E Brie Thumm1,2, Rebecca Rees3, Amy Nacht4, Kent Heyborne5, Bronwen Kahn6. 1. University of Colorado Anschutz College of Nursing, 13120 E 19th Ave, Aurora, CO, 80045, USA. brie.thumm@cuanschutz.edu. 2. Colorado Department of Public Health and Environment, 4300 Cherry Creek S Dr, Denver, CO, 80246, USA. brie.thumm@cuanschutz.edu. 3. Colorado Department of Public Health and Environment, 4300 Cherry Creek S Dr, Denver, CO, 80246, USA. 4. University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA. 5. Denver Health, University of Colorado School of Medicine, 790 Delaware St., Pavilion C, Denver, CO, 80204, USA. 6. Obstetrix Medical Group of Colorado, Presbyterian/St. Luke's and Rose Medical Centers, 2055 High Street Ste 230, Denver, CO, 80205-5503, USA.
Abstract
INTRODUCTION: Social determinants of health and adverse childhood experiences have been implicated as driving causes of maternal mortality but the empirical evidence to substantiate those relationships is lacking. We aimed to understand the prevalence and intersection of social determinants of health and adverse childhood experiences among maternal deaths in Colorado based on a review of records obtained for our state's maternal mortality review committee. METHODS: A 5-member interdisciplinary team adapted the Protocol for Responding to and Assessing Patients' Assets, Risk, and Experiences and the Adverse Childhood Experiences tools to create a data collection tool. The team reviewed records collected for the purpose of maternal mortality review for pregnancy-associated deaths that occurred in Colorado between 2014 and 2016 (N = 94). RESULTS: The review identified an overwhelming lack of information regarding social determinants of health or adverse childhood experiences in the records used to review maternal deaths. The most common finding of the social determinants of health was a lack of conclusive evidence in the record (35.1-94.7%). Similarly, the reviewers were unable to make a determination from the available records for 92.1% of adverse childhood experience indicators. DISCUSSION: The lack of social and contextual information in the records points to challenges of relying on medical records for identification of non-medical causes of maternal mortality. Maternal mortality review committees would be well served to invest in alternative data sources, such as community dashboards and informant interviews, to inform a more comprehensive understanding of causes of maternal mortality.
INTRODUCTION: Social determinants of health and adverse childhood experiences have been implicated as driving causes of maternal mortality but the empirical evidence to substantiate those relationships is lacking. We aimed to understand the prevalence and intersection of social determinants of health and adverse childhood experiences among maternal deaths in Colorado based on a review of records obtained for our state's maternal mortality review committee. METHODS: A 5-member interdisciplinary team adapted the Protocol for Responding to and Assessing Patients' Assets, Risk, and Experiences and the Adverse Childhood Experiences tools to create a data collection tool. The team reviewed records collected for the purpose of maternal mortality review for pregnancy-associated deaths that occurred in Colorado between 2014 and 2016 (N = 94). RESULTS: The review identified an overwhelming lack of information regarding social determinants of health or adverse childhood experiences in the records used to review maternal deaths. The most common finding of the social determinants of health was a lack of conclusive evidence in the record (35.1-94.7%). Similarly, the reviewers were unable to make a determination from the available records for 92.1% of adverse childhood experience indicators. DISCUSSION: The lack of social and contextual information in the records points to challenges of relying on medical records for identification of non-medical causes of maternal mortality. Maternal mortality review committees would be well served to invest in alternative data sources, such as community dashboards and informant interviews, to inform a more comprehensive understanding of causes of maternal mortality.
Authors: Nora B Henrikson; Paula R Blasi; Caitlin N Dorsey; Kayne D Mettert; Matthew B Nguyen; Callie Walsh-Bailey; Jennifer Macuiba; Laura M Gottlieb; Cara C Lewis Journal: Am J Prev Med Date: 2019-12 Impact factor: 5.043