Dr. Carey Eppes and CheyAnne Harris spoke with Aim for a Safer Birth about implementation for the Maternal Early Warning Signs (MEWS) in maternal health care. In this episode, Eppes, the immediate past chair for TCHMB, and Harris, the Director of Clinical Excellence and Operations for Titus Regional Medical Center, addressed how MEWS implementation can serve as a resource for every facility.
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
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.
Q&A: Dr. Charleta Guillory, TCHMB Chair
Dr. Charleta Guillory is the current chair of the Texas Collaborative for Healthy Mothers and Babies (TCHMB). I sat down with Dr. Guillory to learn more about her achievements, passion for infant and mother health, and her vision for TCHMB during her tenure as chair.
Dr. Guillory was selected as chair after serving as co-chair of the neonatal committee for 6 years. She is a Professor of Pediatrics in the Section of Neonatology at Baylor College of Medicine and Director of the Texas Children's Hospital Neonatal-Perinatal Public Health Program.
1. Please describe your education, specifically your medical education.
I was one of the first 2 Black female graduates (out of a mere 4 total women in the entire program) who completed my medical education at Louisiana State University Medical School in New Orleans, earning my MD degree in 1974. Following this, I completed a Pediatric Residency at the University of Colorado Medical Center and Louisiana State University from 1975 to 1978. I then pursued a Neonatal-Perinatal Medicine Fellowship at Baylor College of Medicine's Department of Pediatrics in Houston from 1978 to 1981, and I am board certified in both pediatrics and neonatal-perinatal medicine.
My education also includes leadership and national policy training through the Gallup Leadership Institute and the American Political Science Association's Congressional Fellowship Program. I was 1 of 6 physicians in the United States to receive the Robert Wood Johnson Health Policy Fellowship from the National Academy of Science and Institute of medicine, where I served as a legislative assistant in the United States Senate (office of Senator John B. Breaux, LA) promoting both health policy legislation and programs.
Additionally, I earned a Master of Public Health from UTHealth Houston School of Public Health in 2015, completing a thesis on the High Rate of Prematurity in African-American Women in Houston, Texas and focusing on efforts to advance programs and policies that improve neonatal health outcomes.
2. Please describe your career experience within medicine.
My very first job after completing my fellowship in 1981 was co-director of the Woman's Hospital of Texas NICU, transitioning the nursery from Level II to Level III. In addition, I directed the Texas Children's Hospital Level II Nursery for 21 years, where I established admission and discharge guidelines and coordinated quality improvement projects. My leadership experience included working with multidisciplinary teams of neonatologists, nurse practitioners, fellows, residents, medical students, and nursing staff.
Throughout my career in medicine, I have held numerous key roles that have significantly impacted maternal and child health. As the Director of the Neonatal-Perinatal Public Health Program and the immediate past Director of the Texas Children's Hospital Level II Nursery. I have managed the care of infants with complications such as prematurity, birth defects, and metabolic disorders, overseeing transfers from across Texas and beyond.
Additionally, my training through the Robert Wood Johnson Health Policy Fellowship, Congressional Fellowship, and Gallup Institute Leadership Course has equipped me to influence healthcare policy. As Chair of the March of Dimes State Prematurity Campaign and the State Advocacy and Government Affairs committee, I have led statewide initiatives to reduce premature births and developed materials for legislative advocacy. I also currently direct the Patient Advocacy Elective in Pediatrics at Baylor College of Medicine, further contributing to my extensive career in educating others in neonatal healthcare.
I also chaired the Texas Department of State Health Services (DSHS) Newborn Screening Advisory Committee — championing the increase of the number of newborn screens being done by the state to help decrease infant mortality — and served 10 years on the Texas Health and Human Services (HHS) Perinatal Advisory Council (PAC) — designating levels of neonatal and maternal care.
Recently, I was appointed to serve on the Food and Drug Administration (FDA) Pediatric Advisory Committee and was appointed to the American Academy of Pediatrics (AAP) National Committee on Fetus and Newborn. I served as President of the Texas Pediatric Society (TPS) of the American Academy of Pediatrics for 2021 and now serve as the TPS/AAP Chapter Chair President. My commitment to improving the health of infants led to the Secretary of Health and Human Services appointing me to serve on the HRSA Advisory Committee on Infant and Maternal Mortality.
