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Data Strategy

Every maternal mortality review committee (MMRC) should have a comprehensive data strategy documented in its policies and procedures. This data strategy should include the following:

  • Methods for identifying maternal death cases (e.g. through an agency or agreement)
  • Methods for assigning cases to abstractors
  • Methods for collecting, abstracting, and storing records and data
  • Methods for recording, collecting, and storing MMRC deliberations and recommendations
  • Methods for analyzing, summarizing, and reporting data on maternal death cases

An MMRC’s data strategy should employ best practices in the collection, abstraction, and analysis of maternal mortality data. Adhering to these standards ensures data collection is consistent and comparable across cases within the review and with other jurisdictions. This offers a solution toward solving the existing national dilemma: as most reviews collect and analyze data in a nonstandard way, data cannot be aggregated to create a national picture of maternal mortality in the United States.

MMRCs manage data separately for two distinct parts of the review process: case identification and case review. Potential cases are identified through a partnership between the MMRC, the state Vital Records office, and epidemiologists. This partnership conducts a routine review of deaths to determine if any of the deaths are pregnancy-associated. Death certificates may indicate a pregnancy-associated death through the pregnancy checkbox or a cause of death code related to pregnancy. However, death certificates are not sufficient to comprehensively identify all pregnancy-associated deaths. To identify further pregnancy-associated deaths, the MMRC should coordinate with the state vital records office and epidemiologists to ensure routine linkage is conducted of death certificates of females of reproductive age for a given time frame with infant birth or fetal death records during a related time frame. For a pregnancy-associated death identified from the death certificate alone, there may be value to the committee for a representative of Vital Records or the MMRC to confirm that the death occurred during pregnancy or within one year of the end of pregnancy before sending the case for abstraction and committee review. To view a Case Identification Flow Chart, click here.

Some MMRCs have additional protocols for identifying maternal deaths, including through direct hospital reporting, obituary searches or social media. All identified cases are sent to a designated MMRC contact to enter such cases into a database. A comprehensive database should support standardized case abstraction, case narrative development, documentation of committee decisions, and routine analyses. To view a Standard Committee Review form, click here.

Until recently, MMRCs lacked a standard approach for collecting data. Without consistent data collection, jurisdictions could not share their findings to more fully understand the causes of maternal mortality and develop shared approaches to eliminate preventable maternal deaths. To address the need for a common data language, the Centers for Disease Control and Prevention (CDC) partnered with maternal mortality review committees and subject matter experts to create the Maternal Mortality Review Information Application (MMRIA).

MMRIA supports standard case abstraction, case narrative development, documentation of MMRC decisions around preventability and contributing factors to a death, and routine analyses. MMRIA reflects lessons learned from implementing a previous version of the system, the Maternal Mortality Review Data System (MMRDS), among 13 state MMRCs.