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New Hampshire Alliance for Innovation on Maternal Health (AIM) & ERASE Maternal Mortality Projects

For questions or additional information regarding these initiatives, please feel free to contact us: NNEPQIN@hitchcock.org or 603-653-6898

Table of contents

   

Alliance for Innovation on Maternal Health (AIM)

  • National data-driven maternal safety and quality improvement initiative
  • Works to reduce preventable maternal mortality and severe morbidity
  • AIM works to promote respectful care for all birthing persons, and eliminate disparities in perinatal outcomes

AIM aligns national, state and hospital level improvement efforts

  • AIM works with state health departments, Perinatal Quality Collaboratives, hospitals, community-based teams and patient representatives to address the key drivers of maternal mortality and SMM.
  • AIM utilizes patient safety bundles as core building blocks to improve outcomes

AIM uses data to drive improvement strategies

  • Timely data drives hospital and perinatal quality collaborative QI activities
  • Collaboration with state health departments provides data through vital statistics records and all-payer administrative databases
  • AIM defines standard process and outcome measures for members, to increase opportunities for learning

NH AIM FOCUS

New Hampshire AIM Patient Safety Bundles Focus

AIM relies on critical collaborations between State Perinatal Quality Collaboratives (PQCs) and Maternal Mortality Review Committees

New Hampshire AIM will address two core patient safety bundles in 2021

  • Opioid overdose is the leading cause of pregnancy associated death in New Hampshire
  • Maternal and neonatal outcomes in New Hampshire show the same racial and ethnic disparities which exist nationally

NH-AIM has identified five key initiatives to drive reduction in Substance-related Maternal Mortality and SMM in New Hampshire

NH AIM/ERASE Maternal Mortality & Morbidity Webinars: 

ERASE Webinars:

August 13, 2020

Slides: ERASE Maternal Mortality Slides Aug 13 2020

Recording: August 13 2020 ERASE MM Recording

September 10, 2020

Slides: September 10, 2020 ERASE Slides

Recording: September 10, 2020 ERASE MM Recording

October 8, 2020

Slides:  October 8, 2020 ERASE Slides

November Launch Slides: AIM Launch 11-12-20 presentation

December 10, 2020 Webinar

Slides: AIM Next Steps 12.10 Webinar

Recording: https://video.dartmouth-hitchcock.org/media/1_mvgr8fzq

January 14, 2021 Webinar

Slides: 1.14.21 AIM Webinar Slides

Recording: 1.14.21 NH AIM Webinar Recording

March 11, 2021 Webinar

Slides: March NH AIM Webinar Slides

Recording: March 11, 2021 Implementation of Naloxone Distribution Recording 

April 8, 2021 Webinar

Slides: T.Tellez_SDOH_AIM-NNEPQIN_4.8.21-handout

Recording: April 8, 2021 Social Determinants of Health & Pregnancy

May 13, 2021 Webinar

Slides: May NH AIM ERASE MM Webinar Slides

Recording: May 13, 2021 Operationalizing Screening for SDOH

July 8, 2021 Webinar

Slides: July 2021 AIM ERASE MM Webinar Slides

Recording: July 8, 2021 AIM ERASE MM Moving To a New Era of Real Time Data Access

August 12, 2021 Webinar

Slides: Aug 12 2021 AIM_ERASE MM Naloxone Presentation.FINAL

Recording: August 12 2021 AIM Webinar Recording

September 9, 2021 Webinar

Slides: Sept 9 2021 AIM_ERASE MM PPT_FINAL (002) [Read-Only]

Recording: Sept 9 AIM ERASE Webinar

October 14, 2021 Webinar

Slides: Oct 14 2021 AIM_ERASE MM PPT FINAL

Recording: October 14 2021 AIM Webinar Harm Reduction

January 13, 2022 Webinar

Slides: Jan 2022 AIM Webinar Slides_FINAL for distribution

Recording: Jan 2022 AIM Webinar Recording

March 10, 2022 Webinar

Slides: Improving Maternal Demographic Data-AIM Webinar-Mar2022-HANDOUT

Recording: https://dhvideo.webex.com/dhvideo/March 2022

April 14, 2022 Webinar

Slides:  April 2022 AIM Webinar_New CMS Measures and NNEPQIN QI Bundle Initiatives_final

Recording: https://video.dartmouth-hitchcock.org/media/1_7g2izoa6

May 12, 2022 Webinar

Contact NNEPQIN@hitchcock.org for more information.

