The federal Well being Sources and Companies Administration funds state-level work to deal with excessive ranges of maternal mortality in the US and to scale back disparities in maternal and delivery outcomes. In Maryland, Andreea Creanga, M.D., Ph.D., chair of the Division of Epidemiology and Public Well being on the College of Maryland College of Medication, leads the Maryland Maternal Well being Innovation Program (MDMOM), a $15.8 million HRSA-funded program that drives innovation in knowledge assortment, high quality enchancment, workforce improvement, and group engagement throughout the 32 birthing hospitals in Maryland. She lately spoke with Healthcare Innovation about her workforce’s work.
Creanga’s workforce works to develop, implement and consider statewide initiatives aiming to get rid of preventable maternal deaths and extreme maternal morbidity within the state of Maryland.
Nationally, Creanga serves as principal investigator of the Maternal Well being Information Innovation and Coordination Hub, a nationwide useful resource that helps 12 NIH-funded Maternal Well being Analysis Facilities of Excellence.
Healthcare Innovation: I hoped you can set the stage by speaking in regards to the scope of the issue of moms dying of preventable causes in Maryland and the racial disparities concerned.
Creanga: Maternal mortality has been rising in the US. Throughout the nation, we have now seen a marked improve in maternal deaths because the early 2000s. We will debate whether or not we’re doing a greater job detecting maternal deaths, as a result of we have now made a few adjustments on the demise certificates. We have now a being pregnant checkbox that may be checked if the deceased was pregnant or postpartum. With that, we expect we’re capturing extra of the maternal deaths, however most likely nonetheless not all.
We additionally know nationwide and in Maryland, we have now notable disparities in each maternal mortality and likewise different hostile occasions in maternal well being and hostile being pregnant outcomes. We all know that the disparities have continued over the previous 30 years. That is essential. The excellent news is that in Maryland and nationwide as effectively, about 80% of maternal deaths have been proven to be preventable. Well being system and group components play a task. We all know what’s working in maternal well being. We all know which interventions are life-saving.
However the metaphor we all the time use in maternal well being is that that is simply the tip of the iceberg. Beneath that’s extreme maternal morbidity. These are close to misses — ladies who virtually died however survived the complication of being pregnant on account of interventions in hospitals or by way of the well being system, or interventions in communities or by sufferers themselves. We have now most likely between 50 and 60 occasions extra extreme maternal morbidity occasions than we have now maternal deaths. That is why we need to research them in tandem.
HCI: What’s the Maryland Maternal Well being Activity Power and what’s its relationship to your MDMOM program?
Creanga: The MDMOM program is definitely the Maryland Maternal Well being Innovation Program. We’re one of many 42 states and the District of Columbia funded for one of these work by HRSA. Our focus is statewide. We really began this work by establishing a Maternal Well being Activity Power within the state. We carry collectively colleagues from hospitals, group members, community-based organizations, skilled organizations, and well being businesses. We meet quarterly with the duty pressure, and we have now already put collectively two strategic plans for the state. The newest one was executed in September 2025 for the subsequent 5 years.
We at the moment are working in the direction of delivering on the ways and interventions which were proposed in within the strategic plan.
HCI: Is there any type of networking that takes place among the many state-level teams themselves to share greatest practices or classes discovered?
Creanga: Positively. HRSA brings us collectively a few occasions per 12 months. We do have a little bit of a useful resource hub that interacts with all of the states, they usually present assets throughout this system for the entire states.
HCI: You talked about earlier than that when it comes to interventions, we all know what works to decrease maternal mortality. So if we seemed throughout the applications throughout the nation, would they be doing fairly comparable issues, or are there individuals making an attempt to assume exterior the field on issues that possibly do not have proof for them but, however they’re making an attempt to reveal a brand new type of intervention?
Creanga: So by and huge, we all know what works, and we have now the skilled organizations which have proposed affected person security bundles. All kinds of collaboratives throughout the hospitals work to deal with sure key causes of maternal mortality and morbidity. However that is known as the Maternal Well being Innovation Program, in order a part of the proposal, the appliance really needed to embody improvements. They may very well be improvements in how we gather knowledge, how we take a look at knowledge, how we evaluation data, or particular applications which might be revolutionary, like telehealth initiatives.
