MQI, the Maternal Quality Indicators Work Group, is based at Cedars-Sinai Medical Center and has been involved in the development of hospital-level indicators of safety and quality of childbirth services since 2002. Working in collaboration with colleagues at UCLA, the MQI team has partnered with the California Department of Public Health Maternal, Child and Adolescent Health Branch (CDPH MCAH), publishing numerous academic manuscripts and reports related to this work, and have participated extensively with local, state and national organizations to assist in the improvement of childbirth services. A key safety indicator that we developed was the "Ideal Birth Rate," which is a measure of the proportion of women delivering at a hospital who had no complications to the mother or newborn, which evolved into the NQF-endorsed measure of Healthy Term Infant. These measures were meant to reflect what was valuable (and interpretable) to women and their families -- good physical outcomes for both participants in the childbirth process.
As we explored the potential for the use of such indicators for public reporting, we partnered with BirthSwell, an organization devoted to using social media to improving outcomes for women and their babies, to begin surveying women to identify what was most important to them in their childbirth experiences. We also partnered with a local organization, Los Angeles Best Babies Network, which has organized over 40 agencies that work together to improve and expand perinatal care, particularly in underserved areas in Los Angeles County. What we recognized was that while hospitals and public health organizations were single-mindedly focused on maximizing obstetrical safety, women presumed that hospital childbirth was safe (i.e., safety was the reason for delivering at the hospital instead of at home), and that instead of concentrating on safety concerns, they were focused on the types of services available and how they would be treated on the labor and delivery unit.
Our preliminary work highlighted this gap between what doctors and hospitals were prioritizing and what women expected and needed to support them during childbirth. This work led us to see the necessity for a formal infrastructure to allow women's voices to be heard regarding what should be included in the childbirth experience. Our extensive experience with quality indicator development allowed us to recognize the importance of developing patient-reported outcomes and experiences (PROs) for childbirth that could fit into the current political, financial, and regulatory context of healthcare organizational performance monitoring.
In 2013, multiple stakeholders in women's health joined together to form the PRO Partnership, recognizing that women's priorities must be integrated into childbirth health services, and that achieving these priorities and maintaining a safe environment were not mutually exclusive. The PRO Partnership has created an avenue for women to express their preferences and needs as it continues to engage them on both a local basis through pregnancy and childbirth services providers and coordinators, and on a national basis through BirthSwell. Members of the PRO Partnership interact with patients on a daily basis and can verbalize their collective concerns. The PRO Partnership has also created a structure for patient and stakeholder participation in research, because as members they are involved in the research activities, and some have direct access to diverse patient populations who can participate in focus groups or surveys.
In 2016, Maternal Metrics was formed to enable hospitals to collect and use PRO data. In contrast to routine data collection processes used by longstanding clinical learning collaboratives, PRO data collection requires the development of survey instruments and processes by which they are administered to patients. The vision of Maternal Metrics is to assist hospitals, optimally through PRO learning collaboratives, in the collection, analysis, and interpretation of childbirth-specific PRO data.