July 14, 2022 Webinar

Slides: 7-14-22 AIM Webinar Handout

Recording: https://video.dartmouth-hitchcock.org/media/1_no4f07e7

August 11, 2022 Webinar

Slides: 8-11-22 AIM Webinar_Slides _Handout

Recording: August+2022+NH+AIM+ERASE+Maternal+Mortality+Monthly+Webinar

October 13, 2022 Webinar

Slides: 10-13-22Webinar_HANDOUT

Recording: AIMERASE Maternal Mortality Monthly Webinar – October 2022-20221013 1600-1 – Dartmouth-Hitchcock Video

December 8, 2022 Webinar

Slides: 12-08-2022_NH-AIM_FINAL handout

Recording: https://video.dartmouth-hitchcock.org/edit/1_fewduupr

January 12, 2023 Webinar

Slides: 1.12.23 NH AIM ERASE MM Webinar Handout

Recording: January+2023+NH+AIMERASE+Maternal+Mortality+Webinar

March 9, 2023 Webinar

Slides: 3.9.2023 NH AIM Webinar Handout

Recording: March+2023+NH+AIM+ERASE+MM+Webinar

ERASE Maternal Mortality

 

 

CDC ERASE Maternal Mortality Project
Enhancing Reviews and Surveillance to Eliminate Maternal Mortality

 

The Maternal & Child Health Division of DHHS is working in partnership with NNEPQIN and other state teams and health systems to align national, state, and hospital level quality improvement efforts.  Together we will utilize AIM’s framework and structure to improve maternal care and outcomes.  The implementation of AIM bundles is central to our work on ERASE MM.

  • This funding directly supports agencies and organizations that coordinate and manage Maternal Mortality Review Committees to identify, review, and characterize maternal deaths; and identify prevention opportunities
  • Facilitate an understanding of the drivers of maternal mortality and complications of pregnancy and better understand the associated disparities.
  • Determine what interventions at patient, provider, facility, system, and community levels will have the most effect.
  • Inform the implementation of initiatives in the right places for families and communities who need them most.

ERASE Webinars:

August 13, 2020

Slides: ERASE Maternal Mortality Slides Aug 13 2020

Recording: August 13 2020 ERASE MM Recording

September 10, 2020

Slides: September 10, 2020 ERASE Slides

Recording: September 10, 2020 ERASE MM Recording

October 8, 2020

Slides:  October 8, 2020 ERASE Slides

November Launch Slides: AIM Launch 11-12-20 presentation

December 10, 2020 Webinar

Slides: AIM Next Steps 12.10 Webinar

Recording: https://video.dartmouth-hitchcock.org/media/1_mvgr8fzq

January 14, 2021 Webinar

Slides: 1.14.21 AIM Webinar Slides

Recording: 1.14.21 NH AIM Webinar Recording

March 11, 2021 Webinar

Slides: March NH AIM Webinar Slides

Recording: March 11, 2021 Implementation of Naloxone Distribution Recording 

April 8, 2021 Webinar

Slides: T.Tellez_SDOH_AIM-NNEPQIN_4.8.21-handout

Recording: April 8, 2021 Social Determinants of Health & Pregnancy

May 13, 2021 Webinar

Slides: May NH AIM ERASE MM Webinar Slides

Recording: May 13, 2021 Operationalizing Screening for SDOH

July 8, 2021 Webinar

Slides: July 2021 AIM ERASE MM Webinar Slides

Recording: July 8, 2021 AIM ERASE MM Moving To a New Era of Real Time Data Access

August 12, 2021 Webinar

Slides: Aug 12 2021 AIM_ERASE MM Naloxone Presentation.FINAL

Recording: August 12 2021 AIM Webinar Recording

September 9, 2021 Webinar

Slides: Sept 9 2021 AIM_ERASE MM PPT_FINAL (002) [Read-Only]

Recording: Sept 9 AIM ERASE Webinar

October 14, 2021 Webinar

Slides: Oct 14 2021 AIM_ERASE MM PPT FINAL

Recording: October 14 2021 AIM Webinar Harm Reduction

January 13, 2022 Webinar

Slides: Jan 2022 AIM Webinar Slides_FINAL for distribution

Recording: Jan 2022 AIM Webinar Recording

March 10, 2022 Webinar

Slides: Improving Maternal Demographic Data-AIM Webinar-Mar2022-HANDOUT

Recording: https://dhvideo.webex.com/dhvideo/March 2022

April 14, 2022 Webinar

Slides:  April 2022 AIM Webinar_New CMS Measures and NNEPQIN QI Bundle Initiatives_final

Recording: https://video.dartmouth-hitchcock.org/media/1_7g2izoa6

May 12, 2022 Webinar

Contact NNEPQIN@hitchcock.org for more information.

