Measuring Reproductive Health Outcomes: Vital Records are Vital

Patricia W. Potrzebowski, Ph.D.Executive Director, NAPHSIS

Acknowledgment

Jack C. Smith, M.S.

Division of Reproductive Health

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

About Vital Records

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

About NAPHSIS & Our Members

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

NAPHSIS Vision

An accurate, timely, and secure record

of all vital events in the nation

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

Improving Vital Records

BLUE SKY:

What Success Looks Like

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

Strengthening Partnerships

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

Questions?

Contact Us

www.naphsis.org

Patricia W. Potrzebowski, Ph.D.

Executive Director

962 Wayne Avenue, Suite 701

Silver Spring, MD 20910

301-563-6001

ppotrzebowski@naphsis.org