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

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:

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

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

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: NH Maternal Mortality Legislation

2020 Annual MM report to NH DHHS Legislative Oversight Committee:

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

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