3 Ways CMOs Can Improve Maternal Care

The United States has the highest maternal mortality rate among high-income countries.

For chief medical officers seeking to boost maternal care, a top priority should be care coordination between the inpatient and outpatient settings, the CMO of Ob Hospitalist Group says.

The United States has the highest maternal mortality rate among high-income countries, according to statistics from the National Center for Health Statistics and the Organization for Economic Co-operation and Development. U.S. maternal mortality rates have been rising, with the rate pegged at 32.9 deaths per 100,000 live births in 2021, compared with a rate of 23.8 in 2020 and 20.1 in 2019, according to the Centers for Disease Control and Prevention.

CMOs should be focused on care coordination to achieve good maternal health outcomes, says Mark Simon, MD, CMO at Greenville, South Carolina-based Ob Hospitalist Group.

"Chief medical officers should focus on the continuum of obstetrical care from conception into the postpartum period," he says. "Especially at health systems, CMOs should be focused on how the outpatient setting is connecting to the inpatient experience that the patient has as well as care in the outpatient setting after the patient leaves the hospital. CMOs need to focus on how the outpatient setting and the inpatient setting are working together to ensure that the care is consistent across those locations. Good maternal care is about ensuring that connections are happening in the outpatient and inpatient settings, and those connections are happening consistently across a health system."

Good communication between care teams in the inpatient and outpatient settings is crucial, Simon says.

"Even if there is not a true admission, does the information that is gathered in the hospital setting such as an emergency room visit or an OB triage visit connect to the outpatient setting, where the patient is going to follow-up?" he says. "Is there a process by which that patient can have follow-up in a timely manner for whatever condition was seen in the hospital? Good communication is also required when patients are seen in the outpatient setting. Does the information that the patient has created during their visits in the prenatal experience get to the hospital? Does the physician and the team that is going to take care of the patient in the hospital know what has happened in the pregnancy before hospital admission? They should not be starting with a 'blank canvas.'"

In the hospital setting, care providers need to know where their patients are coming from and have relationships with community-based care providers, Simon says.

"Most patients we see at Ob Hospitalist Group have prenatal care to some extent," he says. "So, you must build relationships with the people providing the care, whether it is community physicians who are obstetricians, or it is midwives in the community. If hospitalists do not have relationships with these other care providers, it can create a very difficult situation."

Evidence-based care

CMOs should be involved in ensuring that maternal health patients receive evidence-based care, Simon says.

"There is evidence on clinical pathways and protocols that should be followed and adhered to," he says. "There are protocols on conditions that affect pregnancy. The key is to make sure those best practices are implemented in your clinical settings, whether they are outpatient settings or inpatient settings. With best practices, you need to implement them, you need to measure them, you need to analyze the data to see how you are performing, and you need to implement changes if things are not going as well as you want them to."

Simon says two key protocols in maternal health are a patient care bundle on hemorrhage and the management of hemorrhage in pregnancy as well as a protocol for hypertensive pregnancies. "Making sure patients are on the path with these protocols is the right thing to do because they can prevent poor outcomes," he says.

There are several maternal health metrics that CMOs should ensure are followed at health systems, hospitals, and outpatient clinics, Simon says.

• Mode of delivery such as C-section rate
   
• Hemorrhage metrics such as blood product use
   
• Hypertensive management such as how quickly anti-hypertensive medications are given to a patient after an abnormal blood pressure reading
   
• How quickly patients receive follow-up care for adverse conditions
   
• Screening for mental health disorders such as postpartum depression

Addressing workforce shortages

CMOs are well-positioned to address workforce shortages in maternal care such as a dearth of physician obstetricians, Simon says.

"What a CMO should be doing is thinking about how they are utilizing their obstetrical clinicians to the best of their ability," he says. "The CMO should be thinking about how they can have their physician obstetricians doing top-of-license work such as caring for high-risk patients and doing C-sections. These physicians should be involved in care pathways that require the highest level of medical support for patients. Then the CMO should be thinking about how they can supplement physician obstetricians with other clinicians such as certified nurse midwives and women's health nurse practitioners, who can manage the low- and moderate-risk patients."

CMOs should work on team building in maternal care, Simon says.

"If you think in siloes, with separate obstetrician practices and separate midwife practices, you will run out of clinicians," he says. "CMOs need to re-think how we do obstetrical care in this country. Most prenatal care does not need a physician obstetrician. Most prenatal care is relatively low risk or moderate risk, which is well-suited to the skill sets of certified nurse midwives or women's health nurse practitioners. CMOs should want physicians seeing high-risk patients or working in the hospital setting."