation of the Preeclampsia Toolkit in the multihospital, statewide Learning Collaborative is intended to reduce rates of severe maternal morbidity and prolonged postpartum length of stay. Learning Collaborative participants who adopted the Toolkit showed measurable improvement in the ability of their sites to respond to this leading cause of pregnancy-related morbidity and mortality.