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Measuring Reproductive Health Outcomes: Vital Records are Vital
Patricia W. Potrzebowski, Ph.D.Executive Director, NAPHSIS
Vital Records Are Needed to Measure Reproductive Health Outcomes
• Teen pregnancy
• Infant and perinatal mortality
• Abortion surveillance (ITOP)
• Maternal mortality, complications of pregnancy
• Preterm birth, SUID, ART, PRAMS, prenatal care, etc.
Overview
• About Vital Records
• About NAPHSIS & Our Members
• Improving Vital Records
• Strengthening Partnerships
Jurisdiction Responsibility for Vital Event Registration
All vital events that occur within each of the 57 jurisdictions (50 states, NYC, DC, 5 territories):
• Live births
• Deaths
• Fetal deaths (based on length of gestation/birth weight)
• Induced Terminations of Pregnancy (ITOP)
• Marriages and Divorces
Vital Records Provide the Foundation for Public Health
• From records to data
• Evaluating progress/outcomes
• Effective intergovernmental partnership• VSCP: data for National Vital Statistics System
• National Death Index for research
• Enumeration at Birth: issue SSN
• Fact of Death reporting to SSA for benefit administration
Two Purposes of Vital Records
Legal/administrative uses (civil registration)
• Proof of citizenship, age, parentage
• Used to obtain identity documents, settle estates, obtain benefits
Public health/statistical uses
• Measure outcomes
• Identify risk factors
• Conduct research
Process for Registering Vital Events and Preparing Data for Release
• Many steps
• Many actors
• Complex systems
• Differs by type of event
• Multiple data quality reviews
• National data depend on slowest jurisdiction
Birth Registration Data Flow1. Birth occurs2. Hospital reports to vital records office (VRO)3. VRO reviews data for quality
• If needed, VRO follows up with hospital
4. VRO shares data with mother’s state of residence5. VRO submits birth data to NCHS6. NCHS reviews data for quality
• If needed, NCHS follows up with VRO• If needed, VRO follows up with hospital
7. VRO submits final complete year end data to NCHS8. NCHS conducts final data quality review
• If needed, NCHS follows up with VRO• If needed, VRO follows up with hospital
9. VRO/NCHS each release aggregate vital statistics data
Death Registration Data Flow• Funeral home reports decedent’s
demographic data
• Attending physician certifies and reports natural causes of death
• Medical examiner/coroner certifies and reports external causes (homicide, suicide, unintentional injuries) and unknown manner or unattended death
• Same process as birth; more data sources
Other Vital Record Functions• Certified copy issuance
• Amendments and adoptions
• Paternity acknowledgment
• Delayed records
• Statistical reports
• Record preservation
• Security – identity theft and fraud prevention
National Association for Public Health Statistics and Information Systems
Organized 1933
57 vital records jurisdictions: 50 states, NYC, DC, 5 territories
About 275 members
7.5 FTE staff + consultants
ASTHO affiliate
Mission
NAPHSIS provides national leadership for both vital records and related information systems in order to establish and protect individual identity and improve population health.
Strategic Objectives• Advocate nationally for member jurisdictions
• Negotiate federal contracts for member jurisdictions (NCHS/CDC and SSA)
• Ensure effective stewardship for VR in HIE/EHR environment
• Strengthen organizational effectiveness
• Develop and deliver quality products & services
• Expand strategic partnerships
Key Projects• Comprehensive Vital Statistics
Standards
• Vital Statistics Improvement:Timeliness and Data Quality
• State and Territorial Exchange of Vital Events(STEVE)
• Cause of Death Physician eLearning Module
• Electronic Verification of Vital Events (EVVE)
What Vital Records Does WellPeriodic revisions to keep data relevant
• 2003 Standard Certificate
Complete mandatory reporting • Not a sample or survey
Consistent, comparable data • Vital Statistics Cooperative Program
Continuous and cost efficient• Administrative data system
What Vital Records Can Do Better
• Improved timeliness
• Enhanced data quality
• Linkages with other data sets
Requirements for Success
• User responsiveness – better timeliness
• Modernization – electronic systems
• Accurate data – cleaner data at the source
• Skilled workforce
• Data integration
Barriers to Success
Factors that slow the flow of data
• Capital: financial, human, political
• Actors: leadership, capacity, buy-in (external)
• Systems: optimization, variation, adoption
• Data: quantity, completeness, lack of policies and protocols
Strategies for Improved Timeliness Professional development to
enhance actor performance
Evaluate system performance
Use champions for marketing to data providers
Release preliminary data
Share best practices
Next Steps: Data Quality• Create birth clerk professional
development program
• Identify model hospital feedback reports on birth data quality
• Develop approaches to promoting hospital awareness of importance and uses of birth data
• Identify/address prenatal care data quality sources of problems
Next Steps: Cultivate the Next Generation of Leaders
Identify specialized core competencies needed by vital records data managers
Conduct gap analysis
Address training needs
Expand training opportunities for mid-career professionals
Work with Data Providers/Users• Address user community needs for improved
data quality, timeliness, and accessibility
• Champion vital records: vital records are often taken for granted
• Obtain commitments to invest in building infrastructure to meet user needs for “more, better, faster” vital statistics data
• Work collaboratively to improve vital records
Benefits of Partnership Between DRH and NAPHSIS
• Assist DRH in achieving its priorities
• Help Vital Records Offices improve data quality, timeliness, and accessibility
Current Joint Efforts• Survey of jurisdictions re: linkage with hospital
discharge data
• Develop and promote technical resource for induced termination of pregnancy (ITOP) reporting
• Maternal and infant mortality reviews
• PRAMS data sharing agreement
• Obtain state-level data (abortion, linked birth-infant death file, ART, etc.)
• Research (e.g. housing mobility)
Potential NAPHSIS Support for DRH • Communicate with vital records jurisdictions
• Conduct surveys about vital records practices
• Coordinate with vital records offices to help meet DRH needs for vital records data
• Facilitate cooperation between DRH and vital records offices
• Promote DRH focus areas/programs
ConclusionsVital Records Are Essential to Assess
Reproductive Health Outcomes
Better Vital Records Are Needed to Measure Reproductive Health Outcomes More Effectively
Effective Partnerships Are Key to Success in Achieving Public Health Goals
Contact Us
www.naphsis.org
Patricia W. Potrzebowski, Ph.D.
Executive Director
962 Wayne Avenue, Suite 701
Silver Spring, MD 20910
301-563-6001