Dr. Catherine Eppes, the new chair of the Texas Collaborative for Healthy Mothers and Babies (TCHMB), has set herself two straightforward but challenging goals for the next two years. She would like to 1) help drive the establishment of a robust data infrastructure for hospitals to report and receive key quality improvement metrics, and 2) further strengthen the alliance between TCHMB and the Regional Advisory Council (RAC) Perinatal Care Region (PCR) Alliance.
“If we accomplish those two goals I will feel as though I have been successful,” says Eppes, who is a maternal fetal medicine physician at Baylor College of Medicine and the Chief of Obstetrics for Ben Taub Hospital in Houston.
Eppes, who was selected as chair after serving for three years as co-chair of the Obstetrics Committee, received her MD from The University of Texas Health Science Center, San Antonio and completed residency at Johns Hopkins. Her fellowship, and masters of public health, were received from Northwestern University. Her primary areas of focus are quality and safety and infectious diseases in pregnancy. She is currently the ACOG District XI (Texas) patient quality and safety chair, a member of the Texas fetal and infant review of HIV and Syphilis, and Faculty Medical Director of the TexasAIM initiative. She holds several grants with the CDC for influenza and HIV in pregnancy.
From where do you hail?
I was born in Maryland. My family moved to Texas when I was in junior high, and I did my undergraduate work at UT Austin. I moved away for medical school, residency and fellowship, and then came back here after my fellowship. I went directly to Ben Taub Hospital in Houston, which is the Harris County safety net hospital, and I’ve been at Ben Taub since.
Did you always know you wanted to be an OB-GYN?
I went to medical school thinking I wanted to be a neurosurgeon, but knew I wanted to be an OB-GYN by the end of medical school, and went to Northwestern University in Chicago for a fellowship in maternal and fetal medicine and a Masters in Public Health as well.
So it’s not an accident that you ended up with TCHMB, at the intersection of perinatal and public health?
I had some really amazing mentors at Northwestern, including Pat Garcia and Ann Borders (who would later be one of the keynote speakers at the 2019 TCHMB Summit). They were working not just on caring for women but on improving the systems that cared for (or in many cases didn’t care for) women. It was largely from watching those two women that I learned what kind of doctor I wanted to be.
How did you end up back in Texas?
I won the job lotto. I wanted to be back in Texas. Baylor College of Medicine is a major medical institution, operating at the highest levels of both research and clinical care. And Ben Taub, where I work, is the safety net hospital for Harris County. We’re the hospital that cares for patients who are medically underserved, the majority of whom are not insured and many of whom are undocumented. It’s an amazing place.
How did you make your way to TCHMB?
After the 2016 election, I felt very strongly that I wanted to be more involved in improving maternal health in our state. Christina Davidson, who is a good friend, had been involved with TCHMB for a number of years at that point, and she encouraged me to apply. I joined in January of 2017 as part of the Data Committee. I subsequently became one of the co-chairs of the Obstetrics Committee.
Where do you think TCHMB is, in terms of its development as a PQC?
We are still young, but I think we are more like a teenager now. Our committees are beginning to work together on projects. We have been through a few cycles of leadership. We have integrated with the RACs and PCRs. We have hired a chief medical officer. We have embarked on a QI project, the Newborn Admission Temperature (NAT) project, that is going to be our first that is truly statewide.
In combination with the work that DSHS has done with TexasAIM, the state has come a long way in only a few years, and other states are watching us now.
What’s next?
A lot, but the biggest thing we need to build, in my opinion, is a good data infrastructure. With the RAC-PCR integration, and the levels of care designation requirements that hospitals engage in QI projects, it is realistic that we can implement projects that involve all 224 of the birthing hospitals in Texas. We are going to get close to that with the NAT project alone. But without a good data infrastructure, and the reporting that it would allow, we will be limited in the impact we can have. That’s the big goal for the next two years, to get to a point where we have a common data infrastructure, where hospitals are submitting to one place, not multiple different places, and we and they can begin to use that data to drive improvement.
What are the big challenges in setting up such an infrastructure?
The technical challenges are significant but surmountable. What system are we going to use? What metrics will we collect? How will our system integrate with electronic health records? Etc.
Perhaps the greatest challenge, however, is persuading the hospitals to share. They have legitimate concerns about privacy, about their outcomes being visible to others, and about it potentially being punitive. We need to create a culture of trust where data is not used punitively.
What do you mean by punitive here?
Neither TCHMB nor the state is interested in using outcomes data to punish hospitals or systems, or to draw invidious comparisons. That would be punitive. Our goal is to provide data to empower hospitals to improve outcomes for mothers and babies, which they all want to do. Everybody really cares so much about improving their own outcomes, and they don’t need to be shamed to be motivated to improve. But knowing where they are, vis a vis other hospitals, can be incredibly helpful. You may be an outlier without knowing it.
Anything else?
I am really excited about the equity work that our Community Health Committee is doing, where the goal is to add that lens to every project we do going forward. I think it will be a hard and emotional journey for a lot of folks, but I think it’s the right time and the right group of motivated people, so I’m excited to see where that goes.
How do you feel about being selected as chair of TCHMB?
Honored.