Maternal morbidity and mortality rates in the United States are among the highest in the developed world—impacting roughly 50,000 women each year and taking the lives of 700 mothers annually. Three in five of these deaths are preventable, according to the Centers for Disease Control and Prevention (CDC).
Last year, the U.S. Department of Health and Human Services (U.S. HHS) announced $350 million in awards to address disparities in maternal health across the country. States are using these funds to expand home visiting services to families most in need, increase access to doulas, address health outcome disparities, and improve data reporting on maternal and neonatal health.
These are all elements of improving these disparities, but the foremost step to alleviating the maternal health crisis is proactively identifying potential risks which are often overlooked—and having the right tools like technology to facilitate notifications to the care team are a critical piece in prevention.
Understanding racial disparities in maternal morbidity
Maternal morbidity and mortality impact women of all races, education, and income levels across the United States, but statistics show that Black, African American, American Indian, and Alaska Native women are at significantly higher risk for maternal morbidity and mortality compared to other races.
Specifically, American Indian and Alaska Native women are more than twice as likely, and Black and African American women more than three times as likely, to have a pregnancy-related death when compared to white women. These racial disparities occur regardless of education or socioeconomic status. The pregnancy-related mortality ratio for Black and African American women with a college degree is five times that of white women with a similar education.
Notably, Nebraska is high nationwide in maternal morbidity and faces significant racial disparity challenges. Maternal morbidity, in particular, impacts Black parents. For instance, Black or African American women have the highest risk for progression from gestational diabetes to chronic diabetes yet have lower rates of getting screened for diabetes postpartum. In addition, one in four women experience postpartum depression, yet only one in eight will seek help, with higher self-reported rates among women of color. Black or African American women ages 20-44 years have more than twice the hypertension prevalence of other racial and ethnic groups.
These numbers are widely published, yet 60 percent of pregnancy-related deaths are preventable. Reported maternal deaths more than doubled between 1987 and 2018, and severe maternal morbidity continues to climb without a clear understanding of the causal factors. However, awareness of the high maternal mortality and morbidity rates in the United States alone is insufficient to fix the disparities.
Improving mortality rates through HIE alerting technology
Health Information Exchanges (HIE) can provide an avenue utilizing technology and interoperability to make meaningful improvements in maternal health nationwide. HIE’s can create programs to leverage coordinated and secure data exchange amongst key stakeholders enabling Medicaid, hospitals, clinics, federally qualified health centers, primary care providers, OB-GYNs, substance use disorder clinics, and medication-assisted treatment facilities to identify mothers and infants in need of care. Once identified, these programs can facilitate and support holistic coordination of each mother’s care throughout the pregnancy and postpartum experience.
It’s imperative that these programs not only identify high-risk patients based on many factors—such as race/ethnicity, geographic influences, medical history, and more—but also keep all providers and organizations involved informed in real-time on their patients. For example, if a pregnant woman visits an urgent care because she’s dizzy and then is diagnosed with high blood pressure, all her treating providers should receive a notification, ensuring proper follow-up care is performed. These notifications are vital as hypertension is a major contributing factor to maternal morbidity.
This utilization of data is just one element of expanding HIEs to operate as a health data utility, allowing health care and community-based organizations across their respective state to assist in the coordination of care, specifically focusing on before, during, and after delivery for Black, African American, American Indian, and Alaska Native women and infants. This in-depth coordination of individualized care prevents women from slipping through the cracks and developing serious complications that could have been prevented.
The good news is that a pilot program is beginning to use this HIE technology in Nebraska, and it’s replicable in other states. The U.S. HHS recently recognized the program as one of its Top 25 winners of Phase I of the HHS Racial Equity in Postpartum Care Challenge.
Improving maternal and infant morbidity rates with technology: three key takeaways
While there is still much work to be done, the recent federal funding and emphasis for maternal health programs are an encouraging step in the right direction. As organizations nationwide work to improve maternal care, there are three key principles to keep in mind:
1. Start with what you know. Statistics on maternal morbidity are often gathered and published on a national level. Insight into what is happening on a community or neighborhood level can be limited. It is easy to think that these disparities are not happening in our own communities, but until we look closely and honestly at data related to our organizations and health systems, we cannot know the extent of the problem, how to fix it, or how applied interventions change outcomes. Utilizing the current health data infrastructures to aggregate location-specific data to identify patterns and potential areas of concern is an excellent way to understand maternal health disparities in our communities.
2. Leverage technology to create and track change. Many grant awardees are using funding to increase home visits or build programs addressing social health determinants. While certainly part of improving maternal health disparities, these programs require significant time and overhead and often fail to offer tangible metrics to back up success. Without visibility into program efficacy, it is difficult to understand what interventions improve maternal mortality and morbidity. Lack of data can also make it difficult to secure future funding to keep programs sustainable and consistent to build or rebuild trust at a community level.
Leveraging technologies and partnerships that facilitate the availability of key indicators, such as key preventative care measures, coordination for transitions of care, and avoidable condition complications offer critical insight into the effectiveness of programs, initiatives, and interventions. Showing program success with tangible numbers increases the odds of sustaining and growing program budgets through grants, donations, other awards, or internal sources to secure the long-term success of improving maternal and infant health disparities.
3. Remember that you are not in this alone. While technology and information systems are necessary for a successful maternal and infant health program, they are not the only tools needed to eliminate the disparities. Maternal and infant mortality components are complex and varied, requiring a coordinated effort between hospitals, health systems, primary care providers, specialists, doulas, community resources, and more.
Organizations that are trusted neutral convenors of health information, like regional and statewide HIEs, can support this collaboration by ensuring the vital maternal health data follows the person wherever the person seeks care. When timely alerts, medication history, encounter information, care plans, and other needed information are automatically shared, transitions of care are a better experience for people, outcomes improve, redundancies are reduced, and—most importantly—mothers and infants are less likely to fall through the cracks of the health care system and are more likely to receive the care they need and deserve.
Jaime Bland is a nurse practitioner and health care executive.
