Background:
The postpartum period is an opportune time to link women to interventions designed to support early infant health, social and emotional development and to address maternal health and psychosocial issues that may jeopardize their future children. Clinical practices that care for women at high risk for subsequent poor pregnancy outcomes, often demonstrate low rates of return for postpartum visits. As part of an initiative to improve pregnancy and infancy outcomes, a quality improvement framework, including Care Quality and Breakthrough Series Learning Collaborative models was adopted to promote and support systems change to increase implementation of best practice guidelines addressing maternal and infant health and development issues, and link clinical practice to community resources.

Objectives:
This Collaborative aims to apply care quality and collaborative models for improvement of maternal and infant health to increase utilization of comprehensive post partum care; and to highlight a web-based registry and forum for shared learning to support improvement efforts.

Methods:
In May 2006, ten clinical sites began using a framework for planned care based on evidence-based clinical guidelines, and models for systems change and collaborative learning to implement improvements that will optimize delivery and utilization of postpartum care. Multidisciplinary teams from each site work as a unit to test incremental changes in their office systems, work flow, and provision of care to improve postpartum care. Teams track and report on key measures including: contact within one week of birth to support breastfeeding, contact and depression screening at two and six weeks postpartum, screening for type 2 diabetes among women with gestational diabetes, and measures for cultural and linguistic competency. A web-based registry and forum allows for ongoing shared learning between Collaborative teams.

Results:
Representatives from ten teams attended all leaning sessions and participate in monthly reporting. Teams are actively working on systems changes within their organizations to increase postpartum return rates and implement post partum depression and diabetes screening.

Conclusion and implications for practice:
Adopting a care quality collaborative model for systems change and shared learning is an effective mechanism for sustainable improvements in maternal and infant health.