Supplement: The Kentucky Severe Maternal Morbidity and Mortality Task Force

ABSTRACT Background: Kentucky has one of the highest maternal mortality rates in the country. Data from the Kentucky Maternal Mortality Review Committee has documented substance use, injury, and behavioral health conditions as common contributing factors. Severe maternal morbidities have also been studied in Kentucky and these outcomes are associated with health care disparities present in the state with rural subpopulations and people of color differentially affected. Methods: An inclusive network of hospitals, providers, community partners, and state governmental agency supporters, the KY Maternal Morbidity and Mortality Task Force will implement and promote further adoption of safety bundles created by the Alliance for Innovation on Maternal Health (AIM) in collaboration with the Kentucky Perinatal Quality Collaborative (KyPQC). We will: (1) coordinate with state agencies to create a maternal scorecard for severe maternal morbidities as documented from hospital discharge ICD-10 codes and track changes in the frequency of these outcomes which may result from adoption of these evidence-based strategies; (2) create a data surveillance system to monitor maternal morbidity and mortality due to violence, substance use or accidental ‘overdose’, and suicide attempts; (3) plan to bring high- fidelity simulation exercises to smaller hospitals and provide resources for instruction of pregnancy-related complications; (4) use novel, bystander-informed, violence intervention and prevention programming, adapted for obstetric healthcare providers, to address maternal health related to violence; and finally, (5) further promote engagement and outreach to birthing facilities through augmentation of telehealth services. Results/Measures: We will measure outcomes for severe maternal morbidity and define metrics for implementation of particular AIM bundles across a growing network of birthing hospitals in our state connected with the KyPQC. We plan to interrogate robust datasets which address adverse outcomes in pregnancy including violence against pregnant women and further extend surveillance to those postpartum. We plan to evaluate the implementation of electronically delivered, violence intervention and prevention training modules statewide and the efficacy of this training to reduce the impacts of violence, substance use, and depression or anxiety. We will coordinate with the KyPQC further role out of the substance use bundle beyond screening. Goals: Our goals are to observe uptake and benefit from educational programming to bring more AIM initiatives to hospitals across the state. We will measure severe maternal morbidities and track changes in these outcomes as we implement evidence-based quality programming. We also plan to observe engagement in our modules addressing violence, substance use, and depression or anxiety. Finally, we hope to observe reductions in maternal morbidity and mortality through a comprehensive project involving multiple engaged stakeholders.