1/23/2019
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Taking AIM at Maternal Mortality
Emergency Medicine’s Role
Jody Jones, MD, FACOG
Outreach Chair Michigan Alliance
for Innovation on Maternal Health
I have no
disclosures
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ObjectivesUnderstand the scope of maternal mortality and
Severe Maternal Morbiditity
Appreciate MIAM’s role in effecting safe
obstetrical care
Identify at risk patients
Utilize MEOWS/Safety Bundles
Improve reporting
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The US has the
highest Maternal
Mortality rate of
any high resource
country and the
only country
outside of
Afghanistan and
Sudan where the
rate is rising.
Economist July 2015
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Everything starts in California….
Right??
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Aiming at 3 leading causes of
maternal deaths
11.1
7.7
10.0
14.6
11.8 11.7
14.0
7.4
7.3
10.9
9.7
11.6
9.2
6.2
16.9
8.9
15.1
13.1
12.19.9
9.9
9.8
13.3
12.7
15.5 16.916.6
19.3
19.9
22.0
0.0
3.0
6.0
9.0
12.0
15.0
18.0
21.0
24.0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Year
California Rate
United States Rate
Maternal Mortality Rate,
California and United States; 1999-2013
Ma
tern
al
Dea
ths
pe
r 1
00
,00
0 L
ive
Bir
ths
HP 2020 Objective – 11.4 Deaths per 100,000 Live BirthsOB Hemorrhage
QI Toolkit*, Collaboratives
Preeclampsia QI Toolkit*,
Collaboratives
*CMQCC QI Taskforces and Toolkit supported by CDPH, thru Title V Grant
support
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Maternal Mortality SurveillanceConcerning Trends in the US & Michigan
1999 - 2010
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US & MI Pregnancy-Related Mortality by Race-EthnicityPer 100,000 live births
Michigan Pregnancy-Related Mortality in comparison to ther states
▪ African American 3rd Highest (tied with New Jersey)
▪ Overall Pregnancy-Related 8th Highest
▪ White 11th Highest
▪ Racial Disparity 15th Highest
.
OverallWhite
African American
RateDifference
RateRatio
Michigan 22.2 16.6 50.8 34.3 3.1
United States 15.6 11.5 35.8 24.3 3.1
Inquire about recent Pregnancy-ALL
African Americans think HIGH RISK
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Mandatory Reporting
Public Act 479 of 2016 was signed into law on
January 5, 2017 making maternal death
reporting a mandatory process in an effort to
capture all maternal deaths that occur in our
state.
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MMMS Case Identification and Review
Voluntary
Reporting
Death
Certificate
Check Box
Cause of
Death
“O” codes
Probabilistic
linkage
MMMS Case Findings Database
Medical
Case
Review
Injury
Case
Review
CommitteeReview
Case-finding
MMMS Case Abstraction
MMMS Provisional Database
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Affect care of obstetrical
patients in all settings to
reduce maternal deaths by:
Risk Stratification
Pregnant/post partum
African American
Early recognition of Maternal
Early Warning Signs
Prompt Treatment and
Escalation of Care
Per Protocols
Aim with the End in Mind
Thank you for partnering with us
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