Q&A with Dr. Catherine Eppes, TCHMB Chair

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.

Webinar: Introduction to TCHMB’s Newborn Admission Temperature Initiative

TCHMB invites you to participate in an introductory webinar for the NAT initiative on March 24 from 3-4pm. This webinar will be the official launch of the project where we will be discussing more details about the initiative including the importance of tracking newborn admission temperature, the data measures, and techniques and strategies for data collection for the project. Please invite your NAT team members to participate in the webinar to learn more and prepare for the project.

When: Mar 24, 2021 03:00 PM Central Time (US and Canada)

Topic: Introduction to TCHMB’s Newborn Admission Temperature Initiative

Register Now for this webinar.

After registering, you will receive a confirmation email containing information about joining the webinar.

If you have any questions, please reach out to Dr. Meliha Salahuddin at nat@utsystem.edu.

Texas Collaborative for Healthy Mothers and Babies Welcomes New Leadership

Austin, TEXAS - The Texas Collaborative for Healthy Mothers and Babies (TCHMB), Texas’s state perinatal quality collaborative, has named Dr. Catherine Eppes as Chair of its Executive Committee and Dr. Rashmin Savani as Vice Chair/Chair-Elect.

Stepping down as chair after a 2-year term is Dr. Michael Speer, Professor of Pediatrics and Neonatology at Baylor College of Medicine and Medical Director of the Neonatal Nurse Practitioner Program at Texas Children’s Hospital. Dr. George Saade, Chief of Obstetrics and Maternal-Fetal Medicine at the University of Texas Medical Branch, will step down from the Executive Committee after serving for over 4 years in the roles of Chair and Past Chair.

“Dr Eppes and Dr. Savani are extraordinary physicians and long-time champions of maternal and infant health in Texas,” says Speer, who will continue to serve on the executive committee as Past Chair for the next two years. “I couldn’t be more confident in the future of TCHMB.”

Catherine Eppes, MD, MPH, is a Maternal-Fetal Medicine physician at Baylor College of Medicine and the Chief of Obstetrics for Ben Taub Hospital. She received her MD from The University of Texas Health Science Center, San Antonio and completed her obstetrics residency at Johns Hopkins. Her fellowship, and Masters of Public Health, were received from Northwestern University. She is currently the ACOG District XI (Texas) patient quality and safety chair, and TexasAIM Medical Director.  She holds several grants, including the maternal opioid misuse grant which is a collaborative grant between Texas Health and Human Services and Harris Health to improve the outcomes of women with substance use disorder. Prior to her selection as Chair, she served on the TCHMB Executive Committee as co-chair of the obstetrics committee.

“Texas has a lot of challenges when it comes to the health of its mothers and babies,” says Eppes. “We also have an extraordinary community of people dedicated to making things better. Under the leadership of Dr. Speer and his predecessor, Dr. George Saade, the Collaborative has been an important part of that larger community, and I look forward to carrying the mission forward.”

Rashmin Savani, MD, is Division Director of Neonatal-Perinatal Medicine and Associate Director of Pulmonary & Vascular Biology in the Department of Pediatrics at The University of Texas Southwestern Medical Center. He obtained his medical degree from the University of Sheffield and was a pediatric resident at Duke University Medical Center and a fellow in Neonatology and in Pulmonary Biology (1989-1991) at Cincinnati Children’s Medical Center. His research focus has been on lung injury and development, including inflammation and angiogenesis. Prior to his selection as Vice Chair/Chair-Elect, he served on the TCHMB Executive Committee as co-chair of the neonatology committee.

“This is a wonderful opportunity to work collaboratively with leaders across Texas to improve the health of moms and babies in Texas,” says Savani. “It’s a privilege to be selected as vice chair.”

Former Vice Chair Dr. Patrick Ramsey, Professor of Obstetrics and Gynecology at the University of Texas Health Science Center at San Antonio, now serves in a staff role as TCHMB’s Chief Medical Officer.

The Texas Collaborative for Healthy Mothers and Babies is a multidisciplinary network made up of health professionals throughout the state. Its mission is to advance health care quality and patient safety for all Texas mothers and babies, through the collaboration of health and community stakeholders in the development of joint quality improvement (QI) initiatives, the advancement of data-driven best practices, and the promotion of education and training.

MMMRC and DSHS Joint Biennial Report

The Texas Maternal Mortality and Morbidity Review Committee (MMMRC) and Department of State Health Services (DSHS) have jointly released their 2020 Biennial Report. The report contains DSHS and MMMRC findings and MMMRC recommendations to help reduce the incidence of pregnancy-related deaths and maternal morbidity in Texas.

