Delivery of Care

Rhode Island joins effort to improve maternal health outcomes

Hospital Association of Rhode Island is spearheading the initiative

PHoto by Richard Asinof

A "Black Moms Matter" rally was held outside Women & Infants Hospital on Friday morning, June 12.

By Richard Asinof
Posted 8/31/20
A new initiative seeks to create a data-driven effort to improve maternal health outcomes in Rhode Island, where there exist significant health disparities.
How has the coronavirus pandemic changed the delivery of pregnancy care in Rhode Island? What kinds of new maternal health outreach and visiting programs have been developed during the pandemic? How have telehealth platforms been integrated into maternal care? What is the intersection between the lack of affordable housing and high rate of poor maternal health outcomes in Rhode Island?
Given that the coronavirus pandemic has exacerbated many of the existing health disparities in Rhode Island, is there an opportunity to design a pilot program for expecting young mothers to provide them with a cash supplement, say $600 a week, with the only condition that they regularly have wellness visits with their providers, as a way to decrease the potential of at-risk births. Given the high costs of caring for low-birthweight babies, would there be a clear economic analysis to justify such a program?

PROVIDENCE – In an effort to combat what is deemed a national crisis in maternal morbidity and mortality, Rhode Island recently became the 33rd state to join the Alliance for Innovation on Maternal Health.

As part of this effort, the Hospital Association of Rhode Island, or HARI, and the National Perinatal Information Center are collaborating to lead the efforts to reduce maternal morbidity and mortality here in Rhode Island, by supporting hospitals, local agencies and community organizations.

The need to improve maternal health was identified in the Community Health Assessment conducted in 2019 as a statewide imperative. Data from the R.I. Department of Health from 2013-2016 showed that Black women in Rhode Island experienced severe maternal morbidity at nearly twice the rate of white women.

Under the new initiative, the AIM program in Rhode Island will provide resources for four of the five birthing facilities in operation in the state. The goal is to implement a series of action steps called “bundles” to improve care for mothers and infants.

In response to the announcement of the new initiative, ConvergenceRI reached out to HARI to ask a series of follow-up questions.

ConvergenceRI: What kinds of specific resources will you be investing in at these hospitals?
HARI: Obstetric teams will receive resources and a platform to share and learn best practices to increase the bundle’s compliance. In addition, patient engagement resources will be provided to increase awareness amongst pregnant women to learn the early signs and symptoms of postpartum hemorrhage These resources will be provided in multiple languages to the community.

ConvergenceRI: Recently, Women & Infants Hospital held a “Black Moms Matter” rally to highlight the health disparities. How is HARI planning to follow up with such efforts? [See link below to ConvergenceRI story, “Black moms matter.”]
HARI: The Rhode Island AIM Collaborative is part of a national patient safety effort to eliminate preventable maternal harm and improve birth outcomes implementing several evidence-based maternal bundles and establishing broad community partnerships that support the bundle.

Rhode Island practitioners selected the Postpartum Hemorrhage bundle where opportunities for improvement exists. Postpartum hemorrhage [PPH] is an obstetric emergency and several studies have shown that Blacks and Hispanics have significantly higher risks of PPH than non-Hispanic whites.

The goal of this effort is to standardize birthing hospital’s approach implementing several actions as the right thing to do for every patient experiencing a PPH.

Hospitals currently submit patient data to multiple siloed reporting agencies. The Rhode Island AIM Collaborative will streamline the collection of data from participating birthing hospitals, using the metrics prescribed by the selected Safety Bundle to improve health outcomes within the targeted at-risk population.

ConvergenceRI: What is the relationship between poor health outcomes and housing insecurity, in HARI’s opinion? Would HARI be interested in supporting the development of affordable housing built on hospital campuses, similar to the work being done in Oakland, Calif., for instance?
HARI: While social determinants have a significant impact on health outcomes, this project focuses on data collection, community partnerships and clinical practices to improve health outcomes.

ConvergenceRI: What kinds of planning is being done in anticipation of a potential baby boom that will follow the COVID-19 shutdown that began in March, with the goal of improving maternal health outcomes?
HARI: Regardless of a baby boom, the birthing hospitals in Rhode Island are always focused on improvement of maternal health outcomes as demonstrated by the formation of the Rhode Island AIM Collaborative.

ConvergenceRI: Is there active coordination between HARI and the existing Health Equity Zones in Rhode Island related to maternal health outcomes?
HARI: Currently, hospitals and health systems are partners in and contribute financially to their local Health Equity Zones.

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