MDMOM Program Launches a Severe Maternal Morbidity Surveillance and Review Pilot Program in Maryland

In July, the Maryland Maternal Health Innovation (MDMOM) Program launched a hospital-based pilot program in six birthing hospitals to test processes for severe maternal morbidity (SMM) surveillance and review in Maryland. This pilot is the first phase of a larger initiative to establish a statewide SMM surveillance and review program in Maryland. A collaboration between Johns Hopkins University, Maryland Department of Health, Maryland Patient Safety Center, and the University of Maryland, Baltimore County, MDMOM is led by Andreea Creanga, MD, PhD, an associate professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health.

Although Maryland has a process in place for maternal mortality surveillance and review, there is currently no standardized process to review and evaluate SMM—any potentially life-threatening condition or complication during hospitalization for delivery. A systematic, ongoing process for case identification, clinical review and analysis of SMM at the hospital- and state-level is needed to identify strategies to improve service delivery and quality of care for pregnant and postpartum women in the state. To date, only Illinois has a formal statewide SMM surveillance and review process in place, but several other states are working to establish such programs.

“Hospital-based SMM surveillance and review should serve as the backbone for quality improvement initiatives in obstetrics. Because the MDMOM Program aims to improve the quality of maternal health in the state, SMM surveillance is the first activity that we designed and are now testing with the help of colleagues in six birthing hospitals in the state. Of key interest is identification of factors that, if changed, would have prevented the severe morbidity from occurring. If we know what these factors are and can address these in future patients, we can reduce the burden of preventable SMM in our hospitals in the state. This is our end goal,” says Creanga.

Pilot testing will be conducted in six birthing hospitals offering various levels of maternity care between July 2020 and March 2021. The hospitals included are Anne Arundel Medical Center, Howard Country General Hospital, Johns Hopkins Hospital, MedStar St. Mary’s Hospital, Mercy Medical Center, and Sinai Hospital of Baltimore.

Each pilot hospital will establish a hospital-based SMM review committee to test and evaluate the new surveillance process. The committees will identify cases that meet the surveillance case definition; abstract data using the developed data abstraction forms; and manage the data entry into a new, common database. Researchers from the MDMOM Program will provide technical assistance throughout the pilot phase, analyze the data, and generate SMM reports for each participating hospital.

From 2010 to 2015, the SMM prevalence in Maryland was 197 per 10,000 delivery hospitalizations—representing approximately 1,500 women each year. Significant disparities exist in adverse maternal health outcomes in Maryland, with non-Hispanic Black women having two times higher rates of SMM and pregnancy-related mortality than non-Hispanic white women.

“Routine SMM surveillance and case reviews will help reduce these health disparities by identifying specific factors that disproportionally affect non-Hispanic Black women and put them at higher risk than white women for developing severe complications,” says Amy Hobbs, MSc, RN, a research associate in the Department of International Health at the Bloomberg School and coordinator of the SMM surveillance and review pilot activities.

Through consultation with state experts and the Maryland Maternal Health Task Force members, the MDMOM Program designed this new SMM surveillance and review process. The MDMOM team incorporated lessons from the Illinois experience and received guidance from professional organizations such as the American College of Obstetricians and Gynecology and the Society for Maternal-Fetal Medicine.

Results from the evaluation of the SMM surveillance and review pilot program will be used to inform the statewide scale-up phase planned for 2021–2024, during which additional hospitals will be invited to voluntarily participate in the program. This work is mandated and supported by Maryland House Bill 837, which took effect on July 1, 2020, and requires preliminary findings from the SMM study to be shared with the General Assembly by the end of 2020. These results will be made available on the MDMOM Program website in a report format and also included in a state-level maternal health data dashboard that is currently under development.

The MDMOM Program is a five-year program, funded by the Health Resources and Services Administration to improve maternal health across the state. MDMOM coordinates innovation in the areas of data utilization, quality improvement and, delivery of hospital and community care.