OBJECTIVE: Maternal Mortality Review Committees (MMRCs) are a key national strategy to improve maternal outcomes in the United States, and most US states and territories currently have a functioning MMRC.1 MMRCs are expected to contribute to reducing maternal mortality by generating data on the causes of maternal death, developing recommendations to prevent maternal deaths, and disseminating their findings to labor and delivery staff and policymakers to support the implementation of their recommendations.2, 3, 4 Limited dissemination and awareness of MMRC findings may lessen the influence of MMRCs. When the Centers for Disease Control and Prevention assessed the performance of 25 MMRCs, only half of MMRCs performed dissemination activities.1 This study aimed to assess labor and delivery staff's awareness of findings from the MMRC in Arkansas and their recommended dissemination strategies.
STUDY DESIGN: Between September 2023 and October 2023, the Arkansas Perinatal Quality Collaborative conducted a survey of labor and delivery staff at 28 hospitals (75% of all birthing hospitals) participating in its initiative to reduce primary cesarean deliveries. The Web-based survey was administered through Qualtrics, and participating hospitals distributed an anonymous link to labor unit staff. Of note, 1 survey module asked respondents to report their awareness of MMRC findings on the causes and preventability of maternal deaths in Arkansas and how they accessed MMRC information. In addition, respondents were asked to select the 3 dissemination strategies, from a list of 9, that they considered to be most effective at reaching labor and delivery staff. The proportions of participants who selected each response were calculated, and differences in proportions by clinical role were assessed using the chi-square test in Stata (version 17; StataCorp, College Station, TX). The survey was determined to be exempt by the institutional review board of the University of Arkansas for Medical Sciences (approval number: 275868). All respondents consented to participate.
RESULTS: Participating hospitals distributed the survey to 1283 total labor and delivery staff, of which 441 provided complete responses (34.4%; see Table). Participation rates were the highest for family medicine physicians (8/21 [38.1%]) and the lowest for obstetricians (45/193 [23.3%]). Awareness of MMRC findings overall was 27%, but significantly higher for delivering physicians (67%) than other roles. Overall participation in dissemination activities was low, with 10.9% of respondents accessing an MMRC report and 7.3% attending a presentation of MMRC findings.
Table.
Labor and delivery staff's awareness of MMRC findings and recommended dissemination strategies
| Results by clinical role |
||||||
|---|---|---|---|---|---|---|
| Variable | Overall results | Delivering physiciana | Labor nurse or midwifeb | Anesthesiologist | Otherc | P valued |
| No. of respondents | 441 | 53 | 302 | 21 | 65 | – |
| Awareness of MMRC findings | ||||||
| Aware of MMRC findings | 119 (27.0) | 26 (67.9) | 71 (23.5) | 5 (23.8) | 17 (26.2) | .003 |
| Previously accessed Arkansas MMRC report | 48 (10.9) | 10 (18.9) | 29 (9.6) | 3 (14.3) | 6 (9.2) | .219 |
| Previously attended a presentation on Arkansas MMRC findings | 32 (7.3) | 6 (11.3) | 18 (6.0) | 1 (4.8) | 7 (10.8) | .329 |
| Dissemination strategies perceived as most effective | ||||||
| Posters for the hospital or unit bulletin board | 206 (46.7) | 18 (34.0) | 150 (49.7) | 6 (28.6) | 32 (49.2) | .058 |
| Short videos posted online | 196 (44.4) | 28 (52.8) | 133 (44.0) | 9 (42.9) | 26 (40.0) | .558 |
| Free recorded trainings available online | 194 (44.0) | 28 (52.8) | 137 (45.4) | 3 (14.3) | 26 (40.0) | .020 |
| E-mails from the state chapters of professional associations (ACOG, AWHONN, etc.) | 160 (36.3) | 28 (52.8) | 98 (32.4) | 10 (47.6) | 24 (36.9) | .025 |
| Infographics posted on social media | 136 (30.8) | 12 (22.6) | 97 (32.1) | 11 (52.4) | 16 (24.6) | .054 |
| Journal articles | 123 (27.9) | 24 (45.3) | 73 (24.2) | 7 (33.3) | 19 (29.2) | .015 |
| Public-facing maternal health dashboard | 103 (23.4) | 8 (15.1) | 71 (23.5) | 4 (19.0) | 20 (30.8) | .237 |
| Annual online webinar or town hall | 95 (21.5) | 8 (15.1) | 65 (21.5) | 5 (23.8) | 17 (26.2) | .535 |
| News stories in local media | 80 (18.1) | 5 (9.4) | 52 (17.2) | 8 (38.1) | 15 (23.1) | .023 |
Data are presented as number (percentage), unless otherwise indicated.
