Garland Caitlin E, Craemer Katherine A, Koch Abigail R, Locher Stephen, Geller Stacie E
Center for Research on Women and Gender (Mss Garland and Craemer and Drs Koch and Geller), Department of Obstetrics and Gynecology (Drs Locher and Geller), and Department of Medicine (Dr Geller), College of Medicine, University of Illinois Chicago, Chicago, Illinois.
J Public Health Manag Pract. 2023;29(3):361-368. doi: 10.1097/PHH.0000000000001717. Epub 2023 Mar 2.
To compare results from facility-level and state-level severe maternal morbidity (SMM) reviews in Illinois.
We report descriptive characteristics about SMM cases and compare the results of both review processes, including the primary cause, assessment of preventability, and factors that contributed to the severity of the SMM cases.
All birthing hospitals in Illinois.
A total of 81 SMM cases were reviewed by a facility-level committee and the state-level review committee. SMM was defined as any intensive care or critical care unit admission and/or transfusion of 4 or more units of packed red blood cells from conception to 42 days postpartum.
Among the cases reviewed by both committees, hemorrhage was the primary cause of morbidity, with 26 (32.1%) and 38 (46.9%) hemorrhage cases identified by the facility-level and state-level committees, respectively. Both committees identified infection/sepsis (n = 12) and preeclampsia/eclampsia (n = 12) as the next most common causes of SMM. State-level review found more cases potentially preventable (n = 29, 35.8% vs n = 18, 22.2%) and more cases not preventable but improvement in care needed (n = 31, 38.3% vs n = 27, 33.3%). State-level review found more provider and system opportunities to alter the SMM outcome and fewer patient opportunities than facility-level review.
State-level review found more SMM cases potentially preventable and identified more opportunities to improve care than facility-level review. State-level review has the potential to strengthen facility-level reviews by identifying opportunities to improve the review process and develop recommendations and tools to aid facility-level reviews.
比较伊利诺伊州医疗机构层面和州层面严重孕产妇发病情况（SMM）审查的结果。
我们报告SMM病例的描述性特征，并比较两个审查过程的结果，包括主要原因、可预防性评估以及导致SMM病例严重程度的因素。
伊利诺伊州所有的分娩医院。
一个医疗机构层面的委员会和州层面的审查委员会共审查了81例SMM病例。SMM被定义为从受孕到产后42天内任何入住重症监护或危重症监护病房和/或输注4个或更多单位浓缩红细胞的情况。
在两个委员会审查的病例中，出血是发病的主要原因，医疗机构层面的委员会和州层面的委员会分别确定了26例（32.1%）和38例（46.9%）出血病例。两个委员会都将感染/败血症（n = 12）和先兆子痫/子痫（n = 12）确定为SMM的第二大常见原因。州层面的审查发现更多可能可预防的病例（n = 29，35.8%对n = 18，22.2%）以及更多不可预防但需要改善护理的病例（n = 31，38.3%对n = 27，33.3%）。与医疗机构层面的审查相比，州层面的审查发现更多可改变SMM结果的医疗服务提供者和系统机会，而患者机会更少。
与医疗机构层面的审查相比，州层面的审查发现更多可能可预防的SMM病例，并确定了更多改善护理的机会。州层面的审查有可能通过识别改进审查过程的机会以及制定建议和工具来协助医疗机构层面的审查，从而加强医疗机构层面的审查。
