N.J. Perinatal Quality Collaborative Reduces Maternal Morbidity, Mortality

Jan. 18, 2023

NJPQC involves a network of clinical teams, healthcare stakeholders, patients and families and other partners that work together to improve pregnancy and infant outcomes

David Raths

New Jersey’s birthing hospitals have reduced birth complications and C-section rates under a statewide patient safety initiative called the New Jersey Perinatal Quality Collaborative (NJPQC).

Led by the New Jersey Hospital Association (NJHA), the effort has reduced maternal morbidity and mortality and averted more than 10,000 C-sections over a five-year period.

The NJPQC involves a network of clinical teams, healthcare stakeholders, patients and families and other partners that work together to improve pregnancy and infant outcomes. NJHA has convened these partners under the NJPQC banner since 2017 with funding from the Centers for Disease Control and Prevention. In September 2022, the CDC renewed the collaborative for another five years with an annual allocation of $275,000 to continue its patient safety efforts.

The NJPQC focused its work on Caesarean sections, hypertensive disorders and maternal hemorrhage, three critical areas that present risks in pregnancy, labor and delivery and the post-partum period. For each area, birthing hospitals adopted “bundles” of best practices spanning provider education, protocols, standardized plans and checklists, screening and more. Compared with 2016 baseline data, the NJPQC hospitals achieved the following improvements for healthier mothers and babies:

The overall C-section rate declined 14 percent, from 32.31 in 2016 to 27.77 in 2021. In addition, the C-section rate for first-time, uncomplicated pregnancies – formally identified by the medical term “nulliparous, term, singleton, vertex,” or NTSV – declined by 18.6 percent, from 29.91 in 2016 to a preliminary figure of 24.36 in 2021. The collaborative explains that although C-sections are a valid and medically necessary procedure in many births, they are a more invasive procedure than vaginal delivery and can pose added risks including surgical site infections. Because of that, helping individuals deliver safely without a C-section is an important patient safety goal.
The rate of hypertensive disorders in pregnancy per 100 cases fell by 29.4 percent, from 8.5 in 2016 to 6.0 in 2021. This measure encompasses illnesses commonly called high-blood pressure, or hypertension. It also includes preeclampsia, a serious condition of persistent hypertension during pregnancy that can impact the function of various organs.
The rate of obstetric hemorrhage declined from 8.25 per 100 cases in 2016 to 6.98 in 2021, a 15.4 percent decline. Obstetric hemorrhage, or rapid blood loss, is one of the most common birth complications. It can arise at any time during pregnancy and delivery, including the days and weeks post-birth.

“New Jersey’s birthing hospitals are delivering on their goal of ensuring that mothers and babies have every opportunity for a safe, successful birth experience,” said NJHA President and CEO Cathy Bennett, in a statement. “This reflects a statewide commitment in our hospitals from the bedside to the Board room to the executive offices. And now, like any quality improvement journey, the work continues for even greater improvement.”

With NJHA’s support, the NJPQC provides a statewide infrastructure and sharing space for collaborative learning, data collection and benchmarking and quality improvement science support. The effort is guided by two co-chairs, Suzanne Spernal, D.N.P., R.N., vice president of women’s services at RWJBarnabas Health, and Robyn D’Oria, A.P.N., R.N., chief executive officer of the Central Jersey Family Health Consortium. The NJPQC utilizes proven standardized bundles from the Alliance for Innovation on Maternal Health (AIM).

“The bundles are built on evidence-based practices,” said Spernal in a statement. “They provide the guidance, while also educating staff and empowering mothers and families to work together for the best patient outcomes.”

NJHA is one of 27 CDC grantees leading these quality improvements at the state level. The federal commitment supports a population-based focus that is then implemented at the facility level.