PURPOSE:
Health disparities continue to challenge the US perinatal healthcare system. In response, community-based, midwifery-led care models are on the rise, and have demonstrated a reduction in disparities while maintaining excellent clinical outcomes. A robust quality improvement (QI) infrastructure that encourages multidisciplinary collaboration while centering shared patients is essential to this successful model. Smooth Transitions, housed at The Foundation for Health Care Quality, a neutral, nonprofit organization based in Washington State, brings together hospital providers and staff, community midwives, EMS personnel, and doulas, to improve the process for transfer of care, while centering whole patient safety.

DISCUSSION:
Smooth Transitions provides a framework for these diverse groups to develop transfer processes that preempt miscommunication, errors, and delays. The program provides education, resources, and opportunities for dialogue and relationships between all groups through regular meetings. Processes are guided by qualitative survey data that captures a 360 degree view of the transfer experience, from involved providers, nurses, EMS, doulas, and patients. Smooth Transitions has evolved to facilitate multidisciplinary simulations of common emergencies and protected case reviews, all of which focus on teamwork, communication, and safety. As the program has gained popularity and visibility, other states and national organizations in the US have expressed interest in collaborating with and/or replicating its work in their jurisdictions. It is a model that can be utilized in other countries where community midwives are present.

EVIDENCE WHERE RELEVANT:
Annual evaluations of participants provide data for analysis illustrating program efficacy.

KEY MESSAGE:
Community-based midwifery care is part of the solution to ongoing disparities in perinatal health outcomes, especially in rural and underserved communities. As efforts to reduce preventable maternal and newborn morbidity and mortality are implemented, it is critical that they are accompanied by a QI structure that evaluates and supports the impact of these efforts. Smooth Transitions is a program that addresses these issues. Regulation - framework