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    Maryland Department of Health
    Maternal and Child Health

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    The Maryland Perinatal-Neonatal Quality Collaborative

    Since 2003, the Maryland Perinatal Neonatal Quality Collaborative (PNQC), a statewide network of birthing hospitals, perinatal providers, public health professionals have worked together to make Maryland the safest place to have a baby. Through continuous quality improvement, the Collaborative works to improve outcomes for newborns and pregnant individuals.

    To learn more about the Maryland Perinatal-Neonatal Quality Collaborative, please visit: https://www.mdpqc.org


    Timeline of the Maryland Perinatal-Neonatal Quality Collaborative


    2003Maryland Department of Health start the Maryland Perinatal Neonatal Quality Collaborative (PNQC)
    2006Maryland Patient Safety Center (PSC) begins overseeing the PNQC with funding from the then Department of Health and Mental Hygiene.
    2007PNQNC provides education in its initial change package which included:
    1. Improving teamwork and communication through TeamSTEPPSⓇ education
    2. Obstetric emergency drills education
    3. Safe use of Pitocin
    2009Grant received from CareFirst Blue Cross Blue Shield to improve neonatal adverse outcomes index with focus on interventions during “Golden Hour” (i.e,. first hour of life) for infants with birth weight less than 1500 grams.
    • Initiative results in statistically significant decrease in neonatal adverse outcomes index (p-value=0.033) during a follow up period from 2007-2010.
    2009Began “Reduce Early Elective Deliveries” at < 39 weeks gestational age without medical indications Quality Initiative
    • Collaborative ends in December 2013 with a 94% reduction in rate of early C-section deliveries in 2009 (10.4% to 0.6%) and 95% reduction in early elective inductions (2% to 0.2%)
    • Maryland becomes first state to have all birthing hospitals recognized by March of Dimes to reduce Early Elective Deliveries to less than 5%
    2014Multidisciplinary clinical and public health experts are added to the Maryland PNQC steering committee.
    2014-2018The Maryland PNQC continues to grow.
    • Participation in the Maryland PNQC regional listserv more than doubles from 320 to over 700 participants.
    2015Maryland PSC becomes the second state designated as a member of the Alliance for Innovation in Maternal Health (AIM), a Health Resources and Services Administration (HRSA) supported program. This program provides technical assistance to implement nationally-endorsed patient safety bundles designed to reduce maternal mortality and severe maternal morbidity.
    2016-2018Maryland launches “Safely Reduce Primary Cesarean Sections” using a complex AIM bundle becoming the first state to do so.
    • Percentage of first-time low-risk (i.e. nulliparous, term, singleton, vertex) cesarean deliveries are reduced from 30.1% to 27.8% to participating hospitals in two years.
    • Results in 470 cesarean sections avoided with a cost reduction of $898,701.
    • Total reduction of NTSV cesarean deliveries and in those following labor reduction by 2nd quarter of 2019 were 7.6% and 13%, respectively.
    • Results from this collaborative were presented at several scientific and profession meetings and published in the journal, Obstetrics and Gynecology
    2016-2018
    		Maryland launches “Neonatal Abstinence Syndrome (NAS): Improving Care to Improve Outcomes” was launched to standardize best practices for infants with NAS.
    • Length of stay (LOS) in the Neonatal ICU was decreased by 3 days in infants diagnosed with NAS with a cost savings of $1.8 million.
    • Transfers out of the birth hospital for infants diagnosed with NAS decreased by 56% (from 16.8% to 7.4%) at the end of the collaborative.
    • Maryland named “State of Education Excellence” by the Vermont Oxford Network as 85% of participating hospitals achieved collaborative goals
    2019 “Obstetric Care of Women with Opioid Use Disorder (OUD)” and “Safe Infant Sleep” collaboratives were launched to reduce drug overdoses in pregnant women (the leading cause of maternal mortality in Maryland).
    2020Undergoing the competitive bid process, the Maryland Department of Health awards Health Quality Innovator as the new vendor to coordinate the Maryland PNQC.
    2021The Maryland PNQC launches “Severe Hypertension in Pregnancy Bundle” and “Neonatal Antibiotic Stewardship" to improve maternal and child health in Maryland.
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    Presentations
    • February 22, 2019, “Maryland Neonatal Abstinence Syndrome (NAS) Statewide Multi-Center Quality Improvement Collaborative: Improving Care to Improve Outcomes”, Maryland Patient Safety Center, Mednax NEO Conference, Orlando, FL.
    • December 3, 2018,” Implementation strategies associated with stronger implementation of a patient safety bundle to reduce primary cesarean delivery rates at Maryland Hospitals. Maryland Patient Safety Center, Oral presentation at the 11th Annual Conference on the Science of Dissemination and Implementation in Health, Washington, DC.
    • September 22, 2018, “Maryland Neonatal Abstinence Syndrome Collaborative: A Statewide Process Improvement Initiative”, Vermont Oxford Network Annual Meeting, Chicago, IL, Maryland Patient Safety Center, Podium Presentation.
    • August 6, 2018, “Reducing Primary Cesarean Sections in Maryland: A Statewide Collaborative”, Maryland Patient Safety Center, Alliance for Innovation in Maternal Health State Leader’s Meeting, Arlington, VA.
    • May 31, 2018, “What do hospitals do with adaptable patient safety bundles? Evaluating implementation of the ‘Safely Reducing Primary Cesarean Bundle’ at Maryland hospitals.” Maryland Patient Safety Center, Presentation at the University of Arkansas for Medical Sciences, Little Rock, AR.
    • October 28, 2017, “Maryland Neonatal Abstinence Syndrome Collaborative: Improving Care to Improve Outcomes”, Vermont Oxford Network Annual Meeting, Maryland Patient Safety Center, Chicago, IL, Podium Presentation.

