Borders Ann, Keenan-Devlin Lauren, Oh Elissa H, Young Danielle, Grobman William, Lee King Patricia
NorthShore University HealthSystem, Evanston, IL; Pritzker School of Medicine, University of Chicago, Chicago, IL; Feinberg School of Medicine, Northwestern University, Chicago, IL.
NorthShore University HealthSystem, Evanston, IL.
Am J Obstet Gynecol. 2025 Jan;232(1):128.e1-128.e9. doi: 10.1016/j.ajog.2024.04.026. Epub 2024 Apr 30.
Hypertensive disorders of pregnancy are a leading preventable cause of severe maternal morbidity and maternal mortality worldwide.
To assess the improvement in hospital care processes and patient outcomes associated with hypertensive disorders of pregnancy after introduction of a statewide Severe Maternal Hypertension Quality Improvement Initiative.
A prospective cohort design comparing outcomes before and after introduction of the Illinois Perinatal Quality Collaborative statewide hypertension quality improvement initiative among 108 hospitals across Illinois. Participating hospitals recorded data for all cases of new-onset severe hypertension (>160 mm Hg systolic or >110 mm Hg diastolic) during pregnancy through 6 weeks postpartum from May 2016 to December 2017. Introduction of the statewide quality improvement initiative included implementation of severe maternal hypertension protocols, standardized patient education and discharge planning, rapid access to medications and standardized treatment order sets, and provider and nurse education. The main outcome measure was the reduction of severe maternal morbidity for pregnant/postpartum patients with severe hypertension. Key process measures include time to treatment of severe hypertension, frequency of provider/nurse debriefs, appropriate patient education, and early postpartum follow-up.
Data were reported for 8073 cases of severe maternal hypertension. The frequency of patients with new-onset severe hypertension treated within 60 minutes increased from 41% baseline to 87% (P<.001) at the end of the initiative. The initiative was associated with increased proportion of patients receiving preeclampsia education at discharge (41% to 89%; P<.001), scheduling follow-up appointments within 10 days of discharge (68% to 83%; P<.001), and having a care team debrief after severe hypertension was diagnosed (17% to 59%; P<.001). Conversely, severe maternal morbidity was reduced from 11.5% baseline to 8.4% (P<.002) at the end of the study period. Illinois hospitals have achieved time to treatment goal regardless of hospital characteristics including geography, birth volume, and patient mix.
Introduction of a statewide quality improvement effort was associated with improved time to treatment of severe hypertension and increased frequency of provider/nurse debriefs, appropriate patient education, and early postpartum follow-up scheduled at discharge, and reduced severe maternal morbidity.
妊娠期高血压疾病是全球范围内导致严重孕产妇发病和死亡的主要可预防原因。
评估在全州范围内实施严重孕产妇高血压质量改进计划后，与妊娠期高血压疾病相关的医院护理流程和患者结局的改善情况。
一项前瞻性队列研究，比较伊利诺伊州108家医院在全州范围内实施伊利诺伊围产期质量协作高血压质量改进计划前后的结局。参与研究的医院记录了2016年5月至2017年12月期间所有妊娠期新发严重高血压（收缩压>160mmHg或舒张压>110mmHg）病例直至产后6周的数据。全州质量改进计划的实施包括实施严重孕产妇高血压诊疗方案、标准化患者教育和出院计划、快速获取药物和标准化治疗医嘱集，以及对医护人员进行教育。主要结局指标是患有严重高血压的妊娠/产后患者严重孕产妇发病率的降低。关键流程指标包括严重高血压的治疗时间、医护人员汇报频率、适当的患者教育以及产后早期随访。
报告了8073例严重孕产妇高血压病例的数据。在计划结束时，60分钟内接受治疗的新发严重高血压患者比例从基线时的41%增至87%（P<0.001）。该计划与出院时接受子痫前期教育的患者比例增加（从41%增至89%；P<0.001）、出院后10天内安排随访预约（从68%增至83%；P<0.001）以及在诊断严重高血压后进行护理团队汇报（从17%增至59%；P<0.001）相关。相反，在研究期结束时，严重孕产妇发病率从基线时的11.5%降至8.4%（P<0.002）。伊利诺伊州的医院无论地理位置、分娩量和患者构成等医院特征如何，均实现了治疗时间目标。
全州范围内质量改进工作的开展与严重高血压治疗时间的改善、医护人员汇报频率增加、适当的患者教育以及出院时安排产后早期随访相关，并降低了严重孕产妇发病率。
