1 / 53

MCH Surveillance: Working the Numbers...

MCH Surveillance: Working the Numbers. William M. Sappenfield, MD, MPH Epidemiologist and MCH EPI Team Leader Division for Reproductive Health Centers for Disease Control and Prevention. MCH Surveillance:. Or, Making the Numbers Work for You!. MCH Surveillance. Presentation Outline

adia
Download Presentation

MCH Surveillance: Working the Numbers...

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. MCH Surveillance:Working the Numbers... William M. Sappenfield, MD, MPH Epidemiologist and MCH EPI Team Leader Division for Reproductive Health Centers for Disease Control and Prevention

  2. MCH Surveillance: Or, Making the Numbers Work for You!

  3. MCH Surveillance Presentation Outline • Public Health Surveillance Overview • SC Perinatal Regionalization Surveillance Story • Keys to Successful Use • Current Practice Challenges

  4. Public Health Surveillance Definition The ongoing systematic collection, analysis and interpretation of outcome-specific data for use in the planning, implementation and evaluation of public health practice. Stephen Thacker (Epi. Review 1988)

  5. Public Health Surveillance The ongoing systematic collection, analysisand interpretation of outcome-specific data for use in the planning, implementation and evaluation of public health practice.

  6. Public Health Surveillance The ongoingsystematic collection, analysis and interpretation of outcome-specificdata for use in the planning, implementation and evaluation of public health practice. • MCH Population-Based Outcomes: • Health Status • Protective/Risk Factor • Health Services

  7. Public Health Surveillance The ongoing systematic collection, analysis and interpretation of outcome-specific data for use in the planning, implementation and evaluation of public health practice.

  8. Public Health Surveillance Loop Data Collection Analysis & Interpretation Dissemination & Response

  9. Public Health SurveillanceHistory • Early--Venice--boarding boats for bubonic plague. • 1680s--Gottfried Wilhelm von Leibniz--numerical analysis of mortality statistics • 1680s--John Graunt--Natural and Political Observations Made Upon the Bills of Mortality. • 1741--Rhode Island--Tavern keepers reporting contagious diseases. • 1850--Lemuel Shattuck--Report of the Massachusetts Sanitary Commission.

  10. Public Health SurveillanceImportance MCH Planning Cycle

  11. Ten Essential Public Health Services to Promote Maternal and Child Health Assess & monitor health status. Diagnosis & investigate health problems. Inform & educate the public. Mobilize community partnerships Provide leadership for policy & planning. Promote & enforce legal requirements. Link & assure access to systems of care. Assure competent work force. Evaluate MCH services. Support research and demonstrations. • Assess & monitor health status. • Diagnosis & investigate health problems. • Inform & educate the public. • Mobilize community partnerships • Provide leadership for policy & planning. • Promote & enforce legal requirements. • Link & assure access to systems of care. • Assure competent work force. • Evaluate MCH services. • Support research and demonstrations.

  12. Premises of Reinventing Government • What getsmeasuredgetsdone. • If you don't measure results, you can't tellsuccessfromfailure. • If you can't seesuccess, you can't reward it. • If you can't rewardsuccess, you're probably rewardingfailure. • If you can't seesuccess, you can't learn from it. • If you can't recognizefailure, you can't correct it. • If you can demonstratesuccess, you can win public support. Osborne and Gaebler (1992: chapter 5, "Results-Oriented Government")

  13. Public Health SurveillanceDetermine Priority/Importance • Frequency of occurrence • Severity of condition • Cost of surveillance • Preventibility of condition • Communicability of condition • Public interest Real Criteria

  14. Public Health SurveillanceDetermine Priority/Importance • Grant dollars • Existing data source(s) • Agency priority • Program interest • Staff capability • Marketability • Available resources

  15. Simplicity Flexibility Data Quality Acceptability Sensitivity Predictive Value Positive Representativeness Timeliness Stability Public Health SurveillanceSystem Attributes

  16. Public Health SurveillanceDescriptors • Person • Time • Place

  17. Public Health Surveillance 5 10 15

  18. Public Health Surveillance Remember to see the faces behind the numbers…William Foege 5 10 15

  19. Public Health SurveillancePlanning Steps • Establish objectives • Develop case definitions • Determine data source/mechanism • Develop/modify collection instruments • Field test methods • Develop/test analytic approach • Develop dissemination mechanisms • Ensure us of analysis and interpretation

  20. South Carolina Perinatal Regionalization Surveillance

  21. S.C. Perinatal Reg. SurveillanceObjectives • To improve perinatal health outcomes • To improve the perinatal health system(s) • To identify both successes and opportunities for improvement • To monitor changes over time

