In response, Pennsylvania became the 38th state to join the Alliance for Innovation on Maternal Health (AIM). AIM is a national data-driven maternal safety and quality improvement initiative that is funded by HRSA and operated by ACOG. AIM provides implementation support and data tracking assistance to participating states to support the adoption of AIM’s patient safety bundles. AIM advised Pennsylvania to select the AIM Hemorrhage Bundle or the AIM Severe Hypertension Bundle, especially since the PA PQC already has a focus on maternal OUD.
Pennsylvania selected the AIM Severe Hypertension bundle based on findings from analyses of hospital discharge data from the PA Health Care Cost Containment Council (PHC4). In comparison to hemorrhage, the analyses showed greater racial disparities for preeclampsia/eclampsia and an increase in eclampsia/preeclampsia rates among black women between 2015 and 2019.
As an action arm of the PA Maternal Mortality Review Committee, the PA PQC is coordinating the rollout of the PA AIM initiative.
- Recruit 15 PA PQC birth hospitals to participate in the PA AIM initiative by the end of March 2021
- Reduce the rate of severe maternal morbidity (SMM) among those with eclampsia/preeclampsia by 25% and reduce the racial/ethnic disparities for that measure by 25% by August 2022
- Increase the proportion of birthing patients with acute-onset severe hypertension who are treated within 60 minutes to 75% across races/ethnicities by August 2022
Click here to view the Integrated PA AIM Bundle for Severe Hypertension and Racial/Ethnic Disparities.
Eligible birth hospitals include those who meet all three of the following criteria:
- Are members of the PA PQC (click here to join the PA PQC if your provider team is not yet involved in the PA PQC)
- Have completed or are actively working on at least one NAS or OUD quality improvement project OR have documentation showing that the core OUD and NAS screening, diagnosis, and treatment components are already in place at the hospital
- Have at least one improvement opportunity related to the PA AIM key interventions
To join the PA AIM initiative:
- Identify a multi-disciplinary quality improvement AIM team
- Complete the Expression of Interest Survey
- Complete the AIM Facility Readiness Assessment Tool (a PDF version is available here to view prior to submitting the responses)
- Complete a Memorandum of Understanding (MOU) and Data Use Agreement (DUA) in March 2021 (the MOU and DUA will be posted here soon)
With guidance from your PA PQC quality improvement coach:
- Further expand, develop, and structure your PA AIM multi-disciplinary team
- Organize monthly quality improvement team meetings to adopt the PA AIM Bundle
- Develop and implement a quality improvement plan and protocols with your team to improve the PA AIM goals based on your current condition, making continuous improvements
- Complete quarterly PA AIM surveys, starting with January-March 2021 as the baseline period, to track your impact on the PA AIM structure measures
- Submit aggregated numerators/denominators for the AIM process measure—time to treatment for severe hypertension—quarterly and by race/ethnicity annually via the PA PQC data portal
- Attend the quarterly PA PQC Learning Sessions
- Provide a Quality Improvement Report Out, using the QI Report Out Template, prior to each quarterly PA PQC Learning Session
- Attend the AIM-related PA PQC Quality Improvement Collaborative Meetings and Team Talks for peer-to-peer learning in-between the Learning Sessions
The PA AIM implementation period is from April 2021 through August 2022, and the PA AIM sustaining period is from September 2022 through August 2023. The expectations related to quarterly surveys and data submissions apply to the implementation and sustaining periods.
These provider-level expectations do not include submitting data related to the PA AIM outcome measure, severe maternal morbidity (SMM), since the Pennsylvania Department of Health will analyze hospital discharge data from PHC4 to track the SMM measure quarterly and by race/ethnicity annually. However, the PA PQC AIM teams are encouraged to continue to collect and report their own SMM data on a quarterly basis for more real-time feedback, especially if your PA PQC team has already put in place a system to track this outcome measure. PA AIM provider teams will also have an opportunity to apply for a PA AIM Innovation Award that will be announced in 2021. The financial award will go to a Level I or II birth hospital that has higher rates of severe hypertension and teams up with a Level III or IV birth hospital through the PA AIM initiative. The larger birth hospital will work with the smaller birth hospital to spread their AIM-related innovations to the smaller hospital and assist them with adopting the PA AIM Bundle.