July 14, 2022 Webinar

Slides: 7-14-22 AIM Webinar Handout

Recording: https://video.dartmouth-hitchcock.org/media/1_no4f07e7

August 11, 2022 Webinar

Slides: 8-11-22 AIM Webinar_Slides _Handout

Recording: August+2022+NH+AIM+ERASE+Maternal+Mortality+Monthly+Webinar

October 13, 2022 Webinar

Slides: 10-13-22Webinar_HANDOUT

Recording: AIMERASE Maternal Mortality Monthly Webinar – October 2022-20221013 1600-1 – Dartmouth-Hitchcock Video

December 8, 2022 Webinar

Slides: 12-08-2022_NH-AIM_FINAL handout

Recording: https://video.dartmouth-hitchcock.org/edit/1_fewduupr

January 12, 2023 Webinar

Slides: 1.12.23 NH AIM ERASE MM Webinar Handout

Recording: January+2023+NH+AIMERASE+Maternal+Mortality+Webinar

March 9, 2023 Webinar

Slides: 3.9.2023 NH AIM Webinar Handout

Recording: March+2023+NH+AIM+ERASE+MM+Webinar

New Hampshire Maternal Mortality Review Process

Link to NH POSC Website Resources: NH Plans of Safe Care check out the Pregnant and Parenting Services and Supports link and map.

NH Review to Action: https://reviewtoaction.org/content/new-hampshire

New Hampshire Maternal Mortality Legislation (Enacted in January 2010, Section 132:29):  NH Maternal Mortality Legislation

To Report a NH Maternal Death: Maternal Mortality Initial Report Letter & Form

2022 Annual MM report to NH DHHS Legislative Oversight Committee:

2022 Annual New Hampshire Report on Maternal Mortality FINAL

2021 Annual MM report to NH DHHS Legislative Oversight Committee:

2021 Annual New Hampshire Report on Maternal Mortality FINAL

2020 Annual MM report to NH DHHS Legislative Oversight Committee:

2020 Annual New Hampshire Report on Maternal Mortality FINAL 10 21 2020

NH MMRC Infographics:

Overview of NH MMRC Infographic 9-27-22 (003)

SUD MM Infographic 9-27-22

Suicide MM Infographic 9-27-22

Cardiac MM Infographic 9-27-22

NH MMRC Recommendations:

2018 Case Recommendations

Recommendations -Women of Childbearing Age:

  • Enhance outreach to homeless individuals, prioritizing access to women’s services
  • Promote standard management of patients with warning signs for substance misuse (ex- early refills), including face to face assessment, screening for presence of substance use disorders, and linkage to SUD treatment services

Recommendations -Prenatal and Post-Partum Care:

  • Provide education to healthcare teams to reduce stigma against people who use substances
  • Develop statewide provider education materials about hazards of co-prescribing benzodiazepines and opioid agonist medications
  • Promote warm handoff from PCP to OB to facilitate engagement in prenatal care

 Recommendations- Education for Providers

  • Introduce assessment of social determinants needs, case management, and linkage to services directly from ED for patients with substance use disorder (SUD)-related complaints
  • Standardize perinatal education for women with OUD about increased risk for overdose after period of abstinence
  • Provide naloxone kits at discharge from inpatient stay; standardize postpartum discharge instructions

Past Recommendations Relevant to 2018 Cases

Recommendations – Pregnant Women with History of Substance Use Disorder:

  • Harm reduction education for all pregnant patients with a substance use disorder
  • Provider education on SHOUT as used in the “Zero Suicide” approach.
  • Social workers/ medical personnel utilize immediate access to treatment for SUD using 211
  • Provider and patient education about benzodiazepine/ opioid interaction.

