{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,24]],"date-time":"2026-05-24T07:05:59Z","timestamp":1779606359072,"version":"3.53.1"},"reference-count":28,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Med-QUEST Division"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Equity"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Hawai\u2018i reports favorable perinatal health outcomes compared to national averages (preterm birth rate: 9.8%; infant mortality rate: 4.6 per 1,000 live births), yet disparities persist. Native Hawaiian and Pacific Islander women experience higher rates of preterm birth (12.6%) and lower early prenatal care (62.7%). Med-QUEST, Hawai\u2018i\u2019s Medicaid program, supported implementation of a Perinatal Quality Collaborative (PQC) to expand access to evidence-based maternal safety practices across birthing facilities. Hospitals implemented protocols (e.g., training, drills, and equipment changes) aligned with the Alliance for Innovation on Maternal Health (AIM) Patient Safety Bundles, with cross-hospital learning facilitated through structured monthly meetings and peer exchange. This study examines how the PQC operationalized quality improvement (QI) among Medicaid-serving hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We used a mixed-methods approach, including observational analysis of severe maternal morbidity (SMM) rates among Hawai\u2018i\u2019s Medicaid population and 10 semi-structured interviews from participating birthing facilities. Interviews explored implementation processes, supports, and barriers. Hospitals\u2019 progress was tracked through milestone completion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Participants reported structured AIM bundle implementation, gap analyses, and sustained peer exchange within a cooperative, non-competitive culture. SMM rates increased from 2016 to 2022 and stabilized in 2023 to 2024; racial\/ethnic disparities persisted throughout the PQC implementation. Qualitative findings emphasized infrastructure and context-specific adaptations rather than targeted disparity-reduction strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Health Equity Implications:<\/jats:title>\n                    <jats:p>Expanding access to structured implementation support across diverse and rural hospitals may strengthen statewide QI infrastructure; targeted strategies beyond inpatient bundle implementation are likely necessary to reduce disparities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The state-level Pay-for-Performance effectively facilitated statewide implementation of AIM bundles and hospital-level QI processes among Medicaid-serving facilities. Observed SMM trends underscore the importance of sustained implementation efforts and complementary strategies to address disparities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/24731242261448657","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T10:32:27Z","timestamp":1779445947000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Perinatal Quality Improvement Among Medicaid Populations in Hawai\u2018i: Insights from a Statewide Learning Collaborative"],"prefix":"10.1177","volume":"10","author":[{"given":"Andrea C.","family":"Ng","sequence":"first","affiliation":[{"name":"Social Science Research Institute, University of Hawai\u2018i at M\u0101noa, Honolulu, Hawaii, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5719-1053","authenticated-orcid":false,"given":"Meldrick","family":"Ravida","sequence":"additional","affiliation":[{"name":"Social Science Research Institute, University of Hawai\u2018i at M\u0101noa, Honolulu, Hawaii, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reinie G.","family":"Gerrits-Goh","sequence":"additional","affiliation":[{"name":"Social Science Research Institute, University of Hawai\u2018i at M\u0101noa, Honolulu, Hawaii, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Yuan","sequence":"additional","affiliation":[{"name":"Social Science Research Institute, University of Hawai\u2018i at M\u0101noa, Honolulu, Hawaii, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlie","family":"Iwata","sequence":"additional","affiliation":[{"name":"Social Science Research Institute, University of Hawai\u2018i at M\u0101noa, Honolulu, Hawaii, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"McKinsey","sequence":"additional","affiliation":[{"name":"Social Science Research Institute, University of Hawai\u2018i at M\u0101noa, Honolulu, Hawaii, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P.","family":"Barile","sequence":"additional","affiliation":[{"name":"Social Science Research Institute, University of Hawai\u2018i at M\u0101noa, Honolulu, Hawaii, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Luo","sequence":"additional","affiliation":[{"name":"Social Science Research Institute, University of Hawai\u2018i at M\u0101noa, Honolulu, Hawaii, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"e_1_3_2_2_1","volume-title":"NCHS Health E-Stats","author":"Hoyert DL","year":"2025","unstructured":"1.Hoyert DL. Maternal mortality rates in the United States, 2023. NCHS Health E-Stats. National Center for Health Statistics: Hyattsville, MD; 2025."