The University of Arkansas for Medical Sciences (UAMS) is partnering with the Arkansas Department of Health to apply for Component A of the funding opportunity CDC-RFA-DP22-2207. This project will build on the strong relationships UAMS has with birthing hospitals in Arkansas through its perinatal outreach program, to establish the Arkansas Perinatal Quality Collaborative (PQC). Arkansas currently has the fifth highest maternal mortality ratio across all states, and the initiation of the Arkansas PQC is an important step to improving outcomes. During the Arkansas PQC’s first initiative, UAMS will support hospitals to implement best practices for the reduction of cesarean deliveries among women with nulliparous term singleton vertex (NTSV) pregnancies. Arkansas’ NTSV cesarean rate of 27.7% is above the national average (25.6%), with disparately high rates among Black (31.1%), American Indian (30.5%), and Asian/Pacific Islander patients (29.5%). The purpose of this initiative will be to reduce Arkansas’ NTSV cesarean delivery rate to the national average, and to decrease racial disparities in cesarean delivery rates.
As a part of the Arkansas PQC, experienced perinatal nurse facilitators at UAMS will provide coaching on quality improvement methods to support all birthing hospitals in implementing practices from the “Safe Reduction of Primary Cesarean Delivery” bundle. Nurse facilitators will identify barriers and facilitators for implementation on an ongoing basis and provide collaborative learning opportunities and tools to assist hospital teams with overcoming common barriers. The Arkansas PQC’s evaluation team will apply epidemiologic and implementation science methods to rigorously evaluate the processes and outcomes of the collaborative—including patient experience of care—and submit measures to the Alliance for Innovation in Maternal Health’s data center. The planned outcomes of the Arkansas PQC are to: 1) increase implementation of maternal safety bundles in birthing hospitals statewide; 2) increase the number of Arkansas birthing hospitals that engage patients/families in quality improvement initiatives; and, 3) improve maternal outcomes and reduce disparities in Arkansas.