title: Maternity care and liability: most promising policy strategies for improvement.
abstract: BACKGROUND
  The present liability system is not serving well childbearing women and newborns, maternity care clinicians, or maternity care payers. Examination of evidence about the impact of this system on maternity care led us to identify seven aims for a high-functioning liability system in this clinical context. Herein, we identify policy strategies that are most likely to meet these aims and contribute to needed improvements. A companion paper considers strategies that hold little promise.
  
  
  METHODS
  We considered whether 25 strategies that have been used or proposed for improvement have met or could meet the seven aims. We used a best available evidence approach and drew on more recent empirical legal studies and health services research about maternity care and liability when available, and considered other studies when unavailable.
  
  
  RESULTS
  Ten strategies seem to have potential to improve liability matters in maternity care across multiple aims. The most promising strategy--implementing rigorous maternity care quality improvement (QI) programs--has led to better quality and outcomes of care, and impressive declines in liability claims, payouts, and premium levels.
  
  
  CONCLUSIONS
  A number of promising strategies warrant demonstration and evaluation at the level of states, health systems, or other appropriate entities. Rigorous QI programs have a growing track record of contributing to diverse aims of a high-functioning liability system and seem to be a win-win-win prevention strategy for childbearing families, maternity care providers, and payers. Effective strategies are also needed to assist families when women and newborns are injured.
authors: Childbirth Connection, New York, New York 10016, USA. sakala@childbirthconnection.org
authors: Carol
authors: C
authors: Sakala
authors: Y Tony
authors: YT
authors: Yang
authors: Maureen P
authors: MP
authors: Corry
mesh_terms: D005260:Female; D006291:Health Policy; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D007231:Infant, Newborn; D007351:Insurance, Liability / Q000191:economics* / Q000331:legislation & jurisprudence; D016365:Liability, Legal / Q000191:economics*; D008318:Malpractice / Q000191:economics* / Q000331:legislation & jurisprudence; D008427:Maternal Health Services / Q000458:organization & administration*; D009774:Obstetrics / Q000191:economics*; D058996:Quality Improvement