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Levels of Maternal Care Verification Pilot

Translating Guidance Into Practice

Zahn, Christopher M., MD; Remick, Arlene, MPH; Catalano, Andrea, MPH; Goodman, David, PhD, MPH; Kilpatrick, Sarah J., MD, PhD; Menard, M. Kathryn, MD, MPH

doi: 10.1097/AOG.0000000000002952
Contents: Health Services Research: Current Commentary

Development of systems for perinatal regionalization and for the provision of risk-appropriate maternal care is a key strategy to decrease maternal morbidity and mortality. Regionalized systems pertaining to neonatal care are broadly implemented in many states, but networks for risk-appropriate maternal care are lacking. In response to increases in maternal morbidity and mortality over the past decade, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) developed and published the levels of maternal care guidelines in 2015. The guidelines are designed to promote collaboration among maternal facilities and health care providers with the goal that pregnant women receive care at a facility appropriate for their risk. The Centers for Disease Control and Prevention (CDC) developed the Levels of Care Assessment Tool in 2013 to assist states and jurisdictions in assessing maternal and neonatal levels of care in alignment with the national guidelines published by ACOG and SMFM and the American Academy of Pediatrics, respectively. With the goal of promoting levels of maternal care, ACOG and SMFM developed and piloted the levels of maternal care verification program. Fourteen facilities across three states (Georgia, Illinois, and Wyoming) participated in the pilot. A multidisciplinary team representing organizations with expertise in maternal risk-appropriate care performed an onsite comprehensive review of the maternal services available in each facility using the results from the CDC Levels of Care Assessment Tool as a previsit screening. A verification program that could be implemented on a local, state, or regional scale is being developed leveraging the lessons learned from the pilot.

In piloting the levels of maternal care verification program, we demonstrated the ability to implement a levels of care program on a broad scale.

American College of Obstetricians and Gynecologists, Washington, DC; the Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Cedars-Sinai Medical Center, Los Angeles, California; the University of North Carolina School of Medicine, Chapel Hill, North Carolina; and the Society for Maternal-Fetal Medicine, Washington, DC.

Corresponding author: Christopher M. Zahn, MD, ACOG, 409 12th Street SW, Washington, DC 20024; email: czahn@acog.org.

Supported by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine to conduct the pilot program.

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank the Levels of Maternal Care core team members for their endless dedication to this project: Lynne Himmelreich, MPH, ARNP, CNM (American College of Nurse-Midwives); Stephen K. Hunter, MD, PhD (American College of Obstetricians and Gynecologists); Robert L. “BJ” Johnson, MD (Arizona Perinatal Trust); Hal C. Lawrence III, MD (American College of Obstetricians and Gynecologists); Haywood L. Brown, MD (American College of Obstetricians and Gynecologists); Lawrence Leeman, MD, MPH (American Academy of Family Physicians); Janet H. Muri, MBA (National Perinatal Information Center); Daniel O’Keeffe, MD (Society for Maternal-Fetal Medicine); Elizabeth Rochin, PhD, RN, NE-BC (Association of Women's Health, Obstetric and Neonatal Nurses); and Kathryn Schubert, MPP (Society for Maternal-Fetal Medicine); and the 14 hospitals in Georgia, Illinois, and Wyoming that participated in the Levels of Maternal Care pilot site visits.

The findings and conclusions in this publication are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. No competing financial interests exist.

Each author has indicated that he or she has met the journal's requirements for authorship.

Peer review history is available at http://links.lww.com/AOG/B178.

Received July 09, 2018

Received in revised form August 20, 2018

Accepted August 23, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.