1 from concept to measurement: core state indicators for monitoring preconception health william m....
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From Concept to Measurement:From Concept to Measurement: Core State Indicators for Core State Indicators for
Monitoring Preconception HealthMonitoring Preconception Health
William M. Sappenfield, MD, MPHWilliam M. Sappenfield, MD, MPHState MCH EpidemiologistState MCH Epidemiologist
Office of Surveillance, Evaluation & EpidemiologyOffice of Surveillance, Evaluation & EpidemiologyDivision of Family Health Services Division of Family Health Services
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Topics to be DiscussedTopics to be Discussed
PurposePurpose ProcessProcess ProductProduct PossibilitiesPossibilities
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We Currently Intervene Too Late
4 5 6 7 8 9 10 11 12
Central Nervous SystemCentral Nervous System
HeartHeart
ArmsArms
EyesEyes
LegsLegs
TeethTeeth
PalatePalate
External genitaliaExternal genitalia
EarEar
Missed Period Mean Entry into Prenatal Care
Critical Periods of Fetal Development
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Perinatal Periods of RiskPerinatal Periods of Risk
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PPOR Analysis of 2000-2002 of data from the 66 largest cities, suggests that preventive action must address maternal health prior to conception and early in pregnancy
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CDC Preconception EffortsCDC Preconception Efforts
• Summit• Select Panel Meeting• Recommendations• Supplement• Lectures/Speakers’ Bureau• Evaluations/Best Practices• Workgroups to develop
implementation strategies• TA to programs• Journal publications
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ConceptConcept MeasurementMeasurement
Preconception HealthPreconception Health
“How do we measure preconception health?”
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BackgroundBackground
FDOH wants to assess, monitor and FDOH wants to assess, monitor and evaluate preconception health and evaluate preconception health and interventionsinterventions
CA has previously developed a CA has previously developed a preconception health report including preconception health report including indicatorsindicators
No real consensus exists as to appropriate No real consensus exists as to appropriate preconception health measurespreconception health measures
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CORE State Preconception CORE State Preconception Health Indicator InitiativeHealth Indicator Initiative
PurposePurpose 7 states formed the initiative7 states formed the initiative
CA, FL, MI, NC, RI, TX & UTCA, FL, MI, NC, RI, TX & UT Review and evaluate potential indicatorsReview and evaluate potential indicators Recommend an initial set of available core Recommend an initial set of available core
state indicatorsstate indicators
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CORE State Preconception CORE State Preconception Health Indicator InitiativeHealth Indicator Initiative
North CarolinaNorth Carolina Alvina Long Valentin RN, MPHAlvina Long Valentin RN, MPH Sarah McCracken CobbSarah McCracken Cobb
TexasTexas Gita Mirchandani, PhD, MPHGita Mirchandani, PhD, MPH Charlotte Brooks, MEdCharlotte Brooks, MEd
UtahUtah Nan Streeter, MS, RNNan Streeter, MS, RN Lois Bloebaum, MPALois Bloebaum, MPA Shaheen Hossain, PhDShaheen Hossain, PhD
CaliforniaCalifornia Moreen Libet, PhDMoreen Libet, PhD Kiko Malin, MPH, MSWKiko Malin, MPH, MSWDelawareDelaware Charlan Kroelinger, PhDCharlan Kroelinger, PhDFloridaFlorida Danielle Broussard, PhDDanielle Broussard, PhD Bill Sappenfield, MD, MPHBill Sappenfield, MD, MPHMichiganMichigan Violanda Grigorescu, MD, MSPHViolanda Grigorescu, MD, MSPH Chris Fussman, MSChris Fussman, MS
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CORE State Preconception CORE State Preconception Health Indicator InitiativeHealth Indicator Initiative
AssumptionsAssumptions Indicators must be currently measurable on an Indicators must be currently measurable on an
annual basis(?)—either core or optional component.annual basis(?)—either core or optional component. Indicators need to be population-based and state Indicators need to be population-based and state
level.level. Indicators must be reasonably accurate & useful.Indicators must be reasonably accurate & useful. Indicators should not be unnecessarily duplicative.Indicators should not be unnecessarily duplicative. Outcomes should not be included as preconception Outcomes should not be included as preconception
health indicators—previously defined.health indicators—previously defined. Adolescents and men need their own set of Adolescents and men need their own set of
indicators; therefore not included.indicators; therefore not included.
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CORE State Preconception CORE State Preconception Health Indicator InitiativeHealth Indicator Initiative
ProcessProcess Identify preconception health domainsIdentify preconception health domains Review available state data sets for potential Review available state data sets for potential
indicators using domainsindicators using domains Identify potential indicatorsIdentify potential indicators Evaluate proposed indicators based on 6 criteriaEvaluate proposed indicators based on 6 criteria Score indicators for selection based on 6 criteriaScore indicators for selection based on 6 criteria Select and recommend CORE indicatorsSelect and recommend CORE indicators Provide for public review and commentProvide for public review and comment
Expert panel in
put & comment a
t decision points
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CORE State Preconception CORE State Preconception Health Indicator InitiativeHealth Indicator Initiative
DomainsDomains General Health StatusGeneral Health Status Chronic ConditionsChronic Conditions Emotional/Social Emotional/Social
SupportSupport Genetics/EpigeneticsGenetics/Epigenetics Health CareHealth Care InfectionsInfections
Mental HealthMental Health Nutrition/Physical ActivityNutrition/Physical Activity Reproductive Health / Reproductive Health /
Family PlanningFamily Planning Social DeterminantsSocial Determinants Tobacco, Alcohol and Tobacco, Alcohol and
Substance UseSubstance Use
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CORE State Preconception CORE State Preconception Health Indicator InitiativeHealth Indicator Initiative
State Level Data SetsState Level Data Sets Abortion reportingAbortion reporting ART Surveillance SystemART Surveillance System BRFSS BRFSS Census / Current Population SurveyCensus / Current Population Survey Cancer registryCancer registry PRAMSPRAMS Pregnancy Nutrition Surveillance SystemPregnancy Nutrition Surveillance System STI reportingSTI reporting Vital recordsVital records
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CORE State Preconception CORE State Preconception Health Indicator InitiativeHealth Indicator Initiative
Indicator Evaluation CriteriaIndicator Evaluation Criteria Public health importancePublic health importance Policy/program importancePolicy/program importance Data availabilityData availability Data qualityData quality Indicator complexityIndicator complexity
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CORE State Preconception CORE State Preconception Health Indicator InitiativeHealth Indicator Initiative
General Health StatusGeneral Health Status Chronic ConditionsChronic Conditions Emotional/Social Emotional/Social
SupportSupport Genetics/EpigeneticsGenetics/Epigenetics Health CareHealth Care InfectionsInfections
Mental HealthMental Health Nutrition/Physical ActivityNutrition/Physical Activity Reproductive Health / Reproductive Health /
Family PlanningFamily Planning Social DeterminantsSocial Determinants Tobacco, Alcohol and Tobacco, Alcohol and
Substance UseSubstance Use
Propose 45 Indicators in 11 Domains
“Turn to your handout table”
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CORE State Preconception CORE State Preconception Health IndicatorsHealth Indicators
Challenges & IssuesChallenges & Issues
Still emerging fieldStill emerging field Preconception health versus women’s healthPreconception health versus women’s health Adolescents, older women and menAdolescents, older women and men True population “at risk”True population “at risk” Limited services data by risk factorLimited services data by risk factor Initial proposal already has 45 indicatorsInitial proposal already has 45 indicators Competing surveillance prioritiesCompeting surveillance priorities