Recognition and Response to Postpartum Preeclampsia in the Emergency Department (PPED)

MoMMAs Voices prepared a blog on the TCHMB PPED quality improvement initiative. Their story describes how MoMMAs Voices supported the project and their vital role with patient integration. Read more on the MoMMAs Voices site: https://www.mommasvoices.org/blog/recognition-and-response-to-postpartum-preeclampsia-in-the-emergency-department-pped

Inside TCHMB: A Conversation with Collaborative Leadership

Our partners at the Michael & Susan Dell Center for Healthy Living and the UTHealth Houston School of Public Health hosted an engaging and insightful conversation with the leadership of TCHMB and dove into the heart of our collaborative efforts in perinatal healthcare. This panel highlighted key partnerships that are driving innovation and improving outcomes for mothers and babies across Texas.

Speakers:

Charleta Guillory, MD, MPH, FAAP

Patrick Ramsey, MD, MSPH

Manda Hall, MD

View slides here. 

Watch recording here.

Helpful Resources

• Texas Health Data - https://healthdata.dshs.texas.gov/

• Rural Texas Maternal Health Rescue Plan (position paper will be published on 10/25) - https://d2bozcc5ollgr4.cloudfront.net/programs/maternal-health/index.html

• TX RPC Project Health Policy Resource on Doula Services - https://sph.uth.edu/research/centers/dell/legislative-initiatives/tx-rpc-project-reports/Doula%20Services%20-%20Rapid%20Response%20Request_03232023.pdf

Family and Child Health Expertise Joins UTHealth Houston School of Public Health

Faculty, staff, and research initiatives, formerly from The UT System Population Health team, join UTHealth Houston School of Public Health in Austin to expand maternal and child health expertise. The Population Health team was established in 2015 to address the needs of maternal and child health through partnerships with and funding from state agencies. These partnerships led to the establishment of state-wide collaboratives and informing public health programs.

David Lakey, MD, vice chancellor for health affairs and chief medical officer for The University of Texas System entrusts UTHealth Houston School of Public Health to take on the collaborative. 

“For the past eight years, the Office of Health Affairs at UT System has been incubating the maternal and child health programs under Population Health. These maternal and child health programs have been successful and are now ready for full integration to UTHealth Houston School of Public Health in Austin,” said Lakey.

Population Health has produced over $6.4 million in research funding this past year, and over $30 million since its inception, for health improvement initiatives established and embedded throughout Texas. Funds are utilized to identify population health approaches to improve the health of Texas families, mothers, babies, and young children. 

“The vision of our location is ‘healthy children in a healthy world’.  For that to happen, we need to have healthy women. This initiative will enable us to improve the health of our littlest Texans by improving the health of their mothers and their support systems, including fathers and other family members.” said Hoelscher, who also serves as the director of the Michael & Susan Dell Center for Healthy Living. 

A key addition includes The Texas Collaborative for Healthy Mothers and Babies, a long-standing multidisciplinary network of health professionals throughout the state. Their mission is to advance healthcare quality, equity, and patient safety for all Texas mothers and babies. The collaborative hosts an annual summit in February to discuss and present topics related to that year’s theme. Most recently, the Summit’s 2023 theme was “Social Determinants of Health and How They Impact Maternal and Neonatal Health Outcomes”.

The new programs and initiatives oversee several projects to address and improve health with primary initiatives focused on the following: 

• Patient care quality improvement

• Expansion, implementation, and dissemination of clinical interventions

• Evaluation of prevention and early intervention methods

• Identification of disparities associated with infant mortality

• Information and support programs that promote community resilience and optimal childhood brain development

• Needs assessment for the early childhood system in Texas and evaluation of the impact of the state’s activities toward strengthening the early childhood system.

