By Garland Land NAPHSIS Executive Director

Performance Measures Committee Dorothy Harshbarger, Alabama Dorothy Harshbarger, Alabama Barry Nangle, Utah Barry Nangle, Utah Trish Potrzebowski, Pennsylvania Trish Potrzebowski, Pennsylvania Julia Holmes, NCHS Julia Holmes, NCHS

Performance Measures Purpose The collection and release of data on vital statistics performance measures is intended to assist vital records jurisdictions in voluntary self- assessment and to encourage improvement of data timeliness, quality and usefulness. If jurisdictional performance increases as a result of these efforts, then the national vital statistics system will also be enhanced. The collection and release of data on vital statistics performance measures is intended to assist vital records jurisdictions in voluntary self- assessment and to encourage improvement of data timeliness, quality and usefulness. If jurisdictional performance increases as a result of these efforts, then the national vital statistics system will also be enhanced.

2010 NAPHSIS Performance Measures Timeliness of 2008 birth records submitted to NCHS Timeliness of 2008 birth records submitted to NCHS Timeliness of 2008 demographic death records submitted to NCHS Timeliness of 2008 demographic death records submitted to NCHS 2007 recorded birth records under 500 grams linked to a death record 2007 recorded birth records under 500 grams linked to a death record 2008 deaths with underlying cause of death codes that are not ill-defined codes 2008 deaths with underlying cause of death codes that are not ill-defined codes

Performance Measures cont Availability of Web-based Data Query System (WDQS) Availability of Web-based Data Query System (WDQS) Timeliness of issuing certified birth copies Timeliness of issuing certified birth copies Restricted access to birth records Restricted access to birth records Electronic birth records go back to 1935 for EVVE Electronic birth records go back to 1935 for EVVE Electronic death records go back to 2000 for EVVE Electronic death records go back to 2000 for EVVE

Timeliness of Birth Data Definition: Percent of 2008 birth records submitted to the NCHS by May 1, 2009 Goal: 99+% Range: 0-100% Median: 99.97% Met Goal: 50 jurisdictions

Timeliness of Death Data Definition: Percent of 2008 demographic death records submitted to the NCHS by May 1, 2009 Goal: 99+% Range: 0-100% Median: 99.8% Met Goal: 36 jurisdictions

Completeness of Infant Deaths Recorded Definition: Percent of 2007 recorded birth records under 500 grams linked to a death record Goal: 80+% Range: % Median: 89% Met Goal: 39 jurisdictions

Acceptable Causes of Death Definition: Percent of 2008 deaths with underlying cause of death codes that are not ill-defined codes (R00- R99)-R95+I469 Goal: 98+% Range: 93.0%-99.8% Median: 98.1% Met Goal: 26 jurisdictions

Web Query System Definition: Has an interactive system, whereby a user can query through a web browser to obtain vital statistics tabulations and statistical computations Distribution: Yes: 28 No: 29

Timeliness of Issuing Certified Birth Certificates Definition: Average number of work days to issue certified copies of birth records for mail requests received in January 2010 Distribution: 0-3 days: 24-- Goal 4-10 days: days: 8 Unknown: 3

Birth Records Restricted Definition: Certified and non-certified copies of birth records less than 100 years old can only be issued or inspected at the jurisdiction and local levels to restricted persons, for research or governmental administrative use. Distribution: Restricted and may be open after 100 years: 40 Goal Restricted and may be open before 100 years: 3 Restricted but provide information copies: 7 Restricted by knowledge of information but not by relationship: 1 Open: 4 Open locally and restricted at state: 2

EVVE Birth Database Definition: Has electronic birth database with EVVE verification data items back to 1935 Distribution: 1935: : : : : 7

EVVE Death Database Definition: Has electronic death database with EVVE data items back to 2000 Distribution: Yes: 55 No: 2

