Attitudes, Knowledge, and Behaviors to Achieve the Quadruple Aim in the Management of a Complex Pregnant Woman

United States has the highest maternal mortality ratio in the developed world with Black mothers 3-4 times more likely to die in childbirth. A woman’s risk of mortality is associated with patient factors especially presence of chronic conditions compounded by social determinants of health; community-public health factors like access to care, lack of management/care coordination between providers and organizations; provider factors like deficits in pregnancy-specific knowledge and communication; facility factors with protocols and safety bundles adoption; and systems of care factors to ensure insurance coverage, risk stratification for appropriate level hospital care.
The traditional multidisciplinary care is focused on own discipline specific plan of care with system-based progress evaluation. This is disorganized, non-transparent, and confusing for the patient who has to make multiple appointments on her own. Women with poor resources and/or increasing medical complexity, resort to non-adherence to medical recommendations. Using the principles of interprofessional collaborative care and Quadruple aim, we started a Maternal-Obstetric-Medicine (MOM) program. A high-risk-pregnancy physician and nurse navigator lead this biopsychosocial model, with the patient at the center of it. They facilitate team development, joint assessments and treatment plans, group discussions on patient care, and shared leadership amongst various disciplines. Some have called this ‘Transdiciplinary Practice’ defined as ‘beyond all but connected to all’.
We have enrolled 20 complex patients to this model. Patients and providers report better experience and rapport with the patient and shared mental model of the entire healthcare team (physicians from multiple disciplines, nurses, psychotherapists, genetic counsellors, sonographers, social workers, hospital administrators, and the patient). No major mortality or morbidity occurred despite complex medical conditions like cardiac disease, renal failure, poorly controlled diabetes, mental health and others. This enhanced professional experience and decreased the stress for the healthcare team who felt prepared to take care of these complex patients.