1. A COLLABORATIVE EXPLORATION OF MINNESOTA PRAMS DIABETES CORE AND STANDARD QUESTIONS Barbara Frohnert, MPH Minnesota PRAMS Project Coordinator, Minnesota Department of Health 2008 PRAMS National Meeting Atlanta, GA December 8, 2008

2. Goals Describe the collaboration process Results of the project Benefits to each partner

3. Minnesota PRAMS 2001 Grantee Data collection began in mid-2002 Data analysis of 2003 data: mid-2005 Limited resources No dedicated analyst, just Data Manager & Project Coordinator Coordinator does analysis in addition to other activities Mostly simple, descriptive analyses Process for sharing analysis datasets had not been tried

4. Collaboration Minnesota Diabetes Program Heather Devlin, Anne Walaszek, Jay Desai

5. Strengths of partnership Minnesota PRAMS Knowledge of methodology and dataset Experience with analyzing complex sample survey data using SAS and SAS- callable SUDAAN Minnesota Diabetes Program Team of experienced analysts Extensive knowledge of diabetes Previous research with existing data (birth certificates) Well-established program with broad partnerships (ex. Minnesota Diabetes Steering Committee est. 1981)

6. Sharing PRAMS Data with External Researchers Diabetes program contacted Minnesota PRAMS to obtain dataset for secondary analysis Minnesota PRAMS formalized their Data Request process Diabetes program piloted this process Request was reviewed and approved by Minnesota PRAMS Internal Steering Team Project Coordinator prepared an analysis dataset Identification of variables required for appropriate analysis Identification of variables requiring special justification (ex. dates, facility IDs, county codes), Logistics: Preparing a subset dataset, providing formats, secure transfer, etc.

7. Exploring the Data, pt. 1 Analysts from both programs worked together on the coding, interpretation, etc. Self-reported diabetes from survey Questionnaire revision: diabetes core question changed between Phase 4 and Phase 5 MN standard question: Pre-existing diabetes Matrix developed to combine PRAMS core and standard variables into pre-existing diabetes mellitus (PDM) and gestational diabetes (GDM)

8. Exploring the Data, pt. 2 Diabetes from birth certificates Minnesota does not yet use 2003 standard PDM and GDM are collected separately, but for PRAMS analysis dataset, they are combined into one variable, MM_DIAB Special request to match-merge to separate PDM and GDM from birth certificate In future years, PDM and GDM will be kept separate in PRAMS analysis dataset Initial explorations applying risk factors for general population to get a state estimate of mothers at risk of DM

9. Results of Analyses Diabetes data from PRAMS survey: Useful for GDM surveillance, but likely over- estimates high blood sugar (diabetes) Less useful for PDM surveillance Standard question L11c preferred for monitoring PDM (~5 States) Core question 22a missed 33% of PDM cases; 13% of PDM cases (7 out of 52) mothers responded yes to both 22a and 22b Poster session at MCH Epidemiology Assessing Pregnancies complicated by diabetes in Minnesota: Birth certificates compared to the Pregnancy Risk Assessment Monitoring System

10. Results of Analyses Input on Phase 6 Diabetes questions: New core: Specific to Type 1/Type 2 and gestational diabetes, should provide more valid and reliable information MN PRAMS will use a postpartum diabetes/high blood sugar screening question A true gold standard for diabetes-related pregnancy still needed to better understand the validity of birth certificates and PRAMS data

11. Partnership, Expanded Scope Minnesota Department of Health Community & Family Health Minnesota PRAMS: Barbara Frohnert Health Promotion & Chronic Disease Minnesota Diabetes Program: Heather Devlin, Anne Walaszek, Jay Desai National: 2008 Diabetes Translation Conference State/Local: Minnesota Diabetes Surveillance and Data Review Work Group National: 2008 MCH Epidemiology Conference State/Local: Regional Public Health Nurse MCH Work Group presentations

12. Benefits of Collaboration MN PRAMS First opportunity to look at quality of PRAMS data Improved variables from birth certificate included in PRAMS analysis datasets Developed and refined processes for data sharing Developed strong working relationship with subject matter experts for input, development of Phase 6 questionnaire Market MCH perspective to Diabetes Program partners Diabetes Program Collaborative learning PRAMS data analysis methods Lobbied for improved survey questions, additional postpartum blood sugar screening Able to integrate PRAMS data into Minnesota Diabetes Plan and use it to evaluate progress Market diabetes issues to MCH audience Partners benefited from the expertise of the other

13. Benefits for PRAMS In Phase 6, improved quality and validity of diabetes information provided from PRAMS Expansion of state capacity for PRAMS analysis Expanded opportunities for Data to Action Minnesota State Diabetes Plan

14. Questions? Barbara Frohnert, MPH Minnesota PRAMS, Project Coordinator/Epidemiologist Senior 651-201-5953 Barbara.Frohnert@state.mn.us