Measuring Reproductive Health Outcomes: Vital Records are Vital Patricia W. Potrzebowski, Ph.D. Executive Director, N

1. Measuring Reproductive Health Outcomes: Vital Records are Vital Patricia W. Potrzebowski, Ph.D. Executive Director, NAPHSIS

2. Acknowledgment • Jack C. Smith, M.S. • Division of Reproductive Health

3. 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.

4. Overview • About Vital Records • About NAPHSIS & Our Members • Improving Vital Records • Strengthening Partnerships

5. About Vital Records

6. Jurisdiction Responsibility for Vital Event Registration • Allvital 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

7. 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

8. 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

9. 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

10. Birth Registration Data Flow • Birth occurs • Hospital reports to vital records office (VRO) • VRO reviews data for quality • If needed, VRO follows up with hospital • VRO shares data with mother’s state of residence • VRO submits birth data to NCHS • NCHS reviews data for quality • If needed, NCHS follows up with VRO • If needed, VRO follows up with hospital • VRO submits final complete year end data to NCHS • NCHS conducts final data quality review • If needed, NCHS follows up with VRO • If needed, VRO follows up with hospital • VRO/NCHS each release aggregate vital statistics data

11. 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

12. Other Vital Record Functions • Certified copy issuance • Amendments and adoptions • Paternity acknowledgment • Delayed records • Statistical reports • Record preservation • Security – identity theft and fraud prevention

13. About NAPHSIS & Our Members

14. 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

15. NAPHSIS Vision An accurate, timely, and secure record of all vital events in the nation

16. 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.

17. 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

18. 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)

19. What Vital Records Does Well • Periodic 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

20. What Vital Records Can Do Better • Improved timeliness • Enhanced data quality • Linkages with other data sets

21. Improving Vital Records

22. BLUE SKY:What Success Looks Like

23. Requirements for Success • User responsiveness – better timeliness • Modernization – electronic systems • Accurate data – cleaner data at the source • Skilled workforce • Data integration

24. 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

25. 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

26. 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

27. 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

28. Strengthening Partnerships

29. 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

30. Benefits of Partnership Between DRH and NAPHSIS • Assist DRH in achieving its priorities • Help Vital Records Offices improve data quality, timeliness, and accessibility

31. 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)

32. PotentialNAPHSIS 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

33. Conclusions • Vital 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

34. Questions?

35. 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