  22. S.C. Perinatal Reg. SurveillanceDevelopmental Steps • Review literature for potential indicators • Propose, review and approve indicators • Develop the surveillance methods and reporting mechanisms • Develop dissemination and response mechanisms • Evaluate and improve surveillance systems

  23. S.C. Perinatal Reg. SurveillanceSurveillance Measures • Place—Regions, Hospitals & Counties • Outcomes—Mortality Rates & LBW • Services—Prenatal Care, Risk-Appropriate Referrals, Delivery Hospitals &Transfers • Risk Factors—LBW, Race, Age & Education

  24. S.C. Perinatal Reg. Surveillance Functional Levels

  25. S.C. Perinatal Reg. SurveillanceReporting Level

  26. S.C. Perinatal Reg. SurveillanceEvaluation • Importance/Health Problem Priority • Objectives of the Surveillance System • Use of Surveillance System

  27. MCH Surveillance 3 Keys To Successful Use

  28. Data & Analysis Community Planning & Programs Politics & Policy MCH SurveillanceData Use Triangle TRANSLATION

  29. Public Health Surveillance Loop Data Collection Analysis & Interpretation Dissemination & Response

  30. MCH Surveillance Challenges

  31. MCH Surveillance • Challenges • Data Quality • Action-Oriented • Conceptual Basis • Many Outcomes • Evaluate

  32. MCH Surveillance Challenge Data Quality

  33. PRAMS Response Rates, 1999

  34. MCH Surveillance Challenge Conceptual Basis • Perinatal Periods of Risk • Engage community partners • Map feto-infant mortality • Focus on overall rate • Examine potential opportunity gaps • Target further efforts

  35. PPOR Analysis: Boston, 1995-97 Number of Deaths Age at Death Birthweight 108 77 27 29 6 Total = 241 Total Excess = 106

  36. MCH Surveillance Challenge Action-Oriented M.S. Maternal Mortality Surveillance System Vital Records—Identify Deaths MSDH Bureau of Women’s Health—Review Associated Deaths District/County MCH Coordinator—Case Investigation MSDH Bureau of Women’s Health—Review Case Mississippi State Medical Association Committee

  37. Occurrence of maternal/infant death Public Health Interventions Reporting Source Vital Records Reporting Source MCH/FP District Nursing Coordinators Others Records Recipient Operations Management Analyst, Principal (OMAP) Dissemination/Audience Conference/Workshop Publication Training Sessions with MCH/FP Coordinators MCH Data Unit Review by Director of Women’s Health for Maternal Death confirmation Review by Health Program Specialist, Senior (HPS) for Infant Death Confirmation MCH Surveillance Challenge Action-Oriented M.S. Maternal Mortality Surveillance System

  38. MCH Surveillance Challenge Action-Oriented Data Recipient MSDH MCH Data Unit/OMAP Investigation of medical and non medical causes of death Nurse Consultant IV Record Abstraction Nurse Consultant IV Home Interviews Social Workers Data Entry and Analysis of Data MCH Data Unit Maternal Mortality Reviews Bureau of Women’s Health Infant Mortality Reviews SIDS and Low Birthweight HPS, Sr. Birth Defects Bureau of Child Health

  39. Washington PRAMS—Data to Action 55% of all pregnancies were unintended Analyzed state data Added state performance measure Implemented educational campaign Expanded coverage for services Collaborated with various stakeholders

  40. Washington PRAMS—Data to Action 55% of all pregnancies were unintended Analyzed state data Added state performance measure Implemented educational campaign Expanded coverage for services Collaborated with various stakeholders

  41. Washington PRAMS—Data to Action 55% of all pregnancies were unintended Analyzed state data Added state performance measure Implemented educational campaign Expanded coverage for services Collaborated with various stakeholders

  42. MCH Surveillance Challenge Many Outcomes

  43. MCH Surveillance Challenge Many Outcomes

  44. MCH Surveillance Challenge Many Outcomes

  45. MCH Surveillance Challenge Many OutcomesPercent of Serum Folate Values from Kaiser Optional Before Mandatory

  46. MCH Surveillance Challenge Many OutcomesPrevalence of Anencephaly and Spina Bifida, MACDP Before After

  47. MCH Surveillance Challenge Evaluate S.C. Perinatal Reg. SurveillanceEvaluation Importance/Health Problem Priority Objectives of the Surveillance System Use of Surveillance System

  48. Public Health SurveillanceImportance MCH Planning Cycle

More Related