},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6835a3"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301294"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.31372\/20200501.1066"},{"key":"e_1_3_2_6_1","unstructured":"5.Hawaii Maternal and Infant Health Collaborative (HMIHC). State health improvement report. HMIHC: Honolulu HI; 2016."},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13662"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1377\/forefront.20251016.231218"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.3109\/10398562.2011.583072"},{"key":"e_1_3_2_10_1","volume-title":"Trends in Severe Maternal Morbidity Complications by Patient Characteristics, 2016\u20132021 (Statistical Brief #312)","author":"Reid LD","year":"2024","unstructured":"9.Reid LD. Trends in Severe Maternal Morbidity Complications by Patient Characteristics, 2016\u20132021 (Statistical Brief #312). Agency for Healthcare Research and Quality: Rockville, MD; 2024."},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2017.03.009"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2018.6941"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39570.749884.BE"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-025-07896-3"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/00333549211021146"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2017.05.007"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2024.151908"},{"key":"e_1_3_2_18_1","volume-title":"Designing and Delivering Whole-Person Transitional Care (AHRQ Publication No. 20-0043-EF).","author":"Agency for Healthcare Research and Quality","year":"2020","unstructured":"17.Agency for Healthcare Research and Quality. Designing and Delivering Whole-Person Transitional Care (AHRQ Publication No. 20-0043-EF). U.S. Department of Health and Human Services: Rockville, MD; 2020."},{"key":"e_1_3_2_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732305276687"},{"key":"e_1_3_2_20_1","volume-title":"NVivo (Version 14) [Computer software]","author":"Lumivero","year":"2023","unstructured":"19.Lumivero. NVivo (Version 14) [Computer software]. Lumivero: Denver, CO; 2023."},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2017.1144"},{"key":"e_1_3_2_22_1","unstructured":"21.Alliance for Innovation on Maternal Health (AIM). AIM SMM codes list v05-14-20241111. 2024. Available from: https:\/\/saferbirth.org\/severe-maternal-morbidity\/ [Last accessed: October29 2025]."},{"key":"e_1_3_2_23_1","volume-title":"Obstetric Hemorrhage Patient Safety Bundle: Core Data Collection Plan (Version 2.0)","author":"Alliance for Innovation on Maternal Health (AIM)","year":"2024","unstructured":"22.Alliance for Innovation on Maternal Health (AIM). Obstetric Hemorrhage Patient Safety Bundle: Core Data Collection Plan (Version 2.0). American College of Obstetricians and Gynecologists: Washington, DC; 2024."},{"key":"e_1_3_2_24_1","volume-title":"Severe Hypertension in Pregnancy Patient Safety Bundle: Core Data Collection Plan (Version 2.0)","author":"Alliance for Innovation on Maternal Health (AIM)","year":"2024","unstructured":"23.Alliance for Innovation on Maternal Health (AIM). Severe Hypertension in Pregnancy Patient Safety Bundle: Core Data Collection Plan (Version 2.0). American College of Obstetricians and Gynecologists: Washington, DC; 2024."},{"key":"e_1_3_2_25_1","volume-title":"Hospital Quality Pay for Performance Guidance for Measurement Year 2025 (Memorandum Nos. QI-2512, FFS 25-06)","author":"State of Hawaii, Department of Human Services, Med-QUEST Division","year":"2025","unstructured":"24.State of Hawaii, Department of Human Services, Med-QUEST Division. Hospital Quality Pay for Performance Guidance for Measurement Year 2025 (Memorandum Nos. QI-2512, FFS 25-06). State of Hawaii: Honolulu, HI; 2025."},{"key":"e_1_3_2_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.01.017"},{"key":"e_1_3_2_27_1","volume-title":"APR DRG Billing Guidance (Memorandum No. QI-2211)","author":"State of Hawaii, Department of Human Services, Med-QUEST Division","year":"2022","unstructured":"26.State of Hawaii, Department of Human Services, Med-QUEST Division. APR DRG Billing Guidance (Memorandum No. QI-2211). 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