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© 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 1 Follow Up of Extremely Low Birth Weight Infants and the Impact.

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1 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 1 Follow Up of Extremely Low Birth Weight Infants and the Impact on Infant Mortality Isabelle Horon, Dr.P.H. Director, Vital Statistics Administration Maryland Department of Health and Mental Hygiene June 8, 2006

2 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 2 Collaborators Robert Hayman, Ph.D. Robert Hayman, Ph.D. Hal Sommers Hal Sommers Garland Land Garland Land Leesa Shem Tov Leesa Shem Tov Rose Trasatti Rose Trasatti

3 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 3 Infant Mortality Death <1 year of age Death <1 year of age Widely used measure of the health of a population Widely used measure of the health of a population

4 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 4

5 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 5 Infant Mortality Rate Infant Mortality Rate x 1000 Number of infant deaths Number of births =

6 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 6 Infant Mortality Rate Infant Mortality Rate x 1000 Number of infant deaths Number of births = Source of data--Death certificates Source of data--Birth certificates

7 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 7 Problem Hospitals don’t always file certificates following the death of an extremely LBW infant Hospitals don’t always file certificates following the death of an extremely LBW infant –Don’t understand definitions –Not necessary for non-viable infants –Unlikely that a copies of certificates will be requested –Funeral home often not involved –“Looks bad”

8 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 8 No birth record, no death record X X

9 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 9 Death record, no birth record Solution--linkage of each infant death certificate to a birth certificate Solution--linkage of each infant death certificate to a birth certificate –Requirement of VSCP contract –NCHS is diligent about making states do this X

10 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 10 Birth record, no death record Why is death record missing? Why is death record missing? –No certificate filed By mistakeBy mistake On purposeOn purpose –Fetal death certificate filed instead X

11 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 11 VSCP Contract “The Contractor…shall perform the following quality assurance activities… …Validate the discharge status of all infants with birth weights <750 grams if no death record can be found. If discharged dead, assure death is registered.” …Validate the discharge status of all infants with birth weights <750 grams if no death record can be found. If discharged dead, assure death is registered.”

12 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 12 Questions 1. Are states following up? 2. If not, what is the impact on infant mortality rates?

13 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 13 Sources of data 1. NAPHSIS surveys

14 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 14 NAPHSIS surveys “Does your jurisdiction follow-up on births under a specific birth weight to determine if the child died?” “Does your jurisdiction follow-up on births under a specific birth weight to determine if the child died?” Yes N = 25 ??? N = 11 No N = 15

15 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 15 Sources of data 1. NAPHSIS surveys 2. 2002 Perinatal Mortality Data File –Number of births and number of infant deaths by state of occurrence ~ 4,000,000 birth records~ 4,000,000 birth records ~ 28,000 infant death records~ 28,000 infant death records –Computed birth weight-specific mortality rates

16 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 16 Infant Mortality Rates by Birth Weight and Follow Up Follow up No follow up <500 gms. Follow up No follow up 500-750 gms.

17 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 17 Infant Mortality Rates by Birth Weight and Follow Up Follow up No follow up <500 gms. Follow up No follow up 500-750 gms.

18 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 18 Infant Mortality Rates by Birth Weight and Follow Up Follow up No follow up

19 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 19 Infant Mortality Rates by Birth Weight and Follow Up Yes No <500 gms. Yes No 500-749 gms.

20 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 20 Infant Mortality Rates by Birth Weight and Follow Up Yes No ??? <500 gms. Yes No ??? 500-749 gms.

21 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 21 Impact — National IMR 7.0 7.1 ??

22 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 22 Impact—State IMR State X IMR = 8.9 Birth weight (grams)IMR State X (no follow up) All follow up states (mean) <500692.3896.6 500-749353.7500.9

23 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 23 Impact—State Data State X Birth weight (grams)IMR State X (no follow up) All follow up states (mean) <500692.3896.6 500-749353.7500.9 IMR = 8.9 10.5

24 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 24 What about the neighbors? State X State Y IMR = 8.9 10.5

25 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 25 Components of a Resident Vital Records File Resident- recorded data Resident data from other states Resident data

26 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 26 What about the neighbors? State X State Y Birth weight (grams)IMR State X (no follow up) State Y (follow up) <500692.3930.1 500-749353.7479.2 State X IMR = 8.9 10.5 IMR = 7.6

27 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 27 What about the neighbors? State X State Y State X IMR = 8.9 10.5 IMR = 7.6 7.8 Birth weight (grams)IMR State X (no follow up) State Y (follow up) <500692.3930.1 500-749353.7479.2

28 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 28 What about the neighbors? State X State Y State X IMR = 8.9 10.5 IMR = 7.6 7.8 County A IMR = 11.4 Birth weight (grams)IMR State X (no follow up) State Y (follow up) <500692.3930.1 500-749353.7479.2

29 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 29 What about the neighbors? State X State Y Birth weight (grams)IMR State X (no follow up) State Y (follow up) <500692.3930.1 500-749353.7479.2 State X IMR = 8.9 10.5 IMR = 7.6 7.8 County A IMR = 11.4 12.3

30 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 30 What should we be doing? Identify all infants with birth weights <750 gms. Identify all infants with birth weights <750 gms. –Determine whether death certificate was filed If no death certificate filed, follow up If no death certificate filed, follow up –Call hospital of delivery to determine status If infant died, make sure death certificate is filedIf infant died, make sure death certificate is filed If infant transferred, follow upIf infant transferred, follow up Continue to follow up until infant is dischargedContinue to follow up until infant is discharged Review out of state data for potential problems Review out of state data for potential problems

31 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 31 Limitations Follow up policies unknown for 11 jurisdictions Follow up policies unknown for 11 jurisdictions 2002 birth and death data; 2006 survey data 2002 birth and death data; 2006 survey data Birth weight errors Birth weight errors Period vs. birth cohort data Period vs. birth cohort data

32 © 2001 By Default! A Free sample background from www.pptbackgrounds.fsnet.co.uk Slide 32 NCHS may come knocking on your jurisdiction’s door… …please agree to help.

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