Establishing a Nevada Maternal Mortality Review Committee (MMRC) to conduct ongoing, comprehensive, multidisciplinary reviews of maternal deaths and severe maternal morbidity (SMM) will help determine factors contributing to maternal mortality and SMM and identify public health and clinical interventions to improve systems of care and prevent mortality and morbidity. According to CDC WONDER from 2014-2016, Nevada had less than four pregnancy-associated deaths (PAD) per year on average compared to 40 per year in the United States. PADs primarily occur disproportionally in Nevada’s black maternal population, as well as among mothers in older age groups.4 The pregnancy-related death (PRD) rate in Nevada from 2012-2014 was 12.3 deaths per 100,000 births by state of residence and 11.3 deaths per 100,000 births by state of death.4 PRDs also primarily occur disproportionally in Nevada’s black maternal population.4 The severe maternal mortality rate in Nevada in 2016 was 127.2 per 10,000 live births (including cases of blood transfusion).7 Mothers who experience SMM are affected disproportionally in Nevada more so than maternal mortality, with disparities in access to care among multiple racial/ethnic and age groups.7 For Nevadan women with any chronic disease diagnosis, especially hypertension and heart disease, the rate of SMM in 2016 was 319.3 per 10,000 live births compared to 122.5 per 10,000 live births for those with no chronic disease.7 The state of maternal mortality and SMM in Nevada can be substantially improved by the development of a MMRC.
Currently, Nevada has no established MMRC. However, the 80th Legislative Session of Nevada signed and passed into law AB 169 on May 3rd, 2019, granting additional authorities and protections for a statewide MMRC. AB 169 establishes the MMRC within the Nevada Department of Health and Human Services (DHHS). The Committee is required to: (1) review incidents of maternal mortality and SMM in Nevada; (2) disseminate findings and recommendations concerning maternal mortality and SMM to providers of health care, medical facilities, other interested persons and the public; (3) publish timely reports consisting of data relating to maternal mortality and SMM, descriptions of incidents reviewed by the Committee, and recommendations to reduce maternal mortality and SMM in Nevada. AB 169 authorizes the Committee to take measures necessary to perform those duties. It entitles the Committee to any records it deems necessary to perform its duties and to petition the district court for a subpoena to compel the production of such records. Furthermore, AB 169 states that information acquired by and records of the Committee are confidential and not subjected to subpoena.
The following short-term outcomes are expected to be achieved by the end of the period of performance: timely, accurate, and standardized information available about deaths to women during pregnancy and the year after the end of pregnancy, including opportunities for prevention, within funded jurisdictions and across funded jurisdictions; and increased awareness of the existence and recommendations of the MMRCs among the public, clinicians, and policy makers; implementation of data-driven recommendations (e.g., evidence-based practices, screenings, and patient and provider education). The following intermediate outcome is expected to be achieved by the end of the period of performance, as a result of short-term outcomes: widespread adoption of patient safety bundles and/or policies that reflect the highest standards of care. The following long-term outcomes are expected to be achieved by the end of the period of performance, as a result of the intermediate outcome: reduction in maternal mortality, SMM and related disparities and improvement in population health for women of reproductive age (e.g., reductions in hypertension, coronary heart disease, substance use, and other chronic diseases).