    Posters
    • December 4, 2019. Factors that influence implementation of a maternal patient safety bundle to reduce primary cesarean delivery rates at Maryland hospitals. Poster presentation at the 2019 Conference on the Science of Dissemination and Implementation in Health, Arlington, VA. Maryland Patient Safety Center.
    • November 29 and 30, 2018, Maryland Neonatal Abstinence Syndrome Collaborative: A Statewide Initiative, Poster Presentation at National Network of Perinatal Quality Collaboratives ((PQC), Atlanta, GA. Maryland Patient Safety Center.
    • April 27, 2019, Reducing Primary Cesarean Section: A Statewide Initiative, Poster presentation at AWHONN Maryland/Virginia Maternal Morbidity and Mortality Conference, Maryland Patient Safety Center. Silver Spring, MD
    • November 29 and 30, 2018, Reducing Primary Cesarean Section: A Statewide Initiative, Poster presentation at National Network of Perinatal Quality Collaboratives (PQC), Maryland Patient Safety Center. Atlanta, GA, Poster
    • September 22 and 23, 2018, Maryland Neonatal Abstinence Syndrome Collaborative: A Statewide Initiative, Poster presentation at Vermont Oxford Network Annual Meeting, Chicago, IL,
    • December 4, 2017, Implementation strategies employed by Maryland hospitals participating in a collaborative to reduce primary cesarean delivery rates. Poster at the 10th Annual Conference on the Science of Dissemination and Implementation in Health, Arlington, VA,
    • December 4 2017, Measuring hospital progress in adopting a bundle of interventions to safely reduce primary cesarean section rates in Maryland. Poster at the 10th Annual Conference on the Science of Dissemination and Implementation in Health, Arlington, VA,.
    • October 28 & 29, 2017, Maryland Neonatal Abstinence Syndrome Collaborative: Improving Care to Improve Outcomes, Poster presentation at Vermont Oxford Network Annual Meeting, Chicago, IL, Poster,
    • April 3 & 4, 2014, Reducing Early Elective C-Sections and Inductions: A State-Wide Initiative, Poster presentation at Florida Perinatal Quality Collaborative, Tampa, FL

    Publications
    • Callaghan-Koru, Jennifer A.; Creanga, Andreea; A. DiPietro, Bonnie; Mark, Katrina; Sowe, Ardy; Aboumatar, Nour; Burke, Ann B. and Geoffrey Curran. “Implementation of the Safe Reduction of Primary Cesarean Births Safety Bundle During the First Year of a Statewide Collaborative in Maryland”, Obstetrics and Gynecology June, 2019
    • Callaghan-Koru JA, Creanga A, DiPietro B, Mark K, Sowe A, Aboumatar N, Burke A, Curran G. “Implementation strategies associated with stronger implementation of a patient safety bundle to reduce primary cesarean delivery rates at Maryland hospitals”. In: Proceedings from the 11th Annual Conference on the Science of Dissemination and Implementation. Implementation Science. 2019; 14(1): 27

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