{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:07:52Z","timestamp":1781626072779,"version":"3.54.5"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T00:00:00Z","timestamp":1780099200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Perinatal quality collaboratives (PQCs) have been widely adopted across US states to improve maternal\u2013infant health care delivery and outcomes, yet rigorous evidence of their national impact on maternal mortality and severe maternal morbidity remains limited. This commentary identifies 2 fundamental challenges constraining causal inference in PQC evaluations. First, inconsistent measurement of key outcomes, stemming from staggered state adoption of revised vital statistics certificates and coding changes, confounds attempts to distinguish genuine health improvements from data artifacts. Second, the causal pathway from state-level PQC adoption to health outcomes involves multiple intermediate changes in clinical practices and care delivery that remain unobserved in administrative data. This imprecision in treatment measurement, combined with rare outcomes, severely limits statistical power, especially for analysis of subpopulations at increased risk of adverse maternal\u2013infant health outcomes (e.g., Black women, those in low-income communities). We recommend establishing a national registry to track quality improvement initiatives systematically, investing in harmonization of vital statistics data across states and time periods, and exploring alternative evaluation designs (e.g., synthetic control methods, stepped-wedge trials) to credibly estimate PQC impacts on maternal health outcomes.<\/jats:p>","DOI":"10.1093\/haschl\/qxag121","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T11:44:58Z","timestamp":1779968698000},"source":"Crossref","is-referenced-by-count":0,"title":["Scaling evidence: national causal evaluation of perinatal quality collaboratives needs better data"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8938-3577","authenticated-orcid":false,"given":"Rachel","family":"Nesbit","sequence":"first","affiliation":[{"name":"Economics, Sociology, & Statistics, RAND Corporation , Pittsburgh, PA 15213 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4618-9430","authenticated-orcid":false,"given":"Rachel K","family":"Landis","sequence":"additional","affiliation":[{"name":"Behavioral & Policy Sciences, RAND Corporation , Arlington, VA 22202 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kandice A","family":"Kapinos","sequence":"additional","affiliation":[{"name":"Economics, Sociology, & Statistics, RAND Corporation , Santa Monica, CA 90401 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"2026061611420975200_qxag121-B1","author":"Gunja"},{"key":"2026061611420975200_qxag121-B2","author":"Declercq"},{"issue":"4","key":"2026061611420975200_qxag121-B3","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1016\/j.clp.2020.08.009","article-title":"Advances in maternal fetal medicine: perinatal quality collaboratives working together to improve maternal outcomes","volume":"47","author":"Lee King","year":"2020","journal-title":"Clin Perinatol"},{"issue":"2","key":"2026061611420975200_qxag121-B4","first-page":"1","article-title":"Maternal mortality in the United States: changes in coding, publication, and data release, 2018","volume":"69","author":"Hoyert","year":"2020","journal-title":"Natl Vital Stat Rep"},{"issue":"4","key":"2026061611420975200_qxag121-B5","doi-asserted-by":"publisher","first-page":"440.e1","DOI":"10.1016\/j.ajog.2023.12.038","article-title":"Maternal mortality in the United States: are the high and rising rates due to changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance?","volume":"230","author":"Joseph","year":"2024","journal-title":"Am J Obstet Gynecol"},{"key":"2026061611420975200_qxag121-B6","doi-asserted-by":"publisher","DOI":"10.1377\/forefront.20260218.186675","article-title":"We must protect the only national data on preventable maternal deaths","author":"Herrick","year":"2026","journal-title":"Health Aff Forefront"},{"key":"2026061611420975200_qxag121-B7","author":"Trost","year":"2022"},{"issue":"3","key":"2026061611420975200_qxag121-B8","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1097\/AOG.0000000000005497","article-title":"Validity of birth certificate data compared with hospital discharge data in reporting maternal morbidity and disparities","volume":"143","author":"Gemmill","year":"2024","journal-title":"Obstet Gynecol"},{"key":"2026061611420975200_qxag121-B9","author":"Nesbit"},{"issue":"1","key":"2026061611420975200_qxag121-B10","doi-asserted-by":"publisher","first-page":"122.e1","DOI":"10.1016\/j.ajog.2015.08.019","article-title":"Black-white differences in severe maternal morbidity and site of care","volume":"214","author":"Howell","year":"2016","journal-title":"Am J Obstet Gynecol"}],"container-title":["Health Affairs 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