Three key researchers with expertise in maternal and child health join UTHealth Houston School of Public Health in Austin as newly appointed faculty, including Dorothy Mandell, PhD; Divya Patel, PhD; and Katharine Buek, PhD.  In addition to these new faculty members, the Austin regional location added 11 new staff members, with expertise ranging from neonatal nursing to project management to health equity.

The newest additions to the faculty body in Austin will continue to drive progress and transformation in their respective fields, particularly the below projects:

1. Texas Collaborative for Healthy Mothers and Babies (TCHMB), funded by Texas DSHS – PI: Deanna Hoelscher

2. CDC Perinatal Quality Collaboratives (Bringing a Health Equity Framework for the Texas Perinatal Quality Collaborative to Eliminate Disparities in Perinatal Health), funded by CDC – PI: Divya Patel

3. Texas Safe Babies, funded by the Department of Family & Protective Services (DFPS) – PI: Dorothy Mandell

4. Maternal Infant and Early Childhood Home Visiting Coordinated State Evaluation, funded by DFPS – PI: Dorothy Mandell

5. Healthy Families/Healthy Mujeres, funded by HHSC – PI: Divya Patel

6. Evaluation of the Preschool Development Grant Birth to Five, funded by the Texas Workforce Commission – PI: Dorothy Mandell

“We look forward to furthering the excellent work and collaborations that Dr. Lakey began and has nurtured over the past few years. We are grateful to Dr. Lakey, his staff, and the state agencies who have funded this work for their partnership and vision in achieving a healthier Texas for our children, our families, and our communities. ” said Hoelscher.

Women in Medicine Month

At the Texas Collaborative for Healthy Mothers and Babies (TCHMB), we are proud to use September (Women in Medicine Month) to recognize the outstanding women leaders driving our quality improvement (QI) efforts through their expertise, vision, and commitment to our Executive Committee and other workgroups and our internal staff. These women provide invaluable expertise and vision to drive our mission forward.

This Women in Medicine Month, we honor the women of TCHMB whose leadership and dedication are shaping perinatal QI efforts across our great state. Dr. Charleta Guillory, TCHMB chair, believes “The children of Texas need you — your voice, your passion, your vigor, your indomitable spirit.”

Their collective impact is reflected in the work of the remarkable women who serve on our Executive Committee and lead key initiatives across the state. As women medical leaders in Texas and nationwide, TCHMB women leaders in medicine advance health care quality and patient safety for all Texas mothers and babies.

Gloria Delgado, MSN, RNC-OB — Obstetrics Co-Chair, Executive Committee

Delgado serves as an Assistant Administrator of Women’s Services at University Medical Center of El Paso, overseeing labor and delivery, mother-baby care, and public health programs like Nurse Family Partnership. She brings extensive expertise in managing health care operations to ensure safe, high-quality care for mothers and babies.

Catherine Eppes, MD, MPH — Past Chair, Executive Committee

As Chief of Obstetrics at Ben Taub Hospital and a maternal-fetal medicine physician at Baylor College of Medicine, Eppes focuses on quality, safety, and infectious disease management in pregnancy. She has collaborated with the Centers of Disease Control and Prevention (CDC), American College of Obstetricians and Gynecologists (ACOG), and Texas Medical Association (TMA) on initiatives including Zika virus prevention and perinatal care improvement.

Jasmine Farrish, CNM, MSN, MPH — At-Large Member, Executive Committee

Farrish, a Certified Nurse Midwife at Los Barrios Unidos Community Clinic, began her career as a postpartum doula and now oversees home visiting and midwifery programs. She is committed to providing personalized, nonjudgmental care to support families across the Dallas area.

Kendra Folh, DNP, RNC-OB, C-ONQS, CPHQ, LSSBB — Data Co-Chair, Executive Committee

Folh is Program Director for Women’s and Children’s Services at Memorial Hermann Healthcare System. Drawing from her personal experience as a preterm birth survivor, she drives QI initiatives and collaborates nationally on perinatal safety to champion healthcare innovation for maternal and neonatal populations.

