CMOP Phase 1

Final CMOP Learning Session

September 13, 2017

 Thank You
Hospital Teams
Patients
State Partners
NC Vital Statistics
NC DHHS
NC Medicaid
Pregnancy Medical
Home
and many others
 The North Carolina HTN Journey
Conservative Management Of Preeclampsia
22-25 hospitals participated (45-52% of deliveries in NC)
Pilot Phase (2014)
Focused on proper diagnosis and timing of delivery
Did not include chronic HTN diagnosis
Phase 1 (2015)
Focusing on timing of delivery and time to treatment of
severe range BP
Included chronic HTN diagnoses
Phase 2/3 (2016-17)
Limited data collection to focus on timing of delivery, full
course ANS and time to treatment of severe range BP
Focused on bedside engagement, steroid administration,
sustainability and patient experience
 What We Learned

Proper BP measurement is critical and there are

many steps to take a proper BP
Multidisciplinary teams are the most effective
Patient and family engagement is essential for the
best care of patients
You have to develop systems to support the work of
providers and nurses
There is a lot of innovation in our state
We are all making North Carolina the best place to
give birth and be born
High Level Data Review
 Criteria for Severe Features with
Preeclampsia Diagnosis (CMOP Pilot phase)
1600

1400 1358

1201
1200

1000
Number of patients

800

600
519

400 352

242
199
200

21
0
All severe diagnoses Blood pressure Cerebral/visual Elevated liver Abnormal renal Thrombocytopenia Pulmonary edema
disturbance enzymes function

Patients may have more than one of these criteria.

 Hypertension diagnosis by gestational age,
race, and payer (CMOP Phase I)
Hypertension diagnosis
Chronic Superimposed Superimposed Gestational Preeclampsia Preeclampsia Total P-value
hypertension preeclampsia preeclampsia hypertension without severe with severe N (%)
N (%) without severe with severe N (%) features features
features features N (%) N (%)
N (%) N (%)

Gestational age <0.001

(weeks)
<34 62 (5) 17 (11) 161 (34) 35 (1) 33 (3) 353 (21) 661 (9)
34-36 114 (9) 39 (25) 163 (34) 189 (6) 136 (14) 574 (34) 1215 (16)
>36 1115 (86) 99 (64) 155 (32) 2722 (92) 805 (83) 778 (46) 5674 (75)
Race <0.001
White 539 (43) 65 (42) 180 (38) 1793 (63) 520 (55) 853 (51) 3950 (54)
African-American
640 (51) 74 (48) 246 (52) 835 (29) 285 (30) 588 (35) 2668 (36)
Other 85 (7) 14 (9) 51 (11) 236 (8) 142 (15) 217 (13) 745 (10)
Payer <0.001
Blue Cross Blue
Shield 373 (29) 47 (30) 128 (27) 865 (29) 304 (31) 511 (30) 2228 (30)
Medicaid 627 (49) 69 (45) 248 (52) 1242 (42) 385 (40) 756 (44) 3327 (44)
Other 248 (19) 34 (22) 77 (16) 733 (25) 234 (24) 352 (21) 1678 (22)
Uninsured 43 (3) 5 (3) 26 (5) 106 (4) 51 (5) 86 (5) 317 (4)
Two-dose ANS Administration for deliveries
< 34 weeks (CMOP)
919/1175 (78.%) patients received two doses
of ANS
by race (phase 1 and 2)
White 85.3%
African-American 72.3% (p < 0.05)
Other 77%
by delivering hospital NICU level
Level 3 and 4 NICUs (14 centers) 79.4%
Level 1 and 2 NICUs ( 11 centers) 73.2%
PQCNC Maternal Projects