accuracy at birth: improving birth certificate data beena kamath, md, mph april 27, 2010
TRANSCRIPT
Accuracy at Birth: Improving Birth Certificate Data
Beena Kamath, MD, MPH
April 27, 2010
Team
• Beena Kamath, MD (Study Lead)• Michael Marcotte, MD (Director, Quality
Maternity Medicine, Good Samaritan Hospital)
• Roni Christopher (QIC)• Edward Donovan, MD (PI-OPQC)• Carolyn Slone, RN (Antepartum)• Jennifer Brodbeck, RN (Labor and Delivery)• Meg James, RN (Manager of Special Care
Obstetrics)
Sentinel Event
Gestational age
• Clinical decisions• Research questions• Intervention programs for at risk infants
• If the vital statistics are incomplete or inaccurate, risk status, clinical factors, or outcomes will not adequately reflect the population being studied.
Birth certificates
From Gould, et al. “Incomplete Birth Certificates: A Risk Marker for Infant Mortality,” 2002.
Measuring Gestational Age• LMP
– Problems with recall– Different menstrual cycles
• Ultrasound– Compared to references that may not reflect natural
variation in population– Measures size, not time (Mustafa, et al., 2001)
• Clinical (maturational assessment)– Not accurate below 28 weeks gestation (Donovan, et al.,
1999)– Over-estimates age for preterms, thereby underestimating
rates of prematurity (Alexander, et al., 1992)
Different results• Methods of estimating GA can lead to disparate results,
resulting in systematic biases
• Post-term birth rates – Clinical (1.2%) vs. LMP (6.4%)
» Wingate, et al., 2007
– Ultrasound (1.1%) vs. LMP (10.1%)» Dietz, et al., 2007
• Rates of prematurity – Clinical (7.9%) vs. LMP (9.9%)
» Wingate, et al., 2007
– Ultrasound (7.9%) vs. LMP (8.7%)» Dietz, et al., 2007
Learning from Observations(Following the Gestational Age on the Birth
Certificate)
Baby born
Delivery log printed from OB TV
Gestational age transcribed directly from OB TV to birth
certificate worksheet
What is going on in OB TV?
Form completed forState & Federal Gov’t
Problems with OB TVReferral from Outside OB
Pregnant mom arrives to GSH
Is ACOG formAvailable?
Yes
No Alternative methods to confirm GA: asking
mother herself, calling practice
Document GA in OB TV with
best data
NICU record of GA
Birth certificaterecord of GA
OB database record of
GA
Perinatal Databaserecord of GA
Since OB TV is the source for multiple repositories of information, it makes sense to make sure OB TV is accurate.
OB TV Screen Shot
Our AIM
• To improve the reliability of gestational age recorded in OB TV from 25% to 75% for Good Samaritan Hospital by January 31, 2010 in the population of women with prenatal care who are pregnant with an infant at least 20 weeks gestation
Reliability at Birth: Gestational Age Recording in OB Trace Vue
0%
20%
40%
60%
80%
100%
120%
09/0
1/0
9 (
n=
24
)0
9/0
5/0
9 (
n=
11
)0
9/0
9/0
9 (
n=
25
)0
9/1
3/0
9 (
n=
13
)0
9/1
7/0
9 (
n=
18
)0
9/2
1/0
9 (
n=
21
)0
9/2
5/0
9 (
n=
17
)0
9/2
9/0
9 (
n=
19
)1
0/0
3/0
9 (
n=
24
)1
0/0
7/0
9 (
n=
25
)1
0/1
1/0
9 (
n=
13
)1
0/1
5/0
9 (
n=
09
)1
0/1
9/0
9 (
n=
23
)1
0/2
3/0
9 (
n=
26
)1
0/2
7/0
9 (
n=
19
)1
0/3
1/0
9 (
n=
16
)1
1/0
4/0
9 (
n=
20
)1
1/0
8/0
9 (
n=
12
)1
1/1
2/0
9 (
n=
21
)1
1/1
6/0
9 (
n=
27
)1
1/2
0/0
9 (
n=
17
)1
1/2
4/0
9 (
n=
25
)1
1/2
8/0
9 (
n=
16
)1
2/0
2/0
9 (
n=
25
)1
2/0
6/0
9 (
n=
11
)1
2/1
0/0
9 (
n=
19
)1
2/1
4/0
9 (
n=
21
)1
2/1
8/0
9 (
n=
24
)1
2/2
2/0
9 (
n=
27
)1
2/2
6/0
9 (
n=
05
)1
2/3
0/0
9 (
n=
17
)0
1/0
3/1
0 (
n=
09
)0
1/0
7/1
0 (
n=
19
)0
1/1
1/1
0 (
n=
21
)0
1/1
5/1
0 (
n=
22
)0
1/1
9/1
0 (
n=
18
)0
1/2
3/1
0 (
n=
13
)0
1/2
7/1
0 (
n=
12
)0
1/3
1/1
0 (
n=
08
)0
2/0
4/1
0 (
n=
15
)0
2/0
8/1
0 (
n=
16
)0
2/1
2/1
0 (
n=
17
)0
2/1
6/1
0 (
n=
22
)0
2/2
3/1
0 (
n=
23
)0
2/2
7/1
0 (
n=
15
)0
3/0
3/1
0 (
n=
18
)0
3/0
7/1
0 (
n=
10
)0
3/1
1/1
0 (
n=
14
)0
3/1
5/1
0 (
n=
20
)0
3/1
9/1
0 (
n=
16
)0
3/2
3/1
0 (
n=
26
)0
3/2
7/1
0 (
n=
14
)0
3/3
1/1
0 (
n=
18
)0
4/0
4/1
0 (
n=
20
)0
4/0
8/1
0 (
n=
15
)
Day (with number of Deliveries)
Pe
rce
nta
ge
of
Pre
gn
an
cy
Re
co
rds
wit
h R
eli
ab
le G
A
Daily Percentage Median Centerline Goal (0.9)
Overall Learning/Challenges
• Process is complex.• Learning OB TV system and people on the
ground.• Dealing with attitudes about change.• Each community practice has different
reasons/ disincentives for not completing ACOG form and sending it in correctly.
Questions??