3/ second, causes of maternal death shifting...deaths due to acute pregnancy conditions (hypertension, hemorrhage) have been declining for decades
meanwhile, deaths due to chronic conditions, particularly mental health on the upswing
4/ and most shockingly...rates of death are increasing for ALL reproductive age women, not just those who are pregnant
since 2010, death rate for ALL women age 15 to 45 jumped by 14%
...for women age 25 to 34 jumped by 20% 🚨
5/ here's what these means about our approach to fixing it...
if we only focus on hospitals, we will miss a critical opportunity (probably most of the opportunity) to save mothers lives--it's equally important that we focus on our communities
6/ can be hard to wrap our minds around what investing in communities means concretely but I've long wondered...
there are many lists of best city to retire in...why no lists of best city to be born in? how can we define what this even means?
9/ finally - we can’t solve the problem of maternal deaths unless we acknowledge that women’s health isn’t something to be concerned about only during pregnancy and then disregarded after the baby is born
10/ state policies that expand Medicaid coverage for women only during pregnancy and then drop them 60 days after giving birth are exhibit A of the bigger picture problem cc: @jamie_dawncbi.nlm.nih.gov/pubmed/28373324
11/ Once we focus on the health of all reproductive-age women, we’ll see that the current concern with deaths during pregnancy was the equivalent of a canary in a coal mine warning of a much larger problem
no quarrel with any of the ideas in this publication
BIG concern with decision to formulate the consensus statement as a "bundle" rather than committee opinion, a KEY difference that risks compromising rather than bolstering improvement efforts --> THREAD
1/ among American hospitals working to improve care, it's common to see good ideas get embedded into bad tools
2/ improvement tools are never neutral, they either help or hurt
how do they hurt?
Beyond unintended consequences is the very real problem of crowd out. Hospitals have limited bandwidth to take on quality (or equity) improvement projects.