Quality care collaboratives for maternal health across U.S. states: a scoping review protocol a scoping review protocol a scoping review protocol a scoping review protocol a scoping review protocol

Abstract Background Maternal and perinatal quality collaboratives (M/PQCs) across nearly all U.S. states focus on improving health care and outcomes for birth parents and their infants. In the context of increases in maternal morbidity (MM) and severe maternal mortality (SMM) in the USA, M/PQCs increasingly focus on addressing maternal care and disparities in care that are partly driving observed increases in SMM and MM. To date, quality care or safety bundles and other programming from state-based M/PQCs have been implemented by hospitals and other collaborating partners, while various studies have assessed their impact. However, no extant reviews synthesize the findings of this literature. The aim of this review is to synthesize the current evidence on implementation approaches of M/PQCs at the health system level in the USA and their impact on maternal health outcomes. Methods We will conduct a scoping review of the literature of studies or reports that qualitatively and/or quantitatively assess the implementation of “toolkits” or “bundles” through state M/PQCs. We will include studies and reports on the implementation of state M/PQC initiatives in health systems/birth facilities or the impact of these on births, maternal and infant health outcomes and clinical care in the USA published after January 1, 2000. We will exclude studies that examine single-site quality improvement initiatives or initiatives outside of state M/PQCs, or studies that do not report on implementation, births, maternal and infant health, nor care outcomes. The information sources will include MEDLINE, Embase, CINAHL, and the Maternity and Infant Care Database, as well as a targeted search using Google Advanced for grey literature to capture information produced outside of academic publishing channels such as government and academics. Each record will be assessed independently by two reviewers at the title/abstract level and then at the full-text level. Included records will be subject to single reviewer data abstraction. We will assess study quality using the Mixed Methods Appraisal Tool (MMAT). Results Findings will be reported in the form of a narrative review and mapping outcomes in tabular form. Discussion This review will identify where additional evidence is needed to understand the relationship between M/PQCs and maternal health care and outcomes, as well as understanding key implementation processes. We will note key limitations of the included studies and general implications for the broader findings. Systematic review registration Open Science Framework–Embargoed/anonymized until August 30, 2025 https://osf.io/bnmpk/?view_only=9e1f754cc2d947cba6ea889e5ae58f19 .