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)
- NH AIM FOCUS
- ERASE Maternal Mortality
- New Hampshire Maternal Mortality Review Process
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:
FLYER FOR JANUARY – JUNE 2024 NH AIM/ERASE MM WEBINARS: 2024 NH AIM Webinars Flyer_FINAL
ERASE Webinars:
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
April 13, 2023 Webinar
Slides: NH AIM ERASE MM April 2023 Webinar Handout
Recording: April+NH+AIM+ERASE+Maternal+Mortality+Monthly+Webinar-2023
May 11, 2023 Webinar
Slides:May 2023 NH AIM ERASE Maternal Mortality Handout
Recording: May+2023+NH+AIMERASE+Maternal+Mortality+Monthly+Webinar+-+Naloxboxes
July 18, 2023 Webinar
Slides: July 2023 NH AIM ERASE MM Webinar Handout
Recording: July+NH+AIMERASE+Maternal+Mortality+Webinar+-+Plan+of+Safe+Care-20230713
August 10, 2023 Webinar
Slides: Aug 2023 NH AIM ERASE MM Webinar Handout
Recording: August+2023+NH+AIMERASE+Maternal+Mortality+Webinar+-+Antenatalperipartum+Drug+Testing+Policies
September 14, 2023 Webinar
Slides: Sept 2023 NH AIM ERASE MM Handout
Recording: Sept 2023 NH AIM Webinar Recording
October 12, 2023 Webinar
Slides: Oct 2023 NH AIM ERASE MM Handout
Recording: Oct 2023 NH AIM Webinar Recording
November 9, 2023 Webinar
Slides: Nov 2023 NH AIM ERASE MM Handout
Recording: Nov 2023 NH AIM Webinar Recording
December 14, 2023 Webinar
Slides: Dec 2023 NH AIM Webinar Handout 12.5.23
Recording: Dec 2023 NH AIM Webinar Recording
January 11, 2024 Webinar
Slides: Jan 2024 NH AIM ERASE MM Webinar Handout
Recording: Jan 2024 NH AIM Webinar Recording
February 8, 2024 Webinar
Slides: Feb 2024 NH AIM ERASE Maternal Mortality Webinar Handout
Recording: Feb 2024 NH AIM Recording
March 14, 2024 Webinar
Slides: March 2024 NH AIM Webinar Handout
Recording: March 2024 NH AIM Recording
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:
FLYER FOR JANUARY – JUNE 2024 NH AIM/ERASE MM WEBINARS: 2024 NH AIM Webinars Flyer_FINAL
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
April 13, 2023 Webinar
Slides: NH AIM ERASE MM April 2023 Webinar Handout
Recording: April+NH+AIM+ERASE+Maternal+Mortality+Monthly+Webinar-2023
May 11, 2023 Webinar
Slides:May 2023 NH AIM ERASE Maternal Mortality Handout
Recording: May+2023+NH+AIMERASE+Maternal+Mortality+Monthly+Webinar+-+Naloxboxes
July 18, 2023 Webinar
Slides: July 2023 NH AIM ERASE MM Webinar Handout
Recording: July+NH+AIMERASE+Maternal+Mortality+Webinar+-+Plan+of+Safe+Care-20230713
August 10, 2023 Webinar
Slides: Aug 2023 NH AIM ERASE MM Webinar Handout
Recording: August+2023+NH+AIMERASE+Maternal+Mortality+Webinar+-+Antenatalperipartum+Drug+Testing+Policies
September 14, 2023 Webinar
Slides: Sept 2023 NH AIM ERASE MM Handout
Recording: Sept 2023 NH AIM Webinar Recording
October 12, 2023 Webinar
Slides: Oct 2023 NH AIM ERASE MM Handout
Recording: Oct 2023 NH AIM Webinar Recording
November 9, 2023 Webinar
Slides: Nov 2023 NH AIM ERASE MM Handout
Recording: Nov 2023 NH AIM Webinar Recording
December 14, 2023 Webinar
Slides: Dec 2023 NH AIM Webinar Handout 12.5.23
Recording: Dec 2023 NH AIM Webinar Recording
January 11, 2024 Webinar
Slides: Jan 2024 NH AIM ERASE MM Webinar Handout
