By David B. Nelson, MD, Division Chief of Maternal-Fetal Medicine, UT Southwestern Medical Center
The United States has the highest maternal mortality rate of any developed nation, and non-Hispanic Black women are three times more likely to die during and after pregnancy than white women. More than half of the pregnancy-related deaths in the United States occur in the 12 months following birth, according to the Centers for Disease Control and Prevention. Among the reasons cited are:
- Lack of access to care
- Missed or delayed diagnosis
- Failure to recognize warning signs
To address these issues, UT Southwestern Medical Center established the extending Maternal Care After Pregnancy (eMCAP) program in partnership with Parkland Health, which operates the public safety-net hospital in Dallas County.
Extending Maternal Care After Pregnancy
The eMCAP program addresses healthcare disparities and access to care for mothers who gave birth at Parkland Health, which is served by UT Southwestern physicians and has one of the highest delivery rates in the country at more than 12,000 births annually.
After childbirth, women living in the program’s target region are approached by dedicated eMCAP nurses about joining. Any patient living in the target region at the time of delivery is eligible to participate free of charge.
Women in the program with diabetes, hypertension, and other medical conditions have access to nurse home visitors as well as virtual provider visits and an in-person mobile unit van. The mobile clinic van travels to specific locations each week with an advanced practice registered nurse who provides care under dedicated physician oversight, along with a social worker and pharmacist for medication access.
The eMCAP program also utilizes patient feedback, culturally appropriate services, which include using the patient’s preferred language, linked electronic data, and features related to social determinants of health to improve outcomes.
Improved Outcomes
Since its launch in the fall of 2020, the eMCAP program has helped more than 3,000 women in southern Dallas County and demonstrated improvement in attendance at follow-up visits and in quality of postpartum care for women living in underserved areas.
Our study, published in The Joint Commission Journal on Quality and Patient Safety, compared mothers from Parkland with others living outside the target region who were provided standard-of-care referrals to primary care services between Oct. 1, 2020 and Nov. 20, 2021.
Follow-up postpartum attendance for women enrolled in eMCAP was significantly better than the control group. Patients with hypertension, for instance, were seen more often at two weeks, one month, three months, six months, nine months, and 12 months compared with those not in the program. Those with diabetes mellitus had significantly better follow-up at two weeks, one month, and three months compared with those not in the program. This resulted in improved blood sugar control.
Additionally, patients in eMCAP with abnormal mental health screenings were successfully referred for behavioral therapy and completed sessions with licensed mental health counselors.
The eMCAP program has been recognized by The Joint Commission and National Quality Forum with a 2022 John M. Eisenberg Award and by the Department of Health and Human Services (HHS) with an HHS Racial Equity in Postpartum Care Challenge award. Also, a team at UT Southwestern has been approved for an $18 million funding award from the nonprofit Patient-Centered Outcomes Research Institute (PCORI) to investigate ways to improve postpartum health among primarily low-income Black and Hispanic women.
Key Insights
eMCAP has established a model to replace the traditionally fragmented care that women typically receive after birth, and the evidence generated from this program can be readily adopted into other clinical practices and tested for implementation.
The postpartum period represents a critical opportunity to understand and improve short- and long-term health with various platforms suggested to combat the maternal health crisis, but the roles of access to care, community-based support, and electronic health management systems remain unknown. We offer our experiences from eMCAP as an opportunity for further study in other healthcare settings. The findings of improved healthcare outcomes are key measures important to improving maternal morbidity and mortality across the United States.
David B. Nelson, MD, is Associate Professor and Division Chief of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, at the University of Texas (UT) Southwestern Medical Center, Dallas. Dr. Nelson’s research focuses on cardiac function in pregnancy and the prevention of preterm birth and postpartum depression.