ACOG, American College of Obstetricians and Gynecologists; AWHONN, Association of Women's Health, Obstetric and Neonatal Nurses; MMRC, Maternal Mortality Review Committee.
Delivering physicians included obstetrician-gynecologists (n=45) and family physicians (n=8)
Certified nurse-midwives represented 4 survey respondents (0.91%)
Positions of respondents in the “other” category included obstetrical and surgical technologist (n=25), other nursing staff (antenatal or prenatal nurse, advanced practice registered nurse, nurse practitioner, certified lactation counselor or licensed practical nurse lactation, neonatal intensive care unit or nursery nurse, labor educator, and postpartum or transition nurse [n=21]), administrator (nursing director, nurse manager, chief nursing officer, director, director of medical staff, director of nursing, and chief medical officer [n=7]), and pediatrician (n=2)
P values calculated using chi-square tests.
Callaghan-Koru. Dissemination strategies for state Maternal Mortality Review Committee findings. Am J Obstet Gynecol Glob Rep 2024.
Several dissemination strategies were frequently selected as effective by both delivering physicians and nurses, including free recorded online trainings (52.8% of physicians and 45.4% of nurses) and short online videos (52.8% of physicians and 44.0% of nurses). Nurses were more likely than physicians to select posters for the hospital or unit bulletin board (49.7%), whereas delivering physicians were more likely than nurses to select e-mails from the state chapters of professional associations (52.8%) and journal articles (45.3%).
CONCLUSION: Less than 1 in 3 labor and delivery staff reported awareness of the findings of the Arkansas MMRC. The first report of the Arkansas MMRC was published in 2021, and dissemination efforts have primarily focused on online publishing of reports and presentations by committee members. Current dissemination strategies seem to be more effective at reaching physicians than other clinical roles. These results may not be generalizable to other states, and awareness of MMRC findings may be lower in states with no dissemination activities. State MMRCs should evaluate the effectiveness of their dissemination strategies and consider various strategies to improve awareness among labor and delivery staff.
CRediT authorship contribution statement
Jennifer Callaghan-Koru: Conceptualization, Funding acquisition, Investigation, Methodology, Project administration, Writing – original draft, Writing – review & editing, Supervision. Tanvangi Tiwari: Data curation, Formal analysis, Writing – review & editing. Dawn Brown: Methodology, Writing – review & editing. Nirvana Manning: Methodology, Writing – review & editing. William Greenfield: Conceptualization, Investigation, Methodology, Writing – review & editing.
Footnotes
The authors report no conflict of interest.
Patient consent is not required because no personal information or detail is included.
This study was supported by grants to the University of Arkansas for Medical Sciences from the Centers for Disease Control and Prevention (CDC; grant number: NU58DP007253) and the Health Resources and Services Administration (HRSA; grant number: U7A46847). The contents are those of the authors and do not necessarily represent the official views of or an endorsement by the CDC, the HRSA, the US Department of Health and Human Services, or the US government. For more information, please visit HRSA.gov.
Supplementary material associated with this article can be found in the online version at doi:10.1016/j.xagr.2023.100306.
Appendix. Supplementary materials
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