Summary of Recommendations

• Increase access to comprehensive health services during pregnancy, the year after pregnancy, and throughout the preconception and interpregnancy periods to facilitate continuity of care, enable effective care transitions, promote safe birth spacing, and improve the lifelong health of women.

• Engage Black communities and apply health equity principles in the development of maternal and women’s health programs.

• Improve access to integrated behavioral health care from preconception through one-year postpartum for women with mental and substance use disorders.

• Improve statewide infrastructure and programs to address violence and intimate partner violence at the state and community levels.

• Implement statewide maternal health and safety initiatives to reduce preventable maternal mortality and morbidity.

• Foster supportive community environments and leverage programs and services that help women of childbearing age achieve their full health potential.

• Support coordination between emergency and maternal health services, and implement evidence-based, standardized protocols to identify and manage obstetric and postpartum emergencies.

• Improve postpartum care management and discharge education for patients and families.

• Continue and strengthen activities to increase public awareness and prevention.

• Support strategies to continuously improve maternal mortality investigation and case review processes.

The full report is available on the DSHS website.

Increasing Access to Healthcare Coverage for Uninsured, Postpartum Women in Texas

This report provides information on access to healthcare coverage during the postpartum period for underserved women, and provides recommendations for improving access to care, specifically through the Texas women’s health programs.

Download the Report

This report is a product of the Postpartum Access to Healthcare (PATH) Project, a study of the system and experience of care during the postpartum period for underserved women in Central Texas. PATH is a project of the Texas Collaborative for Healthy Mothers and Babies (TCHMB), the state perinatal quality collaborative, and is funded by the St. David’s Foundation.

Data sources for the PATH project and this report include interviews with 32 pregnant/postpartum women and with 20 providers and clinic staff who serve this population. Each woman was interviewed up to three times (late prenatal, 1-2 weeks postpartum, and 4-6 weeks postpartum). Qualitative interview data were supplemented with available quantitative data on Texas’ women’s health programs sourced from publicly-available Texas state agency documents. Participant recruitment was conducted in partnership with two large Federally Qualified Health Center (FQHC) systems in central Texas.

This study identified three key areas for action to increase access to public healthcare coverage for underserved women:

1. Close the information gaps among women, providers, and advocates regarding the Texas Family Planning Program and Healthy Texas Women and encourage provider participation.

2. Improve processes to facilitate women’s transition between Medicaid for Pregnant Women and Healthy Texas Women.

3. Bolster the Texas Family Planning Program to expand its reach and scale its impact.

Letter from the Chair and Executive Sponsor

Dear Friends and Colleagues,

Our thoughts are with you and your families as you do your best to weather the COVID-19 crisis. 

Like so many organizations, the Texas Collaborative for Healthy Mothers and Babies has been engaged in a conversation about how to stay true to our commitments while adapting to the realities of a health care system that has had to shift priorities in ways we couldn’t have anticipated even two months ago. 

In light of this new reality, we will continue with our current quality improvement programs, but will shift deadlines, expectations, and metrics as needed. The leadership and committees will continue to meet, but will do so remotely and in some cases less often. We will continue to communicate about our initiatives through our newsletter and on social media, but will do so less frequently than before. We will also post perinatal-specific resources on dealing with COVID-19 on our website. 

Paid staff at UT System will continue to dedicate their time to TCHMB as before, but much of the clinical leadership on the committees and in the hospitals and clinics may not be able to dedicate as much time as they were prior. And we will all continue to adapt as the situation changes.

Stay safe, and please reach out with questions and suggestions.

Sincerely,

Michael E. Speer, MD
Chair, Texas Collaborative for Healthy Mothers and Babies

David Lakey, MD
Vice Chancellor for Health Affairs and Chief Medical Officer, The University of Texas System

TCHMB Wins 2nd Place in National Improvement Video Challenge

The TCHMB-produced video, “MEWS: A Simple Alogorithm for Reducing Maternal Mortality and Morbidity, has been awarded second place in the Council on Patient Safety in Women’s Health Care’s National Improvement Video Challenge. 

Diabetes Screening and Treatment Available for Healthy Texas Women Clients

Healthy Texas Women is a program dedicated to offering women’s health and family planning at no cost to eligible women in Texas. Since July 1, 2016, the HTW program has provided coverage for screening and treatment of hypertension, diabetes and high cholesterol.

