TCHMB Welcomes Four New Executive Committee Members

Read more about why they are a good fit to lead TCHMB’s efforts for quality care, equity and safety for mothers and babies.

Vice-Chair of Executive Committee: Charleta Guillory, MD, MPH, FAAP

Professor of Pediatrics, Baylor College of Medicine

Why are you interested in serving as Vice Chair for TCHMB?

“As the Director of the Neonatal-Perinatal Public Health Program, and as immediate past Director of the Texas Children's Hospital Level II Nursery, I see firsthand, as a pediatrician and neonatologist, complications of prematurity, birth defects and metabolic disorders. These complications require many infants to be transferred into our center from across the state of Texas and beyond its borders.

I have always been an advocate to improve the health of mothers and babies and have recognized that vulnerable populations have poorer outcomes. I have dedicated my life, both professionally and personally, to decreasing infant mortality, improving infant and child health, and eliminating socio-economic, racial and ethnic disparity in maternal, infant and child health outcomes. Serving as Chair of the TCHMB is another opportunity to make an impact on the lives of Texas families. I bring to this committee a voice of experience and a voice of compassionate concern.”

Neonatal Committee Co-Chair: Gillian Gonzaba, NNP

Neonatal Nurse Practitioner, Associate Director for High Reliability/Patient Safety and Simulation, Pediatrix Medical Group, San Antonio

What do you hope to accomplish as Neonatal Co-Chair?

“I would like to work to improve access to care and diversity for all mothers across the state. With improved access to care, there is the potential for improved outcomes for our patients when they are born.”

New At-large EC Member: Jasmine Farrish CNM, MSN, MPH

Nurse Supervisor- Nurse Family Partnership University of Texas at Tyler Health Science Center

What strengths or unique perspectives do you bring to the Executive Committee?

“I have 10 years of maternal child experience in various settings mostly outside of the hospital setting. I believe the community perspective is important piece to serving the entire family in additional to addressing hospital policies. Serving families within the home as a nurse home visitor shed light on the importance of addressing the entire family unit in order to impact change.”

New At-large EC Member: Sonal Zambare, MD

Assistant Professor; Obstetric Anesthesiology, Baylor College of Medicine

What strengths or unique perspectives do you bring to the Executive Committee?

“As a fellowship trained anesthesiologist from a busy practice, I bring my experience in successfully managing many high risk, and complicated pregnant patients. I am the anesthesiologist on the MOM grant (a grant from CMS for helping pregnant patients with substance use disorders, especially opioids), which has broadened my reach to the community. I am the lead on establishing the Enhanced Recovery after Cesarean protocol at Ben Taub Hospital, which has been a successful program.”

Hospitals Are Moving the Needle on Data Collection

The Newborn Admission Temperature (NAT) Project aims to improve the proportion of newborn babies with normal temperatures. We completed more than one year of data collection and early this fall released example evidence-based guidelines that hospitals can choose to use.

The NAT project has also produced benefits for implementing future QI projects and initiatives. For example, we asked hospitals to rate the statement “Being part of the NAT project helps us better report data by race and ethnicity.”

The proportion of hospitals that reported that their participation in the NAT project is helping them improve reporting of data stratified by race and ethnicity increase over the course of the initiative. In the first two data reporting cycles, only about one third (33-38%) of hospitals agreed with this statement, compared to nearly half (47%) of hospitals by the most recent data reporting cycle. (Click here to view the graph.)

Looking at the critical factors and conditions (challenges or barriers) that ensure effective practices are carried out and sustained for future practices is part of implementation science and it is equally as important as improving health outcomes for several reasons:

• Routinely reporting race/ethnicity through the NAT project might have a trickle-down effect as hospitals begin to build these processes within their own systems and projects; and

• The NAT project is the first TCHMB project that has documented outcomes by race and ethnicity and has set the stage for future TCHMB projects to do the same.  This is a strategy that cannot be understated given the disparities in maternal and neonatal outcomes in Texas.

Texas’ perinatal population is diverse and rapidly growing, and despite considerable improvement efforts, disparities in several key perinatal health indicators persist or have widened. Black mothers in Texas had higher rates of severe maternal mortality (SMM) than mothers of any other race or ethnic group over the past decade, and this disparity has widened since 2016.

High-quality, stratified data including race and ethnicity, at a minimum, can help reveal how different subpopulations are faring and track efforts to advance equity in health care and health outcomes. In this way, through its data collection process and through the participation of hospitals, the NAT project is breaking barriers while also working to eliminate disparities in perinatal health outcomes.

Read more about the new CDC grant that will work towards eliminating disparities in Texas.  

DSHS Releases 2022 Morbidity and Mortality Report

The Texas Department of State Health Services released the 2022 Morbidity and Mortality Report, showing that obstetric hemorrhage was the leading cause of pregnancy-related death in Texas, with mental health second. The report shows racial disparities persist and discrimination contributed to 12% of pregnancy-related deaths in 2019.

