Obstetrics in the Finger Lakes Region: 2004

1. Obstetrics in theFinger Lakes Region:2004 Chris Glantz, MD, MPH

2. Original PDS Tenets • 1. Comprehensive • 2. Timely • Immediate access • 3. Hospital and Regional QA • (Research)

3. PDS Changes in 2004 • Electronic Birth Certificate • Fewer information fields • e.g., deleted Oligo, NST, BPP, ultrasound, many medical diagnoses, previa, laceration, abruption • “More like US standard” • Redefined some fields • e.g., Augmentation, congenital anomaly, episiotomy, tobacco abstinence, NICU care • Computer calculates “Trimester care began” • “Repeat CS” determined by previously entered info

4. PDS Changes in 2004 • Data Transmission • Web-based direct to NYSDOH • Click SEND and your data is gone! • Must double-enter to retain own data • No mechanism in place to return data to hospitals or perinatal centers • Data no longer managed by BWH • Now in Vital Records • PDS does not appear to be a high priority

5. PDS Changes in 2004 • De-identification of raw data before eventual return • HIPAA concerns—legal quagmire • QI field consent—unknown denominators? • QA implications • Lack of linkage to NICU database • Inability to geocode • Tabulated report has less information

6. Net Results of Changes • Less data in database and reports • Less comprehensive and some fields cannot be compared to previous years • Raw data is indefinitely inaccessible • No longer timely • Unavailable for regional QA • Currently cannot be linked to NICU database • Bottom Line: All Three Original Tenets Have Been Effectively Undermined

7. What Could Be Done? • 1. Undo revisions to EBC and definitions • 2. Modify the web-based system to allow the hospitals to save a copy of their data • Enable a copy to go the Perinatal Center • Would not de-identify or prevent linkage • 3. Put the PDS database back into the Bureau of Women’s Health

8. Be this as it may…

9. Deliveries: Mothers USA: ≈4 million NYS: ≈250,000

10. Ages and Economics • 1.5% <18 y.o. • 16% ≥35 y.o. (range 7 - 21%) • Both similar to previous years • Medicaid: 37% • Range 29 - 68% • Previous years’ percents included uninsured • Progressive rise from 32% in 2000

11. Genetic Testing AFP Done* (25 - 75%) Genetic Testing (now includes CVS)

12. Induction of Labor Rates Medical—rates higher if AROM included Range 13 - 28%

13. Fetal Monitoring • External 81% (64 - 99%) • Stable rate • Internal 14% (2 - 24%) • Minimal decline over 5 years • DOH no longer reports antepartum testing • NST, BPP, etc.

14. Anesthesia and Operative Vaginal Delivery Epidural* (5 - 67%) Forceps or Vacuum* (1 - 14%) Vacuum = 82% of assisted vaginal deliveries, Up from 67% in 2000

15. Cesarean Delivery Total Range 22 - 41% Primary Coding Change Repeat

16. “Low Risk CS” & VBAC

17. Perineal Trauma Lacerations Episiotomy (6 - 41%)

18. Neonatal Outcomes – 2004 • Preterm Delivery: 10.1% • Low Birth Weight: 7.7% • Low 5-minute Apgar: 0.7% • Congenital Anomaly: 0.6%* • Neonatal Transport: 1.1% • Maternal Transport: 1.4% *redefined in 2004

19. Breastfeeding Intent Range 48 - 84%

20. Breastfeeding Intent Does not look as impressive this way!

21. Healthy People 2010 2004 *redefined in 2004

22. (Limited) Portrait of Obstetrics in the FLR