Alice Gong, MD — Vice Chair/Chair-Elect, Executive Committee

Gong is a Professor of Pediatrics at UT Health San Antonio and Medical Director of the PREMIEre program and the Mother-Baby Unit at University Hospital. She has spent decades advocating for newborns and families, advancing early neurodevelopmental care, and educating generations of clinicians through her research, publications, and presentations.

Gillian Gonzaba, NNPC — Neonatal Committee Co-Chair, Executive Committee

A Neonatal Nurse Practitioner and Associate Director for High Reliability/Patient Safety and Simulation at Pediatrix Medical Group, Gonzaba leads multidisciplinary teams focused on QI, patient safety, and neonatal care. She has extensive experience with simulation training and process improvement in neonatal medicine.

Charleta Guillory, MD, MPH, FAAP — Chair, Executive Committee

Guillory, Professor of Pediatrics at Baylor College of Medicine and Director of the Neonatal-Perinatal Public Health Program at Texas Children’s Hospital, has led efforts to reduce Black infant mortality and improve newborn care. Her leadership in policy and community initiatives has had a profound impact on maternal and infant health statewide.

Sonal Zambare, MD — At-Large Member, Executive Committee member

Zambare, Assistant Professor of Obstetric Anesthesiology at Baylor College of Medicine, brings expertise in anesthesia, analgesia, and critical care for mothers during birth and postpartum. She is actively involved in patient safety, education, and simulation programs, and she supports care for mothers with substance use disorders.

TCHMB also recognizes the invaluable contributions of the non-voting women of the Executive Committee, including Drs. Manda Hall, Gayle Olson, Rashmi Rode, Emily Briggs, Ashley Lucke, and Angela Moemeka, Misty Wilder, MSW, and TCHMB staff members Susan Dimitrijevic, MSN, BSN, RNC-NIC, and Ebony Sherrill, BSN, RN, whose collective expertise supports TCHMB’s mission and helps advance maternal and infant health across Texas.

To learn about the TCHMB Executive Committee members and staff, follow us on social media, subscribe to our newsletter, and view tchmb.org.

Meet Dr. Alice Gong, TCHMB Vice Chair

Dr. Alice Gong is the current vice chair of the Texas Collaborative for Healthy Mothers and Babies (TCHMB). I spoke with Dr. Gong to learn more about her achievements and dedication to improving the health and well-being of newborns.

A Journey Rooted in Curiosity and Compassion

Dr. Gong's career began with a passion for medicine and a particular interest in pediatrics. She grew up in a small town in the Mississippi delta. After completing her undergraduate studies at Mississippi College, she began her journey in healthcare and entered medical school. Although she initially was drawn to pediatrics, it was during her clinical rotations that she was drawn to the complexities of neonatology. The delicate and critical transition that newborns make after birth fascinated her, leading her to pursue a residency in pediatrics and a subsequent fellowship in neonatology.

Significant Research in Neonatal Care Dr. Gong’s training and research has taken place across the United States. Her early research work in neonatology focused on neonatal respiratory distress syndrome, which at the time was the leading cause of death of infant mortality. She was part of some of the initial research on surfactant replacement therapy1, which became a cornerstone of neonatal care and was instrumental in improving mortality and morbidity for premature newborns.

Additional research areas included lung physiology, retinopathy of prematurity in partnership with retinal ophthalmologists, and breastfeeding quality improvement, the latter of which aligns with Breastfeeding Learning Collaborative with Safe Infant Sleep Modeling, a current TCHMB initiative.

A Vision for the Future

Looking ahead, Dr. Gong’s commitment to improving neonatal and maternal healthcare remains strong. As vice chair, she hopes to ensure the progress made in urban hospitals is extended to small community hospitals, particularly those in rural areas. For Dr. Gong, the goal is to elevate care standards in high-level NICUs across the state, regardless of proximity to urban area hospitals.