In the most recent Maternal Mortality and Morbidity Task Force and Department of State Health Services Joint Biennial Report, chronic health diseases such as pre-pregnancy obesity, diabetes and hypertension were all associated with an increased risk for maternal death. The Centers for Disease Control and Prevention reports that almost 25 percent of people with diabetes and 20 percent of people with hypertension are undiagnosed.

By increasing access to vital health services and treating underlying medical conditions, women’s health and pregnancy related outcomes can improve in Texas.

Several commonly prescribed medications used to treat these conditions are available on the current HTW drug formulary. Clients approved for HTW can get these medications at any Medicaid participating pharmacy with their program identification card.

To learn more about which medications are covered, healthcare providers can access the HTW specific formulary at txvendordrug.com/resources/downloads. Participating HTW providers can access information regarding policies, billing guidelines and toolkits at healthytexaswomen.org/provider-resources.

TexasAIM by the Numbers: 206 Hospitals and Counting

In our last issue, we spoke to Dr. Manda Hall, Associate Commissioner for Community Health Improvement at the Texas Department of State Health Services, about TexasAIM, a new initiative focused on reducing maternal mortality and morbidity in Texas. The initiative, which is being implemented by DSHS in partnership with the Alliance for Innovation on Maternal Health (AIM) and the Texas Hospital Association (THA), will help hospitals and clinics in Texas carry out maternal safety projects.

TexasAIM is launching with an Obstetric Hemorrhage Bundle. The initiative will then focus on the Obstetric Care for Women with Opioid Use Disorder Bundle and Severe Hypertension in Pregnancy Bundle.

As of December 2018, 206 birthing hospitals are participating in TexasAIM. That is 92% of all birthing hospitals in Texas.

As of December 2018, 206 (92%) of Texas’ birthing hospitals are participating in TexasAIM. Of those, 167 are designated “TexasAIM Plus” hospitals, and the other 39 are “TexasAIM Basic” hospitals.

Hospital Enrollment

• TexasAIM Basic Hospitals: 39

• TexasAIM Plus Hospitals: 167

• Total TexasAIM Hospitals: 206

TexasAIM Hospital Cohorts

The AIM Plus hospitals are being divided into five cohorts, by geography, with 20-30 hospitals in each cohort. Each hospital will receive in-person learning sessions from DSHS. They will do an intake assessment, implement the QI bundles, and track and share process and outcome data over time. The hospitals in each cohort are also working together as part of learning collaboratives.

Cohort 1: 32 (16% of enrolled hospitals)

• 91% of participating hospitals are Plus

• 76% of hospitals in the region are in AIM

Cohort 2: 47 (23% of enrolled hospitals)

• 89% of participating hospitals are Plus

• 98% of hospitals in the region are in AIM

Cohort 3: 40 (20% of enrolled hospitals)

• 65% of participating hospitals are Plus

• 95% of hospitals in the region are in AIM

Cohort 4: 44 (21% of enrolled hospitals)

• 84% of participating hospitals are Plus

• 96% of hospitals in the region are in AIM

Cohort 5: 42 (20% of enrolled hospitals)

• 79% of participating hospitals are Plus

• 91% of hospitals in the region are in AIM

Geographic Area

Rural Hospitals: 74% of Rural Texas Hospitals are enrolled in TexasAIM (17 Basic, 28 Plus)

Urban Hospitals: 98% of Urban Texas Hospitals are enrolled in TexasAIM (21 Basic, 139 Plus)

AIM Data Center Portal

• Registered Users in Portal: 402

• Hospitals Active in Portal: 191 (93% of enrolled hospitals)

• Hospitals with Structure Measures Entered: 176 (86% of enrolled hospitals)

• Hospitals with Process Measures Entered: 160 (78% of enrolled hospitals)

Remembering James A. Cooley

James A. Cooley, a healthcare researcher and analyst in the Medical and Social Services division at the Health and Human Services Commission, died Nov. 11, 2017. In his ten years at HHSC, he worked on several initiatives, including the Medicaid/CHIP super-utilizers program, but his work in improving the quality of health for Texans stretched beyond that. As a chief legislative staff member for the House Committee on Public Health and the Select Committee on State Health Care Expenditures, he worked on furthering health information technology, including helping to establish the Texas Health Services Authority.

In a post on the Texas Health and Human Services web site, Quality and Program Improvement Director Matthew Ferrara described Cooley as a sunny personality, good-natured and with formidable intellect and keen insight. Ferrara said Cooley’s contributions to healthcare and advancing health were numerous.