Improving maternal outcomes and inspiring change through TexasAIM
In 2020, the national maternal mortality rate was 23.8 deaths per 100,000 live births, according to a National Center for Health Statistics report. In 2022, the state of Texas exceeds that national average with 34.5 maternal deaths per 100,000 live births. As maternal death rates have continued to increase over the past two decades, not only in Texas but across the nation, more health systems are stepping up to create change, leveraging the power of their clinical data.
With over 50 hospitals, and more than 800 patient care sites, a Q-Centrix partner is the most extensive non-profit health care system in Texas and one of the largest in the nation. Knowing their pivotal role in leading maternal care improvement endeavors, the organization sought to inspire state-wide change for the benefit of mothers and their families. One of the system's facilities led these efforts through participation in a project known as TexasAIM.
A joint project from the Texas Department of State Health Services, Alliance for Innovation on Maternal Health, and the Texas Hospital Association, TexasAIM seeks to end preventable maternal death and severe maternal morbidity. Established in 2018, this optional program assists hospitals in carrying out maternal safety projects through one-year “bundles.” Each bundle is designed to target a specific maternal health concern, with obstetric hemorrhage and severe hypertension being a few recent examples of programs completed, or in progress, by the facility.
Successfully integrating change to meet the requirements of each bundle was a rigorous process, demanding a vast amount of data collection and reporting, as well as a monumental effort from hospital staff. Working with a third-party clinical data management partner was key to accurate reporting and assuring the program’s requirements were being met.
- Decrease maternal morbidity and mortality
- Initial focus on post-partum hemorrhage, followed by additional bundles
- Collaborate with other health care facilities to share best practices and learnings
- Lead maternal care improvement efforts for the state of Texas
- Find and create efficiencies in the use and reporting of clinical data related to TexasAIM requirements and all OB-GYN care
- Establish a starting point and process for bundle implementation based on program requirements
- Designate personnel to review charts, gather data, and ensure the success of the program:
- This work often fell on managers and leaders, adding to already heavy time constraints on leadership
- Work through the vast amounts of data necessary to ensure the program’s success
- Every patient was treated as an outlier, with any complication requiring further analysis
At 34.5 maternal deaths per 100,000 live births, Texas' maternal morbidity rate exceeds the national average
Worked with Q-Centrix clinical data experts to generate consistent guidelines and implement best practices to meet all TexasAIM data reporting requirements and compliance needs
Created committees with other facilities to share best practices and discuss the implementation process and goals for each TexasAIM bundle
- Example: A monthly copy committee focused on complex chart audits and determined methods to improve the quality of care, including what changes were needed moving forward and a review of previous changes to verify the intended impact
Assigned a nurse educator to oversee facilities and help align initiatives and best practices across all organizations involved
The partner worked with Q-Centrix clinical data experts to generate consistent guidelines and implement best practices to meet all TexasAIM data reporting requirements and compliance needs
- Fully and successfully implemented the obstetric hemorrhage bundle
- Data collected for TexasAIM was reported to internal team members in monthly meetings designed to foster nimble and effective improvement initiatives
- Greater collaboration within the health care system and with other hospitals across the state was fostered
- The hospital continues to share best practices and learnings with other facilities to inspire and help generate state-wide change
- Additional neonatal program improvements outside of TexasAIM bundle goals were made as a result of their participation
- Maternal clinical data management was streamlined through a partnership with Q-Centrix
- Abstraction load was alleviated from administrative staff, allowing key members to rely on actionable data presented by the Q-Centrix team
- The partnership aided in identifying gaps between the current program and TexasAIM bundle milestones
- New research initiatives were discovered and prioritized, including a potential correlation between hypertensive disorders of pregnancy and COVID-19
TexasAIM seeks to end preventable maternal death and severe maternal morbidity
The partner's participation in the TexasAIM program resulted in better outcomes for their facility and helped drive improvements throughout the state. Developing a continuous and cooperative feedback loop caused transformative change within their facility and across the entire health care system. Moreover, the facility’s willingness to share its findings and best practices meant the information was disseminated to additional hospitals across Texas, accelerating state-wide maternal care improvement goals.
While the results are impressive, the organization is not yet finished. The hospital sees this achievement as the beginning of an enhanced commitment to maternal health. Already, the organization has committed to implementing additional TexasAIM bundles, including targets for determining causes and reducing the prevalence of hypertension in pregnant mothers, and improving obstetric care for women with opioid use disorders. Additionally, the facility has created a regional group to examine social determinants of health and health inequalities.
This work serves as a model for other states and facilities across the country. Through collaborative programs such as TexasAIM, the power of shared clinical data becomes critical, leading to actionable insights for improving patient outcomes and guiding innovative health care for all.