HCI: May you speak in regards to the hospital initiative and the way it works to enhance methods of care in Maryland hospitals? Do you get participation from all or a lot of the birthing hospitals within the state?
Creanga: To begin with, we began with a surveillance program. Surveillance is simply monitoring of extreme maternal morbidity occasions to determine all of them, making an attempt to gather and evaluation the info in the identical manner throughout the hospitals.
We began with a pilot of six hospitals again in July 2020 and now we do have all of the hospitals taking part on this surveillance system. In Maryland, we have been capable of advocate for and cross laws in 2025 to carry all of the hospitals to this undertaking. We have now 32 birthing hospitals within the state. We had 27 of them voluntarily taking part. We had 5 extra that we needed to one way or the other push. The laws did the trick. For the primary time, we have been capable of submit a statewide report back to the governor’s workplace in December 2025 and that was actually well-received by all of our companions.
HCI: Are there applications that go into the hospitals to deal with issues like bias coaching?
Creanga: Sure, with the primary grant that we had from HRSA, we have been capable of provide implicit bias trainings to suppliers. On the time there was just one coaching that was devoted to perinatal well being suppliers within the nation. It was developed by the March of Dimes. So we really bought licenses for that have been capable of prepare about 4,000 perinatal well being suppliers within the state of Maryland with that coaching. Constructing on that, we developed our personal supplies and skill-building workouts and movies about learn how to speak to your sufferers and the way to not speak to your sufferers.
We reached plenty of perinatal well being suppliers and to create consciousness round implicit bias, as a result of that is step one.
HCI: May you speak about your telehealth initiative round extreme hypertension in being pregnant?
Creanga: We began in Might 2022 with making an attempt to supply knowledgeable maternal medication recommendation help from College of Maryland Medical Heart to the lower-level hospitals that have been a part of the College of Maryland Medical System. Our suppliers right here at College of Maryland Medical Heart have been credentialed to supply telehealth help, knowledgeable recommendation to their sister hospitals within the system.
Then the Maryland Perinatal Neonatal High quality Collaborative determined to implement statewide the extreme hypertension bundle from ACOG [American College of Obstetricians and Gynecologists]. Due to that, we noticed a possibility to help them, and we began the second a part of the telehealth initiative, which is distribution of free blood stress cuffs with Bluetooth to allow them to be built-in into the EHR. The concept was to place one of these system into the palms of sufferers, in order that they’ll test their blood stress at dwelling, and alert their suppliers if there are irregular blood stress readings. And we hope that this initiative is definitely going to enhance the follow-up, and sufferers are going to be seen sooner. We’re at the moment distributing between 13 and 15 blood stress cuffs per day. We work with 29 of the 32 hospitals for this initiative, and that is as a result of the opposite three hospitals produce other technique of offering the blood stress cuffs to their sufferers.
We evaluated this system within the fall of 2025 and we at the moment are analyzing the info. We talked to all of the hospitals which might be a part of the initiative, and we have discovered fairly a bit from them, as a result of each single one in every of them did issues differently. So we’re studying what labored greatest for them, after which making an attempt to share the learnings throughout the initiative.
HCI: I learn that your group created a Maryland Maternal Well being Sources Map. What sort of assets are on the map and the way would households use it?
Creanga: We’re very happy with it. This was a spot recognized by the duty pressure initially, and we have been requested to help the event of the map.
We began very small. We initially thought that we’d simply be concerned with hospital-based or clinic-based providers. Then we realized that the wants are better, so we began to take a look at social providers — schooling, birthing lessons, issues like that. Then we found the 211 useful resource. For those who go to mdmomresources.org, you’ll be able to see the classes that we have now, beginning with reproductive well being providers, maternal well being providers, postpartum providers, and likewise social providers. We have now all the things organized round 28 classes of providers, and all collectively, we have now greater than 2,600 providers out there. I do not assume our moms, our sufferers, really know what number of providers can be found to them and the place to search out them. With a map, you really are capable of determine these assets in your group, very near your own home, very near the hospital the place you are going to give delivery, in order that you’ll be able to get the helps that you simply want.
It is also device for suppliers, as a result of many occasions sufferers ask suppliers the place ought to I am going for that? And suppliers didn’t have a repository previously, so now they’re utilizing the map themselves.
