HJBR Jul/Aug 2021

HEALTHCARE JOURNAL OF BATON ROUGE I  JUL / AUG 2021 35 complexity and acuity of their medical is- sues. As it stands now, Louisiana’s levels of maternal care are not consistent with na- tional recommendations. The bureau and the Louisiana Department of Health has made recommendations to update our cur- rent system of care, but we will need to con- tinue to work with communities, providers and hospital organizations to make lasting change. We must be honest about the care we can provide to make sure mothers get the care they need. While maternal and infant outcomes in Louisiana traditionally have been poor compared to the other states, the tides are changing. Through the Bureau of Family Health, we have already seen that change is achievable, and the LaPQC has demonstrat- ed that quality improvement programs are making a difference in the lives of mothers, infants and children. There is much work to do, but we are hopeful that in the future, every mother in Louisiana can experience a safe, equitable birth that allows every fam- ily, regardless of their race or their back- ground, able to reach their full potential. n REFERENCES 1 2020 March of Dimes Report Card. March of Dimes. https://www.marchofdimes . org/peristats/tools/reportcard.aspx? frmodrc=1&reg=22. Retrieved June 13, 2021. 2 Wallace, M., Dyer, L., Felker-Kantor, E., Ben- no, J., Vilda, D., Harville, E., & Theall, K. (2021). Maternity Care Deserts and Pregnancy-Asso- ciated Mortality in Louisiana. Women’s Health Issues: official publication of the Jacobs In- stitute of Women’s Health, 31(2), 122–129. https://doi.org/10.1016/j.whi.2020.09.004 Veronica Gillispie-Bell,MD, is a board-certified obste- trician and gynecologist and associate professor for Ochsner Health in New Orleans. She serves as the senior site ead and section head ofWomen’s Services at Ochsner Health Center - Kenner. Additionally, she serves as the director of quality forWomen’s Services for Ochsner Health System.In addition,Gillispie-Bell is the medical director of the Louisiana Perinatal Quali- ty Collaborative and Pregnancy Associated Mortality Review for the Louisiana Department of Health. In this role, she leads initiatives in the state of Louisiana to improve birth outcomes for all birthing persons in Louisiana and eliminate the Black-white disparity gap. members. An additional program, known as Louisiana Maternal Infant Early Child- hood Home Visiting Family Support and Coaching Program addresses some of the antenatal drivers of maternal mortality as identified by PAMR. This no-cost voluntary program implements two national models — Nurse-Family Partnership and Parents as Teachers — serving clients that are eligible for Medicaid, WIC, TANF or SSI at enroll- ment. The program improves the health and well-being of pregnant women and parent- ing families with young children. Families are paired with registered nurses or parent educators who provide personalized edu- cation, guidance and referrals to services to empower families to reach their goals. As we look at the drivers of maternal and infant morbidity and mortality, we know that providing patient-centered care will be critical going forward. Through the preg- nancy and after the birth occurs, birthing fa- cilities must be ready with evidence-based practices to address the leading causes of maternal morbidity and mortality. To en- sure that children not only live but thrive, the first year is crucial for identifying med- ical and genetic disorders and matching children with services for support. The Bureau of Family Health is key to all aspects in the continuum of care, but our work is not the only solution. Ongo- ing policy work, including in the Louisiana Legislature, will be needed to ensure pro- grams such as PAMR and the LaPQC are mandated and receive continued funding. Mothers with Medicaid need our support to ensure they have insurance coverage up to one year postpartum, because having insurance coverage to facilitate access to the healthcare system can reduce all causes of maternal mortality.2 Additional support will also be needed to ensure systems are in place that provide pregnant women with the appropriate level of care based on the view of causes that will greatly improve our approach to prevention. Launched in August 2018, the Louisiana Perinatal Quality Collaborative is an ini- tiative dedicated to improving maternal outcomes in Louisiana. Since its launch, LaPQC has worked constantly to expand our network of care providers, public health professionals and patient and community advocates who work not only to improve maternal outcomes by using quality im- provement, but also to advance and achieve equity. The two key areas for improvement we identified through the 2011-2016 review were hemorrhage and hypertension, which were the two leading clinical causes of ma- ternal mortality. Reducing severe maternal morbidity from hemorrhage and hyperten- sion as well as reducing the disparity gap in Black-white outcomes was the goal of the first initiative of the LaPQC. Specifically, the Reducing Maternal Mor- bidity Initiative aimed to reduce severe maternal morbidity among those individ- uals who experience a hemorrhage and/ or hypertension by 20% by May 2020 and to reduce the Black-white disparity gap. Through the efforts of the LaPQC from August 2018 to May 2020, severe maternal morbidity among hypertension decreased by 11.6%, and severe maternal morbidity among hemorrhage decreased by 35%. For Black individuals, the severe maternal mor- bidity among hemorrhage decreased by 49%. There was a slight increase in severe maternal morbidity among hypertension in Black individuals at 8.1%. While there was improvement in SMM among individuals with hypertension, the improvement was not as high as expected. This is thought to have been due to effects of the pandemic. The LaPQC primarily works with birth- ing facilities: there are now 42 facilities participating with 92% of births in Loui- siana now occurring in LaPQC-affiliated Veronica Gillispie-Bell, MD Medical Director of the Louisiana Perinatal Quality Collaborative and Pregnancy Associated Mortality Review Louisiana Department of Health