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California Pregnancy-Related and Pregnancy-Associated Mortality Review (CA-PAMR)

MO-07-0132 CA-PAMR

The goal of CA-PAMR is to identify all deaths of women within one year of having a live birth or fetal death and to determine whether the death was pregnancy related, the cause of death, and what factors (such as community, patient, health care facility, and health care professional factors) contributed to the death. Analyses will result in improvement of public health programs and clinical practices in California, which will help improve maternal outcomes and reduce maternal deaths. CA-PAMR is a partnership with the University of California, San Francisco, the Public Health Institute, the California Maternal Quality Care Collaborative, and the California Department of Public Health. Funding is provided by the Federal Title V Maternal and Child Health (MCH) Block Grant Funds.

Goals

The analysis and review will identify specific maternal quality of care issues to be addressed by MCAH Program partners who provide direct care to pregnant and postpartum women.
Results will be used to develop peripartum care quality indicators in conjunction with the California Maternal Quality Care Collaborative, professional societies, healthcare providers and researchers.

Problems

Maternal mortality rates have been increasing in California (PDF)since the mid-1990s, although there are annual fluctuations.
Maternal mortality rates for California are likely to be underestimates, as they rely on maternal deaths indicated by the death certificate, which are underreported.
Maternal mortality rates in California are three times higher for African-American women (PDF)than for non-Hispanic White women.

Program Activities

Beginning with the 2002 cohort of births CA-PAMR assesses all women who died within a year of a live birth or fetal death to determine whether a death was pregnancy-related, the cause of death, and what factors (community, patient, health care facility, and health care professional) contributed to the death.
Deaths of African-American women are over-sampled due to the State MCAH Program’s concern about the continuing large racial/ethnic disparity in pregnancy-related mortality.
The CA-PAMR Advisory Committee (PDF)conducts maternal death case reviews. These OB/GYN and nursing leaders in California identify quality improvement opportunities.
CA-PAMR collaborates with the California Maternal Quality Care Collaborative (CMQCC) to identify data-driven quality improvement and educational opportunities for healthcare providers and local health departments to address and improve maternal outcomes.

The Public Health Institute (PHI) reviews and abstracts hospital and other provider medical records, codes and enters the data into an electronic format, and cleans the data.

Who Benefits

All women of childbearing age and their families, but especially pregnant and post-partum women.

Funding

Federal Title V MCH Block Grant Funds. Maternal, Child and Adolescent Health (MCAH) Program administers the California Pregnancy-Related and Pregnancy-Associated Mortality Review (CA-PAMR).