Number of Measures Met Number of Number of Measures Met Jurisdictions

Number of Jurisdictions Met Goal MeasureNumber Met Goal Timeliness of Births50 Timeliness of Deaths36 Completeness of infant deaths39 Acceptable causes of death26 WDQS28 Timely issuance of birth certificates24 Restricted issuance of birth records40 EVVE data for births40 EVVE data for deaths55

Outstanding States Outstanding States StateMeasures Met (9 possible) Kansas9 Missouri9 Alabama8 Colorado8 Florida8 Maryland8 Mississippi8 New Hampshire8 New York City8 North Dakota8 Vermont8

Suggested Ways to Improve Timeliness Eliminate paper based state or local registration where possible Eliminate paper based state or local registration where possible Allow local registrar access to central vital record database for online local registration Allow local registrar access to central vital record database for online local registration Accept electronic record for the jurisdiction before the paper record is received from the local registrar or hospital Accept electronic record for the jurisdiction before the paper record is received from the local registrar or hospital Do not delay registration to conduct QA; perform QA after records have been submitted to NCHS; provide corrected records subsequently if needed Do not delay registration to conduct QA; perform QA after records have been submitted to NCHS; provide corrected records subsequently if needed

Suggested Ways to Improve Timeliness Develop reports that show the number of events by hospital, funeral home, local registrar by month for the previous year and monitor the events submitted, particularly for November and December events. Develop reports that show the number of events by hospital, funeral home, local registrar by month for the previous year and monitor the events submitted, particularly for November and December events. Develop a report that tracks the timeliness of submission of records by local registrars if applicable. Develop a report that tracks the timeliness of submission of records by local registrars if applicable. Contact hospitals and funeral homes in March to determine if all records have been filed Contact hospitals and funeral homes in March to determine if all records have been filed Follow up with hospitals/funeral directors in February and March on any unfiled infant death certificates Follow up with hospitals/funeral directors in February and March on any unfiled infant death certificates

Suggested Ways to Improve Timeliness Do not delay birth registration when paternity documents are not received within two weeks Do not delay birth registration when paternity documents are not received within two weeks Submit birth records to NCHS even if the paternity affidavits have not been returned by the parents or hospital Submit birth records to NCHS even if the paternity affidavits have not been returned by the parents or hospital Notify the NCHS by the end of April of the final certificate numbers, voided numbers and that the files are closed even if there are a few records that are awaiting corrections. Notify the NCHS by the end of April of the final certificate numbers, voided numbers and that the files are closed even if there are a few records that are awaiting corrections. Submit all available records by May 1 Submit all available records by May 1

Suggested Ways to Improve Causes of Death Identify the physicians, coroners and MEs that use ill-defined causes more frequently than 2% and provide statistical reports to them on the frequency of ill-defined causes in relation to other providers Identify the physicians, coroners and MEs that use ill-defined causes more frequently than 2% and provide statistical reports to them on the frequency of ill-defined causes in relation to other providers Identify the physicians, coroners and MEs that use ill-defined causes most frequently and provide training to them Identify the physicians, coroners and MEs that use ill-defined causes most frequently and provide training to them Allow for pending causes of death Allow for pending causes of death

Suggested Ways to Improve Causes of Death Query death records with ill-defined causes Query death records with ill-defined causes Ask state ME (if state ME exists) to follow-up with physicians and coroners that frequently use ill- defined causes. Ask state ME (if state ME exists) to follow-up with physicians and coroners that frequently use ill- defined causes. Train hospital personnel where ill-defined causes are most frequently used. Train hospital personnel where ill-defined causes are most frequently used. Recommend physicians use an EDRS with front end cause of death edits Recommend physicians use an EDRS with front end cause of death edits

Recommendations Share the report with your staff Share the report with your staff Share the report with your supervisor Share the report with your supervisor Contact NAPHSIS if assistance is needed to improve your performance Contact NAPHSIS if assistance is needed to improve your performance

Past and the Future Performance measures (2009, 2010) Performance measures (2009, 2010) NAPHSIS Standards (2011) NAPHSIS Standards (2011) Accreditation Accreditation