Recording: Jan 2024 NH AIM Webinar Recording
February 8, 2024 Webinar
Slides: Feb 2024 NH AIM ERASE Maternal Mortality Webinar Handout
Recording: Feb 2024 NH AIM Recording
March 14, 2024 Webinar
Slides: March 2024 NH AIM Webinar Handout
Recording: March 2024 NH AIM Recording
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
2023 Annual MM report to NH DHHS Legislative Oversight Committee:
2023 Annual Report on Maternal Mortality_Revised
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)
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
| Member | Organization |
| Alison Palmer | Women’s Health OBGYN and Psychiatric-Mental Health Nurse Practitioner |
| Carol Whitman | NH DHHS Perinatal Nurse Coordinator & MMRC Coordinator |
| Carolyn Nyamasege | NH MCH Epidemiologist |
| Cheri Breyer | Public Member with Lived Experience & Recovery Coach/CRSW |
| Colleen Whatley | DH Senior Quality and Safety Specialist & MMRC Recommendations Facilitator |
| Daisy Goodman | CNM & Director of the DH Perinatal Addiction Treatment Program |
| DaNae Belt | Nurse Manager, Labor & Delivery Unit, Elliot Hospital |
| David Laflamme | NNEPQIN, Epidemiologist |
| Diane Proulx | Chair, NH AWHONN & Clinical Quality & Safety at Wentworth Douglass Hospital |
| Elaine de Mello | National Alliance on Mental Illness, NH Chapter, Expert on Suicide |
| Emily Baker | DH Maternal Fetal Medicine Specialist |
| Erica Tenney | NH DHHS Clinical Services Program Administrator |
| Jess Bacon | Chair, NH ACNM & Nursing Practice Specialist Wentworth Douglass Hospital |
| Jessica Bates | NH MCH, DHHS, Administrative Support |
| Julia Frew | DH, Psychiatrist and Addiction Medicine Physician |
| Kerry Norton | Director, Hope on Haven Hill |
| Kiera Latham | New England High Intensity Drug Trafficking Area (HIDTA), Overdose Response Strategist |
| Kimberly Koschek | Perinatal Social Worker, Catholic Medical Center |
| Kris Hering | NH Foundation for Healthy Communities, Vice President of Quality Improvement |
| Kristen Kraunelis | Mental Health Center of Greater Manchester |
| Kristine Nikitas | NH Bureau of Drug and Alcohol Services, NH DHHS |
| Lauren Lessard | Chair of the NH Chapter of ACOG & Obstetrician/ Gynecologist Concord Hospital |
| Lissa Sirois | NH Bureau of Population Health and Community Services, NH DHHS, Interim Bureau Chief, Expert in Nutrition, WIC and Breastfeeding |
| Margaret Minnock | Executive Director DH NNEPQIN |
| Meagan Smith | NH AWHONN Member at Large & Director of Nursing, Speare Memorial Hospital |
| Pam Doubleday | Concord Hospital, Labor and Delivery Nurse |
| Rhonda Siegel | NH MCH, DHHS Maternal and Child Health Section/Title V Director |
| Suzanne LaMontagne | NH Division of Program Quality and Integrity, DHHS Sentinel Review Committee |
| Tim Fisher | DH NNEPQIN Medical Director & Obstetrician/Gynecologist |
| Victoria Flanagan | MMRC Case Abstractor & DH NNEPQIN Director of Operations |
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:
For additional information and support, please contact:
Amy: aoliva@naminh.org
or Elaine: edemello@naminh.org
at NAMI NH: Home – NAMI NH