Using Birth Certificate Data for Rapid-Cycle Quality Improvement:

1. Using Birth Certificate Data for Rapid-Cycle Quality Improvement: The Partnership Story of the California Department of Public Health-Vital Records and the California Maternal Quality Care Collaborative NAPHSIS June 4, 2012

2. Collaborating Organizations Terri Mack, MPA Chief, Health Information and Research Section California Department of Public Health Anne Castles, MA, MPH Project Manager, California Maternal Data Center California Maternal Quality Care Collaborative (CMQCC) CMQCC is a multi-stakeholder collaborative dedicated to improving childbirth outcomes in California

3. The California Maternal Data Center:Using Data to Drive Excellence in Maternity Care

4. Background: Performance Measurement • Perinatal care performance measurement now in the national spotlight • Performance measures assess extent to which providers are meeting standards of good clinical practice • If standards not being met, measures serve as tool for motivating QI: • Internal hospital tracking on progress towards standard • Public reporting (to inform consumer decision-making and create public pressure) • “Pay for performance” (P4P) incentive payments for meeting defined standards • Component of meeting accreditation standards

5. Background • New requirements that hospitals report these perinatal measures to national and state reporting organizations (Center for Medicare Services/CMS, Joint Commission, Leapfrog Group) • BUT: the nationally-endorsed performance measures require data elements that are not found in patient discharge data sets (the data traditionally used for performance measurement) • Key data elements include gestational age, birthweight, parity—all of which are found in Birth Certificate data

6. CMQCC Goals Assist hospitals in generating nationally-endorsed perinatal measures via a statewide Maternal Data Center Envisioned Capabilities: • Generate overall hospital performance measures • Generate drill-down statistics and case review worksheets to help hospitals identify their quality improvement opportunities—for both clinical quality and data quality • Produce provider-level statistics • Provide benchmarking statistics to compare themselves to their regional, statewide, and like-hospital peers

7. Key Issue BUT only useful/feasible if: • Data available in rapid-cycle fashion—so actually useful for motivating quality improvement! • Program does not entail significant additional data reporting burden for hospitals

8. The Idea • Approach Vital Records to assess feasibility of receiving monthly transfers of de-identified birth certificate data to populate the Maternal Data Center. • Key questions to resolve: • Feasibility: Technical • Frequency, timeliness and completeness of data • CMQCC ability to comply with patient confidentiality provisions • Identifying the data elements required • Determination regarding whether de-identified data be sufficient for meeting CMQCC goals

9. California Department of Public Health Defining the Partnership Summer 2011: Initial Meeting to Discuss Idea • Agreed feasible from technical perspective. • Agreed to run statistics to determine the timeliness of providing real-time data. • Discussed the data elements required.

10. California Department of Public Health Defining the Partnership Fall 2011: Data-Request Application Approval Process • Approval from the California State Committee for the Protection of Human Subjects that serves as the institutional review board for all departments under the California Health and Human Services. • CDPH administrative review of data-request application for completeness. • Approval from the California Vital Statistics Advisory Committee that provides recommendations to the California State Registrar regarding the use of vital statistics data.

11. California Department of Public Health Defining the Partnership Key Internal Discussions: Providing real-time data • For 2010, to determine the timeliness of registered California births, CDPH decided to do a time-delay study. • CDPH examined delays in times (e.g., 20, 30, 40 days) between the dates of birth and the local registration dates. Overall, the majority of California births, 503,229 of 511,056 (98.5%), were registered within approximately 45 days.

12. California Department of Public Health Defining the Partnership Key Internal Discussions: Providing real-time data (Continued) • Since the birth dataset does not have unique record identifiers, it is difficult to account for duplicate records. • CDPH decided to do a one-time send on the 15th of each month for dates of birth occurring two months before giving a minimum of 45 days after the event (e.g., on May 15th, the March dataset is produced – March 31st less May 15th = ~45 days. • CDPH determined that real-time data could be provided to CMQCC every 45 days and that data dissemination via secured email was a feasible method for providing the data.

13. Feasibility from CMQCC perspective Is de-identified administrative data sufficient for purposes of generating perinatal metrics? • Low Burden Data Capture Strategy Envisioned • Birth certificate data: VR transfers monthly (nohospital time) • Patient Discharge Data: Hospital submits monthly or quarterly; when file created by same department that submits PDD for state agency, minimal time required

14. Feasibility from CMQCC perspective • Need to link PDD with BC data; no unique patient identifiers! • Developed and tested linkage algorithms

15. Data Quality Hospitals concerned about quality of the data (both BC and PDD) • Gestational age accuracy and completeness a key concern—underlies all performance measures • Elected to use OB-Estimate of Gestational Age, not LMP-based GA • Provide data quality statistics back to the hospital along with easy-to-download worksheets that show discrepancies • Tool for data quality improvement • Use in performance measurement: The Joint Commission now permits use of BC data for key data elements • Use of BC data in performance metrics provides extra incentive for hospitals to improve the quality of their BC data!

16. How Data Center Used Inform decision-making across multiple stakeholder groups! Already: • Hospital internal QI • Hospital performance reporting • Public Health policymakers and professionals • State Medicaid Agency: Medi-Cal • CDPH: Maternal, Child and Adolescent Health and Regional Perinatal Program Coordinators Future: • Medical Group Level Performance Statistics • Reporting for Consumers

17. Demonstration of CMDC Web Tool

18. Summary • Vital Records wonderful to work with: Flexible, timely and willing to answer questions • Using BC data to inform performance improvement and reporting provides major incentive for hospitals to improve data quality! • Hospitals identifying ways to have birth clerks abstract data for BC from EMRs—data is better and cost-efficient from hospital perspective • Spawned statewide discussion on strategies for improving BC data quality