Project Abstract—component A
Indiana has consistently high infant and maternal mortality rates, with significant disparities across race and ethnicities. In 2020, the infant mortality rate was 6.6 deaths per 1000 live births with significant disparities, especially in non-Hispanic Black populations. In 2020, the non-Hispanic Black infant mortality rate was 13.2 deaths, compared to 6.0 non-Hispanic White infant deaths, and 5.5 Hispanic infant deaths per 1000 live births. According to data compiled by HRSA for Region V, if Indiana continues the current trend lines for Non-Hispanic White and Non-Hispanic Black infant mortality rates, Non-Hispanic Black infants will have to wait 38 years to achieve the 2019 Non-Hispanic White infant mortality rate. In other words, even though the rates continue to decline, Indiana must do more to close the wide gap between population groups.
Indiana also experiences significant maternal deaths. According to the latest report authored by the Indiana’s Maternal Mortality Committee, 60 pregnancy-associated deaths occurred during pregnancy or within one year of the end of pregnancy. Indiana sees 85% of pregnancy-associated deaths occurred during the postpartum period, including 56% after 6 weeks. In 2018 and 2019, substance use disorder has been the leading cause to maternal deaths accounting for 33.3% of all pregnancy-associated deaths.
Indiana Department of Health Maternal and Child Health Division (IDOH-MCH), Indiana Perinatal Quality Improvement Collaborative (IPQIC), and the Indiana Hospital Association (IHA) have been partnering for the past decade in efforts to improve health outcomes for mothers and babies in Indiana. This partnership is best described as three legs to a stool—each organization as important as the other in the work to improve health outcomes for the maternal and infant health population. In this proposal, IDOH will serve as the applicant organization, and will provide subgrants to both IPQIC for project management, and IHA for support in expansion of a data dashboard.
While considerable work has been done in recent years to improve birth outcomes and maternal health outcomes, Indiana seeks to increase capacity of its PQC to collect data and use that data for continuous quality improvement projects within the facilities. Indiana will (1) enhance IHA’s data dashboard in order to
(2) use that data to provide technical assistance to facilities through a staff at MCH, and (3) integrate the work of AIM bundles as a launching point to start QI projects.
Indiana proposes focusing on substance use disorder as its initial QI focus, however, will plan on expanding its QI work to follow the implementation of other AIM bundles and into ‘level 0’ facilities and stand-alone emergency departments.
This funding will provide the opportunity for the implementation team to review data quickly, act on the data, and improve policies and practices in hospitals. Seeing improvements quickly will allow hospitals to adjust using evidence based CQI methodologies. Through the collaboration with CDC, Indiana will implement an approach for Component A of this opportunity to build and strengthen capacity of PQCs to improve the quality of perinatal care statewide; engage facilities statewide to improve perinatal outcomes; support facilities to implement QI initiatives; build and strengthen data systems to improve identification and documentation of disparities; engage patients/communities in QI initiatives; and build partnerships and conduct outreach and dissemination of QI results