Download - PQCNC: Kamath presentation
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Accuracy at Birth: Improving
Birth Certificate Data
Beena Kamath, MD, MPH
April 27, 2010
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Team
Beena Kamath, MD (Study Lead)
Michael Marcotte, MD (Director, QualityMaternity 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 CareObstetrics)
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Sentinel Event
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Gestational age
Clinical decisions
Research questions
Intervention programs for at risk infants
If the vital statistics are incomplete orinaccurate, risk status, clinical factors, or
outcomes will not adequately reflect thepopulation being studied.
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Birth certificates
From Gould, et al. Incomplete Birth Certificates: A Risk Marker
for Infant Mortality, 2002.
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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)
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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
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Learning from Observations
(Following the Gestational Age on the Birth Certificate)
Baby born
Delivery log printed fromOB TV
Gestational age transcribed
directly from OB TV to birth
certificate worksheet
What is goingon in OB TV?
Form completed for
State & Federal Govt
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Problems with OB TV
Referral from
Outside OB
Pregnant momarrives to GSH
Is ACOG formAvailable?
Yes
No Alternative methods toconfirm GA: asking
mother herself,
calling practice
Document GA
in OB TV with
best data
NICU record
of GA
Birth certificate
record of GA
OB database
record of
GA
Perinatal Database
record of GA
Since OB TV is the source formultiple repositories of
information, it makes sense to
make sure OB TV is accurate.
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OB TV Screen Shot
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Our AIM
To improve the reliability of gestational agerecorded in OB TV from 25% to 75% for GoodSamaritan Hospital by January 31, 2010 in the
population of women with prenatal care who arepregnant with an infant at least 20 weeksgestation
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ReliabilityatBirth:GestationalA
geRecordinginO
BTrace
0%
20%
40%
60%
80%
100%
120%
09/01/09 (n=24)09/05/09 (n=11)09/09/09 (n=25)09/13/09 (n=13)09/17/09 (n=18)09/21/09 (n=21)09/25/09 (n=17)09/29/09 (n=19)10/03/09 (n=24)10/07/09 (n=25)10/11/09 (n=13)10/15/09 (n=09)10/19/09 (n=23)
10/23/09 (n=26)10/27/09 (n=19)10/31/09 (n=16)11/04/09 (n=20)11/08/09 (n=12)11/12/09 (n=21)11/16/09 (n=27)11/20/09 (n=17)11/24/09 (n=25)11/28/09 (n=16)12/02/09 (n=25)12/06/09 (n=11)12/10/09 (n=19)
12/14/09 (n=21)12/18/09 (n=24)12/22/09 (n=27)12/26/09 (n=05)12/30/09 (n=17)01/03/10 (n=09)01/07/10 (n=19)01/11/10 (n=21)01/15/10 (n=22)01/19/10 (n=18)01/23/10 (n=13)01/27/10 (n=12)01/31/10 (n=08)02/04/10 (n=15)02/08/10 (n=16)02/12/10 (n=17)02/16/10 (n=22)02/23/10 (n=23)
Day(withn
umberofDeliveries)
Percentage of Pregnancy Records with Reliabl
DailyPerce
ntage
MedianCenterline
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Overall Learning/Challenges
Process is complex.
Learning OB TV system and people on theground.
Dealing with attitudes about change. Each community practice has different reasons/
disincentives for not completing ACOG form andsending it in correctly.
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Questions??