Still today, I continue to work in the Neonatal Intensive Care Unit Level IV and serve on the ECMO team. My advocacy for improving maternal and infant health, especially for vulnerable populations, has been a central theme in my work. I have been dedicated to reducing infant mortality and eliminating disparities in health outcomes based on socioeconomic, racial, and ethnic factors.
3. How did you become involved with TCHMB?
I started as a member of the Expert Panel in 2011 advising Healthy Texas Babies, the state infant mortality reduction initiative housed at DSHS, and I continued as a member of TCHMB at its inception, which began officially operating as the state perinatal quality collaborative in 2013. As the group continued to evolve, I served as the Co-Chair of the Neonatal Standing Committee of the Executive Committee for over 6 years.
4. What does it mean to you to be TCHMB Chair?
Every job that I have, or have had, I approach with commitment, service, and an opportunity to improve the lives of others. I bring to TCHMB a vast variety of experiences/preparation to work in a community of like-minded experts to effect positive change. I feel both humbled and proud to have the privilege to be part of this awesome team.
I remain committed to identifying the social determinants of health and their effects on the maternal and infant population before and after NICU admission. As a leader in the field of neonatology at the city, state, and national levels, my mission is to identify and implement solutions for these adverse determining factors that impact infant and maternal health.
In my tenure as TCHMB Chair, I aim to achieve several key goals that align with best practices in maternal and child health. Firstly, I intend to reduce infant mortality rates and improve overall infant and child health outcomes, particularly focusing on addressing health disparities. By enhancing access to high-quality care for vulnerable populations, I hope to create more equitable health outcomes for all Texas families.
Secondly, I plan to implement and support quality improvement initiatives across neonatal and perinatal care units. This includes developing and refining guidelines and protocols to ensure consistent, evidence-based care for premature and critically ill infants. Collaborating with healthcare professionals, I will promote best practices and foster a culture of continuous improvement.
Lastly, I hope to build collaboration and knowledge sharing among healthcare providers, researchers, and policymakers. By creating a robust network of partners, we can drive innovation and ensure that Texas remains a leader in neonatal and perinatal care.
Through these efforts, I aspire to make a lasting impact on the health and well-being of mothers and infants, contributing to a healthier future for Texas families and continuing to make the work of TCHMB impactful.
Written by Kirsten Handler, Communication Specialist at UTHealth Houston School of Public Health in Austin.
TCHMB is funded by the Texas Department of State Health Services.
Understanding Preeclampsia: A Guide for Preeclampsia Awareness Month
May is Preeclampsia Awareness Month, an annual event that promotes improved healthcare practices as they relate to preeclampsia. Patients are encouraged to share their experiences, and researchers, clinicians, and legislators are encouraged to prioritize preeclampsia research. The Preeclampsia Foundation, which leads a month-long campaign about the hypertensive disorder every May, named the 2024 theme ‘Predict Prevent Prevail.’
Texas Collaborative for Healthy Mothers and Babies (TCHMB) — the state’s perinatal quality collaborative that comprises healthcare providers, scientists, hospitals, state agencies, advocates, and insurers — developed Understanding Preeclampsia: A Guide for Preeclampsia Awareness Month to support improved care and outcomes for preeclampsia patients in Texas.
Defining Preeclampsia
Preeclampsia is a life-threatening condition that affects 5-8% of pregnant patients, characterized by elevated blood pressure (BP) and, at times, elevated protein in the urine (proteinuria). It may be accompanied by other symptoms, including chest pain, abdominal pain, liver problems, headaches, and changes in vision.