Read the Texas Maternal Mortality and Morbidity Review Committee and DSHS Joint Biennial Report 2022 online.

Diving into Social Determinants of Health

It is common for patients to leave the hospital and not get prescriptions or health-related services post-discharge. These factors, some of which are external to the healthcare system, still affect a person’s health. Therefore, hospitals have begun addressing social determinants of health, also known as health-related social needs. Examples of social determinants of health include employment, transportation, and access to medicine and food. Social determinants of health make up 80% of the care that patients need for optimal health. Everyone has social determinants that affect their health, and for those who lack the resources to meet their needs, there are community organizations and programs to address these needs.

The theme of the 2023 Texas Collaborative for Health Mothers and Babies Summit is Social Determinants of Health and How They Impact Maternal and Neonatal Outcomes. Our aim is to provide examples from other Perinatal Quality Collaboratives, hospitals and partner organizations and programs to show that addressing social determinants of health can improve birth outcomes for mothers and babies, beyond the first year of birth. Hospitals are learning it is not enough to document needs or even supply a list of services. Some patients need navigators and advocates who can walk alongside them for a period. Therefore, some of the Summit sessions will include how and when to measure social needs; how to find partners to address social needs; how to refer patients in a meaningful way; and how to ensure or document how patients’ needs have been met, also known as closing the loop.

To learn more about social determinants of health, what your organization can do, and tools, visit the following websites:

• https://www.cdc.gov/socialdeterminants/about.html

• ttps://www.healthcarevaluehub.org/cost-and-quality-problems/browse-cost-driverquality-issue/social-determinants-health)

• https://www.aha.org/social-determinants-health/populationcommunity-health/community-partnerships - See article – Emerging Strategies to Ensure Access to Health Care Services – Social Determinants of Health

• Get Started | 2-1-1 Texas (211texas.org)

NAT is TCHMB's largest Statewide Initiative to Date

The Newborn Temperature Admission (NAT) Project posted new data from the Jan.-March reporting period, showing a majority of hospitals participating, the largest initiative in TCHMB’s history. When the April-June 2022 data is complete (due July 31st), the hospital level data will be shared back via the dashboard. The hospital level dashboard can establish a “baseline” and prepare for implementing evidence-based guidelines to increase the proportion of newborn infants with admission temperatures within normal limits. Read the Jan.-March summary report here.

Key Points:

• An astounding 76 percent of enrolled hospitals reported data for the period.

• There are currently 160 hospitals enrolled, making it TCHMB’s largest statewide initiative to date.

• This is the first time a TCHMB initiative has tracked data by race/ethnicity.

Why it matters:

By tracking data from each hospital, the NAT project can complete statewide analyses, including by region or type and size of hospital, as well as hospital-specific analyses.

Testimonials from NAT Project Ahead of Hospital-Level Dashboard

Only July 31, 2022, hospitals actively participating in the Newborn Admission Temperature Project will submit another round of data, marking one full year of data collection. This data will allow TCHMB to provide participating hospitals with hypothermia prevalence at their own hospitals, and more. Having a full year of data means that the estimates are more reliable, and can provide meaningful insights into patterns at the state and regional levels.

The NAT project is the largest in TCHMB history with 160 hospitals enrolled. During the most recent round of data reporting, over 75% of enrolled hospitals submitted data to TCHMB. See what some hospitals are saying, after nearly one year of participating in the NAT project:

Memorial Hermann Health System decided to participate in the project because we consider the work that TCHMB is doing as important, and we are focusing on reducing disparity in equity, diversity, and inclusion work.

 With 25,000 deliveries a year, we were faced with a daunting project to obtain race and ethnicity on each newborn and collect temperatures according to the different parameters for well baby and NICU. We leveraged our ability to create documentation reports and perform data analysis to avoid the manual tracking and chart review, cutting down manual validation by an estimated 95%.

- Memorial Hermann Health System

The project was a definite challenge for our institution because of the large number of patients we care for. Obtaining data was very labor intensive and required working with a data architect to get a custom report built. Building the report, obtaining data outside of our NICUs and validating data were all challenges we encountered which required a lot of time, but we eventually overcame those challenges.

- Texas Children’s Hospital

In 2019-2020, Doctors Hospital of Laredo (DHL) solely tackled the newborn admission temperature QI project knowing that thermoregulation is the holy grail of neonatology. Huge strides were made towards adequate thermoregulation of the newborn, bringing DHL very close in achieving the goal.

In late 2020, when TCHMB announced the QI initiative of Newborn Admission Temperature (NAT) to increase newborn health care quality and patient safety; DHL did not hesitate in enrolling.  We are hopeful in reaching the goal and provide quality care to every single baby born at DHL by participating in the state-wide NAT project.

Thank you for allowing us to participate.

- Doctors Hospital of Laredo

If your hospital has questions about the project or needs technical assistance in reporting to the project, visit NAT Office Hours, every Wednesday from 12-2 p.m. CST.