Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) in Massachusetts - Background: Massachusetts (MA) is consistently one of the healthiest states in the nation. However, racial inequities in maternal health outcomes exist. Since 1998, rates of pregnancy-associated deaths and severe maternal morbidity have steadily risen in MA. Black birthing people are almost twice as likely to die during pregnancy or within one year postpartum as White birthing people. The MA Department of Public Health (DPH) aims to improve capacity to characterize pregnancy-associated deaths and implement data-informed and community-engaged strategies to prevent maternal deaths and reduce inequities in maternal health outcomes. Purpose: DPH proposes to expand, enhance, and expedite our current process to identify all pregnancy-associated deaths; collect and analyze timely and relevant data, including informant interviews; conduct a comprehensive review of each death by the MA Maternal Mortality and Morbidity Review Committee (MMMRC) to better understand contributing factors; engage community members in committee reviews, data interpretation, and development of prevention recommendations; and disseminate findings through provider and community partners. Outcomes: The MMMRC seeks to eliminate preventable deaths that occur during or in the year after pregnancy and inequities in maternal deaths. The project’s desired short and intermediate outcomes include: 1) Increased timeliness, accuracy, and standardization of information available about pregnancy-related deaths, including opportunities for prevention; 2) Increased engagement and cooperation between the MMMRC, partners, and communities to communicate information from data on pregnancy-related deaths; 3) Increased availability of MMMRC recommendations among communities, clinicians, public health practitioners, and decision makers; 4) Increased adoption of clinical and non-clinical policies and programs that reflect the highest standards of care; and 5) Increased implementation of recommendations that reach or consider the needs of populations disproportionately affected by pregnancy-related mortality. Strategies and Activities: The DPH team will identify pregnancy-associated deaths within 12 months of death and fully abstract clinical and non-clinical data on all pregnancy-associated deaths and enter them into MMRIA within 18 months of death. CDC-generated Quality Assurance Reports will launch internal reviews that together improve data quality, completeness, and timeliness. The review process will result in the development of prevention strategies to reduce maternal morbidity and mortality and associated racial and ethnic inequities. These recommendations will be broadly disseminated to communities, clinicians, and policy makers. Evaluation & Performance Measurement Plan: The evaluation will assess whether proposed activities are implemented as intended and the extent to which the desired outcomes are achieved. DPH will collect process and outcome/performance data, and evaluation findings will frequently be shared with key partners and used throughout the project to identify barriers to progress and opportunities to improve performance and sustain improvements over time. Capacity: DPH is well-positioned to lead this work. The MMMRC has statutory authority to implement the proposed activities and support from DPH leadership and key clinical and community partners. DPH and MMMRC have capacity to access data, ensure confidentiality, staff and manage the project, and use the CDC developed MMRIA database. With a robust accounting, purchase of services, and multiple checks and balances in place, DPH has extensive and successful experience managing federal grants.
