Comparing Two Review Processes for Determination of Preventability of Maternal Mortality in Illinois.

OBJECTIVES: To compare the results of two maternal death review processes conducted from 2002 to 2012 by Illinois regionalized perinatal centers with those conducted by the Illinois Department of Public Health's (IDPH's) statewide multidisciplinary external Maternal Mortality Review Committee (MMRC). METHODS: This is a retrospective record review linking MMRC case assessment forms to the IDPH's Maternal Mortality Review Form database to compare causes of death and potential preventability as determined by both review processes. RESULTS: MMRC records for 76 maternal death reviews were linked to the IDPH maternal mortality review form database. Most deaths reviewed by the statewide MMRC were due to pregnancy-related causes. The statewide MMRC differed from the regional perinatal centers on cause of death in 55.3% (n = 42) of cases and on the disposition of potential preventability in 48.7% (n = 37) of cases. The statewide MMRC judged 69.7% (n = 53) of cases potentially preventable, compared with 40.8% (n = 31) for the regional perinatal centers. The MMRC identified more preventable provider and systems factors for potentially preventable deaths compared with regional perinatal centers which identified more preventable patient factors. CONCLUSIONS FOR PRACTICE: The statewide MMRC found more potential preventability and determined that preventability was associated with provider and systems factors, not patient factors. Observed discrepancies between regional perinatal center and statewide MMRC reviews were likely due to the complexity of cases selected for review, the multidisciplinary external composition of the review team, and the de-identification of cases. Multidisciplinary statewide expert panels should be implemented in addition to local and regionalized reviews.

Substance Use Disorders, Comorbidity, and Arrest among Indigenous Adolescents.

Indigenous adolescents are overrepresented at multiple stages of the justice system, but we know very little about the role that mental health, particularly substance use disorder, plays in Indigenous pathways to arrest. This study examined the association between substance use disorder, its comorbidity with other disorders, and arrest using a longitudinal sample of Indigenous youth from the Northern Midwest and Canada. Of the 16% of youth who reported at least one arrest at Wave 5, half met criteria for substance abuse/dependence, and slightly more for conduct disorder. Substance abuse/dependence and conduct disorder were each associated with an increased risk of arrest, although co-occurring disorders were not. The reciprocal effects of arrest and mental disorder are discussed.

Reducing maternal deaths through state maternal mortality review.

BACKGROUND: Illinois has one of the highest rates of maternal death in the United States, and in 2000, the Illinois Maternal Mortality Review Committee (MMRC) was created to address this high rate of maternal death. METHODS: This is a detailed description of the development of the MMRC, its process of review, its impact on the state's attention to maternal mortality and its obstetric hospitals, and a summary of its initial findings. RESULTS: The Illinois MMRC, specifically designed to be multidisciplinary, was created to provide secondary review of select maternal deaths. Between 2000 and 2010, 45 of the 93 deaths reviewed had complete analysis. Hemorrhage was the leading cause of death, and 69% of all cases were deemed potentially avoidable. Compared to the primary required review conducted by the State Perinatal Center, the secondary review by the MMRC changed the cause of death in 20% of cases and changed the determination of avoidability in 36% of cases. Based on these findings and advocacy by the MMRC, in 2008, Illinois mandated that every M.D. and R.N. provider working in the obstetric unit of every obstetric hospital must complete the maternal hemorrhage education program. CONCLUSIONS: The MMRC has had a positive impact on Illinois' approach to reducing maternal deaths by being instrumental in getting the state to mandate that every obstetric hospital must comply with the Obstetric Hemorrhage Education Project to maintain its credentials. Further, the high rates at which cause of death and potential avoidability of death were changed by the MMRC underscore the need for multidisciplinary independent review of maternal deaths to achieve more accurate data and, hence, ultimately institute focused interventions to decrease preventable deaths.