1. Problems in Birth Registration What is the National Standard? Why is the data so important? Joanne M. Wesley Office of the State Registrar

2. Data Done Right!  Currently there are 10 data items that are a problem in Minnesota birth registration.  The National Center for Health Statistics requires all states to report data accurately with the fewest “unknowns” as possible.  NCHS sets the standard for an acceptable percentage of “unknowns”.

3. Understanding Data  Understanding what the data field is allows a birth registrar to identify that data item in the medical record.  When birth registrars understand the importance of each data field, why the information is needed and how it is used it increases the accuracy and quality of data.

4.  Sometimes found in the medical record  Should be asked on the Mother’s Worksheet NCHS Standard: 1.32 Minnesota: 1.45 1. Education of the Mother

5. Why Mother’s Education? Because it tracks:  trends in completed family size  fertility rates by age group  maternal/child health outcomes by age

6. Last Normal Menses 2. Month / Day / 3. Year  Actual date is best but month/year is acceptable  May be found in medical record under prenatal care  Should be asked on the Mother’s Worksheet  Try not to file an unknown NCHS Standard: Minnesota: Month…….5.6410.67 Day….....17.7810.67 Year........5.0310.67

7. Why Date of Last Normal Menses? Because it helps track:  Gestational age Pre-term – before 34 weeks Late pre-term – 34 to 37 weeks Full term – 38 to 41 weeks Post date – after 41 weeks  Gestational age is a key factor in infant outcomes

8. 4. Tobacco Use 5. Number of Cigarettes  Should be asked on the Mother’s Worksheet  Women often under report their tobacco use  Smoking may change during the pregnancy Tobacco use: NCHS Standard: 1.00Minnesota: 1.12 Number of Cigarettes: NCHS Standard: 4.76Minnesota: 4.82

9. Why track tobacco use? Obvious risk factor in pregnancy Because it tracks:  Adverse effects on infant outcomes  Low birth weight  Intrauterine growth retardation  Miscarriage  High infant mortality  Negative consequences on the child’s long term health and development

10. 6. Alcohol Use  Should be asked on the Mother’s Worksheet  Women often under report their alcohol use  Alcohol use may change during the pregnancy  Healthcare provider usually ask during prenatal care NCHS Standard: 2.03 Minnesota: 2.24

11. Why Alcohol Use? Because it:  Alerts healthcare providers to possible adverse outcomes at birth and beyond  May allow for early screening and intervention for fetal alcohol spectrum disorder

12. 7. Medical Risk Factors  Know about each risk factor  Learn where each risk factor is found in the prenatal record and medical record  Best practice is to ask if you don’t know  Try not to file an unknown NCHS Standard: 1.00 Minnesota: 1.23

13. Why Medical Risk Factors? Because:  Maternal and infant outcome are affected by pregnancy and medical risk factors  Documenting risk factors may allow for healthcare interventions and additional care

14. 8. Complications of Labor  Know what the complications are  Know why they affect labor and birth  Know where data is located in the medical record  Best practice is to ask if you don’t know  Try not to file an unknown NCHS Standard: 1.00 Minnesota: 1.28

15. Why Complications of Labor? Because:  All complications have the potential to impact or significantly affect maternal and infant health  Accurate reporting will assist in research and planning for prevention  Helps in planning public health intervention that may improve quality of life

16. 9. Congenital Anomalies  Know what congenital anomalies are  Know where data is located in the newborn medical record  Best practice is to ask if you don’t know  Try not to file an unknown  Some anomalies are repairable and some are not NCHS Standard: 1.00 Minnesota: 1.44

17. Why Congenital Anomalies? Because:  Congenital anomalies remain the leading cause of infant death  Congenital anomalies are under reported on the birth record.  Helps in planning public health intervention that may improve quality of life  Know what the “other” conditions are to add excellence to the data collection

18. 10. Abnormal Conditions  Know what these conditions are  Know why they affect the newborn  Found in the newborn medical record  Best practice - ask if you don’t know NCHS Standard: 1.00 Minnesota: 1.32

19. Why Abnormal Conditions? Because:  Abnormal condition may impact the child’s health and development  Helps in planning public health intervention that may improve quality of life  Know what the “other” conditions are to add excellence to the data collection

20. Improvements Number of Data Categories above the National Standard  2006 - 14 data items  2007 - 13 data items  2008 - 13 data items  2009 - 10 data items Each year you get closer to meeting all the data standards set by NCHS.

21. Public Health Implications More accurate, comprehensive reporting on the birth record will enhance our ability to analyze and track crucial indicators of maternal child health, including demographic characteristics, healthcare utilization and outcomes.

22. Data Quality “Excellence is in the details. Give attention to the details and excellence will come.”

23. Thank you for the work you do!