The Arizona Department of Health Services (ADHS) has an established history of identifying potential cases of maternal mortalities/morbidities and facilitating case reviews by long standing committee members who are invested in identifying strategies for preventing maternal deaths and complications. Through a successful application, ADHS will focus its efforts to systematically increase access, quality of care and overall health for all women in Arizona by executing four main strategies. First ADHS will standardize the current maternal mortality review process. Strengthening the current Maternal Mortality Review Program (MMRP) staffing structure and documentation of the Maternal Mortality Review Committee (MMRC) process will provide standardized and timely identification of maternal deaths and generate high-quality data. In addition, ADHS will execute MOUs with Arizona’s Medicaid Agency and County Medical Examiners to formalize the sharing of valuable information on maternal deaths and secure commitment to statewide initiatives to address maternal morbidities and fatalities. Secondly, ADHS will support the MMRC in developing actionable recommendations. Adhering to the Review to Action guidelines, will assure that each review of a preventable maternal death produces an actionable recommendation for prevention and intervention. In addition, ADHS will engage non-clinical and clinical partners that work with populations most at risk for pregnancy-related complications and death in Arizona to reduce disparities and address health inequities in maternal care for Black and American Indian women. An implementation subcommittee of the MMRC will lead the implementation of recommendations at different contributing factor levels. Third, ADHS will disseminate the findings of the MMRC to different audiences. A maternal mortality webpage will be updated with semi-annual updates and a year-to-date interactive dashboard will be published on the agency’s website.
The MMRP plans to present findings at several stakeholder meetings involving clinicians, community organizations, tribal nations and tribal affiliated agencies, and health management organizations. A statewide summit on maternal morbidity and mortality will be scheduled within the 1st year of funding to share preliminary findings, collect feedback on the project evaluation plan, and future plans for analysis with stakeholders and the public. In addition, an annual report on the incidence and causes of maternal fatalities and morbidity that includes all readily available data will be produced and delivered to the Governor. Fourth, ADHS will lead and support the adoption of safety bundles at birthing facilities. In partnership with the Arizona Hospital and Healthcare Association, the Arizona Chapter of the MOD and the Arizona Perinatal Trust (Perinatal Quality Collaborative), the MMRP will recruit hospitals to implement safety bundles following ACOG’s AIM Initiative. ADHS will calculate and submit bi-annually outcomes measures on severe maternal morbidity to the AIM dashboard for participating hospitals for benchmarking and progress monitoring. ADHS will be the lead Agency for the AIM initiative and the AHHA will provide coordination and technical support to participating hospitals. Outcomes: ADHS anticipates achieving the following period performance outcomes upon project completion: 1) Generation of timely, accurate and standardized information for deaths to women during pregnancy and deaths within a year after the end of a pregnancy, including documenting opportunities for prevention; 2) Increased awareness of the existence and recommendations of the MMRC among the public, clinicians, and policy makers; 3) Implementation of data driven recommendations; 4)Widespread adoption of patient safety bundles and/or policies that reflect the highest standards of care and subsequently 5) Reduction in maternal complications of pregnancy.