In her words: "A woman that lives in rural Texas, her wants and desires for her child and her family are no different than someone who lives in an urban area."

A Legacy of Dedication

Dr. Alice K. Gong’s career is a testament to a lifetime of dedication to improving the health of newborns and supporting families in their most vulnerable moments. Through groundbreaking research, system-wide improvements, and a compassionate approach to neonatal care, Dr. Gong has changed the trajectory of countless lives. Her work continues to inspire future generations of healthcare professionals and advocates for maternal and neonatal health.

Her personal mission mirrors that of TCHMB, which works to advance healthcare quality and safety for all Texas mothers and babies and finds success in its collaboration-based efforts. Both Dr. Gong and TCHMB work to ensure better care standards can flourish across the state.

As she reflects on her career, Dr. Gong's mission remains clear: to create a world where every baby can grow up healthy, safe, and nurtured by their families and communities. Her legacy is one of scientific achievement and a profound expression of her compassion and commitment to improving the world for the most vulnerable.

Results from NAT Initiative show promising, meaningful clinical improvements in newborn healthcare

The NAT Initiative Executive Summary delivers background and overview information, results, key findings, and lessons learned from the Newborn Admission Temperature initiative.

The Newborn Admission Temperature (NAT) Initiative was the first TCHMB project to measure outcomes disaggregated by race and ethnicity from hospitals, an important step toward understanding and reducing disparities in perinatal healthcare and health outcomes in Texas. Of particular note are the following findings:

• The findings of decreased hypothermia among NICU admissions — in NICUs that consistently reported race and ethnicity disaggregated data — highlight the potential of statewide initiatives for improvement in settings caring for the most vulnerable newborns.

• The NAT Initiative identified significant disparities in hypothermia incidence, with newborns of non-Hispanic Black mothers having approximately twice the incidence compared to newborns of non-Hispanic White mothers.

More key findings, data, and conclusions & future directions are available in the NAT Initiative Executive Summary.

A Majority of Birthing Hospitals Enrolled in NAT Project

The Newborn Admission Temperature (NAT) Project is a TCHMB Quality Improvement project to increase the number of newborn infants with admission temperatures within the normal limits – released hospital-reported data from Oct.-Dec. 2021. The project uses this data to inform hospital quality assurance and performance improvement programs, ultimately affecting positive outcomes for infants who are at risk for illness, disease or death if they do not fall in the normal limits.  

From October to November 2021:  

• 3.1% of infants had hypothermia and 5.9% of infants had hyperthermia at admission to the NICU;  

• 0.5% of infants had hypothermia and 3.3 % of infants had hyperthermia at admission to the Mother-Baby Unit;  

• Very low birthweight infants were significantly more likely to have hypothermia and hyperthermia at NICU admission. 

TCHMB continues to work with the RAC Perinatal Care Region (PCR) Alliance in order to connect with every single hospital stakeholder across the state. The current number of enrolled hospitals is 158. It continues to be geographically well-represented across TX. In this reporting period, NAT project covered approximately 58% of annual deliveries in Texas (compared to 51% for the July-September 2021 reporting period).  

The summary is available on the NAT project page. 

Newborn Admission Temperature (NAT) Project Update

The Neonatal Committee of the Texas Collaborative for Healthy Mothers and Babies (TCHMB) has completed two data collection periods for the Newborn Admission Temperature (NAT) Project. Of the 157 hospitals enrolled, 110 (70%) have submitted data for the most recent (second) data collection period. Overall, data quality has improved since the first data collection period, with more hospitals submitting data stratified by race/ethnicity. The NAT team is currently working on a report that will be published to the website in the coming month.

For hospitals needing additional support, we will provide weekly “NAT Office Hours” on Wednesdays from 12-2pm. Please feel free to drop in any time during these sessions for individual support. If you need the link for the meeting or if this time does not work for you, please reach out to us at nat@utsystem.edu.