1. Accuracy at Birth: Improving Birth Certificate Data Beena Kamath, MD, MPH April 27, 2010

2. 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)

3. Sentinel Event

5. 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.

6. Birth certificates From Gould, et al. “Incomplete Birth Certificates: A Risk Marker for Infant Mortality,” 2002.

7. 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)

8. 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

9. 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 for State & Federal Gov’t

10. Problems with OB TV Referral from Outside OB Pregnant mom arrives to GSH Is ACOG form Available? 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 certificate record of GA OB database record of GA Perinatal Database record of GA Since OB TV is the source for multiple repositories of information, it makes sense to make sure OB TV is accurate.

11. OB TV Screen Shot

13. 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

15. 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.

16. Questions??