          Example: Reference information in the Greater Manchester Mental Health brochure

  • Promote use of the Northern New England Perinatal Quality Improvement Network’s (NNEPQIN) Substance Use Guidelines.

          Example: Consider echocardiogram for patients with injection drug related infection

  • Pregnant women who are incarcerated received Medicated Assisted Treatment (MAT)
  • Planning and collaboration between prison and community providers for pregnant patients around post- release treatment transition

Recommendations –Women in Recovery in Postpartum Period

  • Prioritize keeping mother and baby together in safe environment for both, rather than separation/foster placement.
  • Provide access to residential treatment which accepts children as an alternative to separation/foster placement for vulnerable women with complex dual diagnosis
  • Provide access to higher level of care (residential care which accepts children) for women who are struggling with complex co-occurring disorders

Recommendations –Public Education

  • Provide public education re: importance of prenatal care especially for women who use substances
  • Provide public education re: importance of engaging in treatment for SUD for pregnant women

NH Maternal Mortality Review Committee

Name Representing Title
Emily Baker MD American Congress of Obstetrician & Gynecologists (ACOG)(Maternal Fetal Medicine) Vice Chair, Department of Obstetrics and Gynecology Director, Maternal Fetal Medicine
Ellen Joyce MD American Congress of Obstetrician & Gynecologists (ACOG) Chair, NH ACOG
Anne Diefendorf Foundation for Healthy Communities Associate Executive Director
Kim Fallon Dept of Justice:  Medical Examiner’s office Alternate for Thomas Andrew
Victoria Flanagan Northern New England Perinatal Quality Improvement Network (NNEPQIN) Representative Perinatal Outreach Coordinator
David Laflamme, PhD, MPH Maternal & Child Health Section MCH Epidemiologist
Kristen Kraunelis The Mental Health Center of Greater Manchester Director, Quality Improvement
Meaghan Smith Association of Women’s Health, Obstetric & Neonatal Nurse (AWHONN) Coordinating Council Member
Open position AAPNH Pediatric Society Executive Committee Neonatologist
Patricia Tilley Bureau of Population Health and Community Services Bureau Chief
Dawn Reams Public Member Executive Director, Bridges:  Domestic & Sexual Violence Support
Rhonda Siegel Maternal & Child Health Section Maternal & Child Health Administrator Title V Director
Shawn Broderick Am. College of Midwives Midwife
Linda Parker Division of Behavioral Health
Bureau of Drug and Alcohol Services Clinical Service Unit
BS,CPM/ Program Specialist IV
Farrah Deselle MSN, RN, CLC Catholic Medical Center Pregnancy Care Center Childbirth Education and Lactation
VACANT DHHS Maternal & Child Health Section Perinatal Nurse Coordinator/Maternal Mortality Review Coordinator
Daisy Goodman DNP, MPH, APRN, CARN-AP,CNM Dartmouth-Hitchcock Director, Women’s Health Services, Perinatal Addiction Treatment Program
Michele Harlon DHHS Director of Mental Health Services
Suzanne LaMontagne NH Department of Corrections LICSW/Senior Psychiatric Social Worker
Frances McLaughlin, RD, MEd NH DHHS
Renee Maloney, RN Roots for Recovery, Catholic Medical Center
Pamela Doubleday, BSN Concord Hospital Perinatal Nurse Educator
Abigail Rogers DHHS Public Health Services
Julia R. Frew, MD Dartmouth-Hitchcock Medical Center Psychiatry
Margaret Minnock, MBA NNEPQIN Executive Director
Katherine Stokes, BSN, MPH Dartmouth-Hitchcock Medical Center Birthing Pavilion Nurse

For questions or additional information, please feel free to contact us:

NNEPQIN@hitchcock.org or 603-653-6898

Suicide Prevention Resources:

For suicide loss survivors: https://theconnectprogram.org/find-support/coping-with-suicide-loss/ [theconnectprogram.org]

Free training for physicians to talk with families about firearms and safety in the home:

https://shop.aap.org/calm-for-pediatric-providers-counseling-on-access-to-lethal-means-to-prevent-youth-suicide/ [shop.aap.org]

For additional information and support, please contact:

Amy: aoliva@naminh.org

or Elaine: edemello@naminh.org

at NAMI NH: Home – NAMI NH