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:
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
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
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)
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:
For additional information and support, please contact:
Amy: aoliva@naminh.org
or Elaine: edemello@naminh.org
at NAMI NH: Home – NAMI NH