Partnering to improve data quality and birth outcomes Extending our reach through partnerships June 2-6, 2013, Phoenix AZ

From Good to Great – Collaborating to Advance Data Quality The Birth Data Quality Workgroup Extending our reach through partnerships June 2-6, 2013, Phoenix AZ

Members Birth Data Quality Workgroup Co-chairs Isabelle Horon (MD), David Justice (NCHS), Joyce Martin (NCHS)Members Sukhjeet Ahuja (NAPHSIS), Sally Almond (MN), Marie Aschliman (UT), Karyn Backus (CT), Karin Barrett (MA), Krista Bauer (MN), Mary Chase (CO), Bruce Cohen (MA), Cindy Coleman (MN), Greg Crawford (KS), Cheri Denardo (MN), Judy Edwards (MN), Claudia Fabian (IL), Mark Flotow (IL), Coleen Fontana (RI), Kelly Friar (OH), Melissa Gambatese (NYC), Gloria Haluptzok (MN), Cindy Hooley (VT), Renata Howland, (NYC)Priya Kakkar (KS), Larry Nielsen (NAPHSIS), Lloyd Mueller (CT), Ann Madsen (NYC), Carol Moyer (KS), Laura Ninneman (WI), Michelle Osterman (NCHS), Sharon Pagnano (MA), Mariah Pokorny (SD), Phyllis Reed (WA), Matthew Rowe (WY), George Rudis (IL), Margarita Segundo (CO), Neeti Sethi (MN), Shae Sutton (SC), Marie Thoma (NCHS), Elaine Tretter (MD), Regina Zimmerman (NYC)

Origins Birth Data Quality Workgroup NAPHSIS/NCHS Good to Great collaboration VSCP Directors’ conference calls Workgroup established one year ago at 2012 Joint Meeting

Mission Birth Data Quality Workgroup Assess and improve the quality of vital statistics birth and fetal death data Focus on improving data at the source i.e., at the hospital

Priorities Birth Data Quality Workgroup Subgroups Hospital reports Karyn Backus (CT) Engaging hospitals Kelly Friar (OH), Colleen Fontana (RI) Prenatal care items Isabelle Horon (MD) New subgroups E-learning training for hospital staff Identify items to drop from the national birth data file Working with the Good to Great to develop process for dropping items

Birth Data Quality Workgroup Meeting 7:15 am Please join us!

Data Quality Workgroup Subgroup 1 Members: Karyn Backus (CT) Ann Madsen Straight (NYC) Phyllis Reed (WA) Elaine Tretter (MD) Greg Crawford (KS) Carol Moyer (KS) Mary Chase (CO) Sharon Pagnano (MA) David Justice (NCHS) Marie Thoma (NCHS) Sukhjeet Ahuja (NAPHSIS)

Charge: Recommend a process (metrics, means of communication, actions) for vital records offices to improve hospital reporting of birth certificate data Aim 1: Survey jurisdictions on their current activities to Measure hospital-level data quality Communicate findings to hospitals Act on information Background

NAPHSIS survey participants Characteristics of Jurisdictionsn/N (%) Response rate41/52 (78.8%) – United States 2/5 (40.0%) – Territories 2003 Birth Certificate33/41 (80.5%) – United States 1/2 (50.0%) – Territories Data quality responsibility Registration Staff14/41 (34.1%) Registration and Statistics (shared)18/41 (43.9%) Statistics Staff9/41 (22.0%)

Current Practices: Standardized Worksheets Jurisdictions using the 2003 birth certificate (n=33)

Current Practices: Evaluating Data Quality U.S. jurisdictions (n=41)

Current Practices: Evaluating Data Quality Does your jurisdiction maintain a desire to perform a more extensive quality review? 90% indicated “Yes” 95% indicating limited resources as main impediment

Current Practices: Evaluating Data Quality 63-71% 29-37% 100% Evaluated ImpactDetected Improvement No Yes! Completeness Reports, 63% (n=19) Medical Record Audits, 67% (n=9) Other Detailed Analyses, 71% (n=17)

Current Practices: Raising Awareness U.S. jurisdictions (n=40)* * No response for 1 jurisdiction

Produce Final Summary Report Subgroup 1 - Goals: Develop metrics to evaluate birth facility data quality that are feasible for jurisdictions to implement Develop means of communications to promote birth data quality Prepare best practice recommendations for data quality management Support overall data quality workgroup and ongoing national initiatives Future Directions