Alone, each of these symptoms does not indicate preeclampsia, but it’s important for pregnant patients to report these symptoms and any existing conditions to their healthcare provider. Some conditions put pregnant patients at a higher risk of developing preeclampsia:
A woman who has never delivered a baby
Type 1 or Type 2 diabetes
History of hypertension
35 years or older
Teenager (under 20)
Chronic medical conditions, including kidney disease or Lupus
Preeclampsia/hypertension in a previous pregnancy
Twin pregnancy
Diagnosing Preeclampsia
Providers will diagnose preeclampsia when a patient meets the following conditions:
Been pregnant for at least 20 weeks
Reported systolic BP of 140 or higher -or- diastolic BP of 90 or greater
On at least 2 occasions that are at least 4 hours apart
A diagnosis of preeclampsia can be given with or without the presence of proteinuria.
Treating Preeclampsia
The course of action following a preeclampsia diagnosis depends on the stage of pregnancy. In most cases, a patient confirmed to have BP greater than 140/90 will be sent for an initial evaluation at a hospital, where providers will monitor BP, collect laboratory tests including a urine test for proteinuria, and assess for symptoms of preeclampsia.
Treatment for Preeclampsia Based on Stage of Pregnancy
To prevent preeclampsia in patients at risk, doctors will prescribe a low-dose aspirin at around 16 weeks of gestation.
Developing Recognition and Response to Postpartum Preeclampsia in the Emergency Department (PPED), a TCHMB Quality Improvement (QI) Project
11% of pregnancy-related deaths are related to preeclampsia/eclampsia, with 50% of those deaths occurring in the first six weeks (42 days) after delivery, according to the Texas Maternal Mortality and Morbidity Review Committee and Department of State Health Services Joint Biennial Report 2022. Consequently, it is important for the public to recognize preeclampsia symptoms, which can occur not only during pregnancy but also during the postpartum period.
Based on this data — and because so many patients who experience preeclampsia symptoms visit the emergency room — TCHMB developed the PPED QI project. This initiative aims to reduce maternal morbidity and mortality related to severe hypertension in postpartum patients by increasing the collaboration between obstetric and emergency departments with:
Enhanced screening for postpartum status
Education on diagnosis, treatment, and follow-up care in the emergency department
Latest Research and Future Directions
Research into preeclampsia has recently focused on understanding its underlying causes, with particular attention to the placenta’s role. While the exact cause remains elusive, ongoing studies are investigating inflammatory components and antibodies that may contribute to the condition. Experts predict that within the next decade, advancements in this area will provide valuable insights into prediction and prevention strategies.
Clinical Review
Special thanks to the following healthcare professionals for contributing their expertise to this article:
James Hill, MD, the Obstetrics Committee Co-Chair for TCHMB and the Division Chief for the Division of Maternal-Fetal Medicine at Baylor College of Medicine/The Children’s Hospital of San Antonio. Previously, he was a Field Artillery officer and retired Colonel in the United States Army and a mathematics professor at West Point.
Susan Dimitrijevic, BSN, RNC-NIC, the Senior Nurse Program Manager for TCHMB. For the past 25 years, she has focused her nursing career on Neonatal Intensive Care, caring for critically ill infants and their families. Before joining TCHMB, she was the Neonatal Program Manager and Clinical Nurse Manager of the Level NICU Transport team at Dell Children’s Medical Center.
Written by Kirsten Handler, Communication Specialist at UTHealth Houston School of Public Health in Austin.
TCHMB is funded by the Texas Department of State Health Services.
Placenta Accreta Spectrum Workshop
Learn about postpartum preeclampsia in the emergency department
Family and Child Health Expertise Joins UTHealth Houston School of Public Health
Start Planning How to Integrate Social Determinants of Health at Your Hospital
More than 400 people attended the 2023 TCHMB Summit, which focused on Social Determinants of Health (SDoH) and its Impact on Maternal and Neonatal Outcomes. A majority of attendees reported that one of the major objectives was to take actionable quality improvement strategies back to hospitals, according to the post-summit survey.
During the summit, TCHMB provided an action plan and worksheet to get people thinking about the steps to make this happen. Even if you didn’t attend the summit, you can use these resources as a framework for building your plans to address SDoH at your hospital. It helps you list goals, milestones and think about target specific outcomes, as well as identify who in your organization can help you get there.
Be sure to check out the 2023 summit webpage for a copy of the slides if you need them to get your action plans started!
Download the summit pre-session worksheet.
Download the post-summit action plan.
