Case abstractors are critical members of Maternal Mortality Review Committees (MMRC). Their expertise and skill at reviewing and abstracting information about a person’s story directly affects key decisions and recommendations made by the MMRC.
Abstractors are most successful in their role when they have numerous years of experience in clinical obstetric care (for example, as a nurse). This is because abstractors need to know the significance of changes in vital signs, reported symptoms, subsequent events, and documentation of escalation of care. Additionally, abstractors need to be able to identify instances when care or services were provided in a way that could have been influenced by the person’s race, age, culture, chronic disease diagnosis, marital status, insurer, language, or a combination of these factors. For this reason, it is essential that abstractors receive focused training that supports them in understanding the bias inherent in data sources they abstract, such as medical records; their personal biases; how those biases could influence the information they abstract; and how information about the case is presented in the case narrative.
It is the responsibility of the abstractor to remain mindful and aware during the case abstraction process for instances of implicit bias, both within themselves as they compile case information, but also within the individual case records and the committee itself.
Sources of Information for Abstraction
Abstractors typically work closely with the MMRC coordinator to request, collect, and abstract the records of birthing persons whose deaths were selected for abstraction and review by the MMRC. Unless legislative limitations on what the MMRC can collect exist, case abstractors can collect information from as many of the following sources as possible:
- After abstraction is complete, the abstractor creates a case narrative to summarize the details of each maternal mortality. Abstractors should use a template to promote a standardized format for review. A template is provided in the MMRIA MMRC Abstractor Manual, linked below, and within MMRIA. The narrative should succinctly capture all relevant information about her life and the events leading to the woman or birthing person’s death in chronological order. The case narrative supplements but does not replace the full set of data abstracted by the case abstractor.
- Vital records (death certificates, birth certificates, fetal death records)
- Outpatient clinic records related to each of the following: primary care, family planning, prenatal, postpartum, mental health, and other office visits
- Emergency department and hospitalization records (outpatient and inpatient stays)
- Autopsy reports and findings from the hospital, coroner, or other medical examiners
- Medicaid claims data
- Child protective services
- Prescription Drug Monitoring Program (PDMP)
- Violent Death Reporting System (VDRS)
- State Unintentional Drug Overdose Reporting System (SUDORS)
- Plan of Safe Care (POSC)
- Police/first responder reports
- Medical transport records
- Informant interviews of providers, family, or friends