Abstract / Summary
Background: The Alliance for Innovation on Maternal Health (AIM) developed evidence-based patient safety bundles to improve maternal outcomes. Maternal mortality in the United States remains higher than in other high-income countries, with over half of deaths occurring during the postpartum period. The Postpartum Discharge Transition (PPDT) Bundle aims to improve the transition from hospital to home. This review examines state-level maternal mortality trends following PPDT Bundle implementation and identifies challenges in evaluating outcomes across states. Methods: A descriptive literature review was conducted using PubMed with the search terms “maternal mortality,” “AIM Bundle,” and “postpartum discharge.” Publications from the past 10 years reporting state-level PPDT implementation or maternal mortality outcomes were reviewed. Maternal mortality data from 33 states were obtained from publicly available state reports. For states with documented PPDT implementation, mortality rates were compared before and after implementation when available. For states without documented implementation, mortality rates from 2020 and 2022 were compared. Trends were analyzed descriptively. Results: States with documented PPDT Bundle implementation demonstrated mixed maternal mortality trends. California (-43.6%), Virginia (-63.2%), and Kansas (-21.7%) reported decreases in maternal mortality during the evaluation period, whereas Mississippi (+14.0%) and New York (+16.1%) experienced increases. Among states without documented implementation, maternal mortality increased in Georgia, Kentucky, and Hawaii, with Hawaii demonstrating the largest increase (+87.4%). Connecticut and Louisiana showed modest decreases despite no documented implementation. Considerable variation in outcome reporting, implementation timelines, and available state-level data limited direct comparisons. Conclusion: Maternal mortality trends varied substantially across states, regardless of PPDT Bundle implementation status. While several implementing states demonstrated notable reductions in maternal mortality, outcomes were not consistent across all states. Variability in data collection methods, reporting practices, implementation fidelity, and concurrent maternal health initiatives limits the ability to attribute observed changes directly to PPDT Bundle implementation. These findings underscore the need for standardized outcome measures and more rigorous evaluation of postpartum care interventions to better assess their impact on maternal health outcomes.