A recent story in the San Francisco Chronicle highlights the successes of the Stanford-based California Maternal Quality Care Collaborative, the engine behind the state's dramatic reduction in pregnancy- and childbirth-related deaths over the last decade.
California's maternal mortality rate peaked in 2006 at 16.9 maternal deaths per 100,000 births; as of 2013, the most recent year for which the rate is reported, it had declined to around 7 deaths per 100,000 births for the state, significantly below the national rate of 22 deaths per 100,000 births for the United States as a whole.
As we've reported before, the CMQCC has taken a multi-pronged approach to reducing preventable maternal deaths among California women. A new paper out this week in the scientific journal Health Affairs explains the four major components of the approach, medical director Elliott Main, MD, told the Chronicle:
'It’s all of the above — that’s what it takes to move the dial at the population level,' he said. 'You can’t just have one approach. You have to whack-a-mole all at once.'
The four-pronged plan of attack combined analyzing public health data, convening an array of public and private health groups, creating a data system for hospitals to measure their progress, and developing health interventions for use across the state.
The CMQCC has made excellent headway on reducing maternal deaths from certain specific causes, including obstetric hemorrhage and preeclampsia. Next, they are focusing on reducing Cesarean sections in low-risk deliveries, as well as lowering the still-sizeable gap in mortality rates between black and white mothers, Main explained:
In California, while maternal mortality rates for black and white moms both dropped by 40 to 50 percent, the gap between the two did not close, the study said.
Even after accounting for socioeconomic status, age and obesity and other conditions, the racial disparity remains. A college-educated black woman is more than 2 times as likely to have serious complications from pregnancy as a college-educated white woman, after adjusting for other variables, Main said.
Of note, the scientific paper describing the CMQCC's approach is part of a special issue of Health Affairs that focuses on California's leadership in many areas of health policy, including efforts to provide health insurance for the uninsured, attempts to give nurse practitioners a broader role in primary care, and work to improve health equity among patients who have language barriers or are members of racial or ethnic minorities.
Photo by Andrew Seaman