Data Quality Workgroup Subgroup 2 Members: Kelly Friar, Ohio Colleen Fontana, Rhode Island Melissa Gambatese, New York City Matthew Rowe, Wyoming Sharon Pagano, Massachusetts Elaine Tretter, Maryland Shae Sutton, South Carolina Joyce Martin, NCHS

Overall Charge Develop approaches in engaging hospitals to improve the quality of the birth certificate data provided to the jurisdictions’ Vital Records office Goal Develop a set of standard guidelines for jurisdictions to follow to engage hospital staff to improve the quality of the birth data. Can be tailored to any jurisdiction Can be self-sustaining Engaging Hospitals

Deliverables Short List of Deliverables Recommendations to Engage Hospitals Introduce intent of project/campaign to high level hospital key players Ways to identify key data elements that could/should be of concern to hospital Key points to consider when addressing hospital staff Such as…

A Few Key Points of Consideration Purpose of birth health data Contributing factors of birth outcomes How does quality data help the hospital with the community it serves What could be the “burning platform” for the hospital (QI – PDSA model) Develop ways for the hospital to access the data Standardization of definitions Training Metrics for vital records offices to improve hospital reporting – Subgroup 1

Action Items 1)Collaborate with national partners 2)Steal shamelessly from other jurisdictions that may have done this! 3)Determine why a hospital should care and how to convince them they should care 4)Determine who in the hospital needs to be convinced 5)Develop methods of communication – what and how

1) Collaborating with National Partners American Congress of Obstetricians and Gynecologists (ACOG) March of Dimes Association of Women’s Health, Obstetric and Neonatal Nurses (AWHNN)

2) Steal shamelessly from other jurisdictions – we did! Ohio – Kelly Friar Ohio statewide initiative Improve birth outcomes and reduce infant mortality Key data elements of focus Letter of introduction to hospital executives Dr. Jay D. Iams, Ohio State University Wexner Medical Center Joined our subgroup conference call to gain doctor’s perspective – very enlightening and encouraging California Maternal Quality Care Collaborative - Dr. Elliott Main

We would love to hear from other jurisdictions – just contact any member of the workgroup Thank You !

Members: Sukhjeet Ahuja (NAPHSIS) Karyn Backus (CT) Bruce Cohen (MA) Isabelle Horon (MD) Renata Howland (NYC) Michelle Osterman (NCHS) Elaine Tretter (MD) Prenatal Care Data Items Subgroup 3

To assess the quality of prenatal care data items collected on the U.S. Standard Certificate of Live Birth; and Recommend changes for improvement Charge

1.Determine which prenatal care data items should be studied 2.Prepare summary of why these data items were selected for inclusion on the certificate, and how they are used for public health purposes 3.Compile information available on data quality and barriers to collection of accurate data 4.Compile information on state efforts to improve data quality 5.Prepare best practices document 6.If warranted, recommend changes to data items on certificate Workgroup plan

Date of first prenatal care visit Date of last prenatal care visit Number of prenatal care visits Data items selected for study

History of collection of PNC data 1968 Month PNC began to be collected 1972 Number of PNC visits added 2000—Panel recommendations Month PNC began Date of 1 st PNC visit Slight revision to number of PNC visits question 2001—Addendum to Panel Report Date of last PNC visit added

Barriers to collecting accurate data Missing data PNC records not sent to hospital Mothers may change PNC providers Inaccurate data PNC records sent well before delivery and don’t contain current data Birth clerks may estimate date of last PNC visit and total number of visits Some states have placed PNC items on mother’s worksheet Difficult to evaluate what constitutes: A first PNC visit A PNC visit Very time-consuming for birth clerks to collect data items Providers may provide inaccurate data

Data Accuracy Range of level of agreement in hospitals in 3 states Data item Level of agreement Medical records and birth certificates Date of first PNC visit30% - 90% Date of last PNC visit10% - 80% Number of PNC visits5% - 90% **Accuracy rates probably even poorer, since data in medical records often incorrect**

Jurisdictions with efforts aimed at improving PNC data quality 79% believe efforts are making a difference 2013 NAPHSIS Survey

Does poor data quality prevent PNC data items from being useful for public health purposes? % of respondents indicating “yes” 2013 NAPHSIS Survey

Summary Problems with data accuracy Limited efforts underway to improve data accuracy Data quality limits usefulness for public health purposes Collection/correction requires considerable effort Medical staff Birth clerks Vital Records staff Next steps Can the data be improved? Should changes be made to certificate?