birth data quality vital records: a culture of quality naphsis annual meeting | seattle | june 8-11,...
TRANSCRIPT
BIRTH DATA QUALITY
VITAL RECORDS: A CULTURE OF QUALITY
NAPHSIS Annual Meeting | Seattle | June 8-11, 2014
An Update
THE BIRTH DATA QUALITY
WORKGROUP
Karyn Backus(Cha i r ) (CT)
Col leen Fontana (Cha i r ) (R I )
Sukhjeet Ahuja(NAPHSIS)
Mary Chase (CO)
Greg Crawford (KS)
Mel issa Gambatese(NYC)
Jean Hreczan (DE)
Andrew Jessen (AK)
David Just ice
(NCHS)
Ann Madsen
Stra ight(NYC)
Joyce Mart in
(NCHS)
Judy Nagy (OH)
Sharon Pagnano
(MA)
Phyl l i s Reed (WA)
Shae Sutton (SC)
Marie Thoma
(NCHS)
Ela ine Tretter (MD)
Louise Wishart
(DE)
BIRTH DATA QUALITY WORKGROUP
HOSPITAL REPORTS/ ENGAGING
HOSPITALS SUBGROUP
CHARGE
Birth Data Quality Workgroup mission was to address identified issues with birth data quality.
Subgroup 1: Hospital ReportsCharge: Recommend a process (metrics, means of communication, actions) for vital records offices to use to provide data to hospitals to help them improve their reporting.
Goal 1: Survey all jurisdictions to learn their current activities
Subgroup 2: Engaging HospitalsCharge: To develop approaches to engaging hospitals to improve systems and procedures for data gathering.
Step 1: Develop an outline for engaging hospitals
In October 2013, subgroups 1 and 2 were combined as charges were overlapping.
CHARGE
SURVEY RESULTS
The survey is a starting point; a tool to gauge where we are and who is doing what.
• Are all jurisdictions actively engaged in Evaluating and Ensuring Data Quality (EEDQ) from the birth facilities?
• Is communication with hospitals on EEDQ issues regularly utilized as a means for improving quality?
• Does communication with hospitals make a difference?
WHY DID WE DO THE SURVEY?
The survey is a starting point; a tool to gauge where we are and who is doing what. (cont . )
• What else are jurisdictions doing to improve the data quality from hospitals? (types of metrics, types of awareness efforts)
• Do jurisdictions want to do more or are they satisfied with where they are?
• What other barriers are there to EEDQ (organizational dynamics, staffing, failure to utilize standard tools, etc.)
WHY DID WE DO THE SURVEY?
First administered in March 2013 41/52 (78.8%) – United States 2/5 (40.0%) – Territories
In October 2013, non-responding jurisdictions contacted by email with opportunity to participate 5 additional U.S. jurisdictions responded
SURVEY PARTICIPATION
Final participation rates: 46/52 (88.4%) – United States; representing 83% of
US Births 2/5 (40.0%) – Territories
SURVEY PARTICIPATION
Participated 84.2%
Did not participate
15.8%
All jurisdictions
Encourage Improved Collaboration within
the Jurisdiction
Findings:Majority maintain registration and statistics staffs in same unit
Majority indicate room for improvement to maximize EEDQ
More than half reported being understaffed for EEDQ activities
Nearly all report desire to do more extensive EEDQ
FINDINGS & RECOMMENDATIONS
JURISDICITONAL DYNAMICS
Encourage Improved Collaboration within
the Jurisdiction
Recommendations: Jurisdictions should improve collaboration between staffs
Next steps: Identify jurisdictional successes with or impediments to collaboration
Offer recommendations for improving or enhancing the relationship between the two staffs
FINDINGS & RECOMMENDATIONS
JURISDICITONAL DYNAMICS
Increase Jurisdictional Compliance with Established Standards
Findings: (revised only)
FINDINGS & RECOMMENDATIONS
STANDARDIZATION NOT UNIVERSAL
Increase Jurisdictional Compliance with Established Standards
Recommendations:All jurisdictions should develop standardized worksheets based on NCHS standard
Jurisdictions should mandate use by birth facilities
Next steps:Clarification from NAPHSIS/NCHS regarding what constitutes compliance
Explore why jurisdictions did not adopt standards
Consider improving the standards based on identified issues
FINDINGS & RECOMMENDATIONS
STANDARDIZATION NOT UNIVERSAL
Increase Jurisdictional Compliance with Established Standards
Findings (all jurisdictions):EBRS vary in their forward-facing quality control measures Missings versus unknowns Logic checks, soft edits, hard edits
Jurisdictional interpretation of completeness varied Some reported that EBRS was suffi cient to ensure
data quality
Recommendations: Jurisdictions should confirm that systems are compliant with standards
FINDINGS & RECOMMENDATIONS
STANDARDIZATION NOT UNIVERSAL
Increase Jurisdictional Compliance with Established Standards
Next steps:Clarify whether missing versus unknown is a QA concern as it pertains to record completeness
Review existing standards for data collection systems and document rationale for why various standards are imposed
Share review with jurisdictions so they can better evaluate their systems
FINDINGS & RECOMMENDATIONS
STANDARDIZATION NOT UNIVERSAL
Increase Data Quality Evaluations
Finding 1: Range in jurisdictional utilization of data quality
analyses
Recommendations: Learn about the various metrics available for
assessing quality Self-evaluate to expose data validity issues
Next steps: Develop ways to educate jurisdictions about data
quality constructs Collaborate with NCHS to provide additional data
quality reports
FINDINGS & RECOMMENDATIONS
DATA QUALITY EVALUATIONS
Increase Data Quality Evaluations
Finding 2:Types of QA metrics utilized variesFrequency and timing of QA reports varies
Completeness: 52% outside EBRS Logic checks: 61% outside EBRS Audits: 6% regularly, 17% rarely or as needed Other QA: 78% perform at least one, 17% perform
all three
FINDINGS & RECOMMENDATIONS
DATA QUALITY EVALUATIONS
Increase Data Quality Evaluations
Recommendations:Move closer to near real-time evaluations and away from year-end
Use multiple metrics to detect quality issuesLook for alternative resources for QA, given staffing limitations Hospital self-audits, collaborate with other
programs, funding for targeted QA, linkage with hospital discharges
FINDINGS & RECOMMENDATIONS
DATA QUALITY EVALUATIONS
Increase Data Quality Evaluations
Next steps:Determine which metrics are efficient and effective at measuring quality and recommend these as a best practice
Develop standardized analytical programs for recommended metrics (69% prefer SAS)
Investigate the development of NCHS-based hospital reports
FINDINGS & RECOMMENDATIONS
DATA QUALITY EVALUATIONS
Advocate for Data Quality
Findings 1: Jurisdictions that provided feedback realized improvement.
FINDINGS & RECOMMENDATIONS
PROVIDE FEEDBACK
Some jurisdictions have no efforts in place to advocate for birth data quality; many have only a few targeted efforts.
Advocate for Data Quality
Recommendations: Improve communication with hospital partners about performance.
Increase education and awareness about the merit of data quality and common issues. Provide trainings and newsletters. Educate hospital staff about the public health value
of birth certificate data. Educate non-hospital staff about data quality initiatives and data limitations.
Publish reports about performance to increase transparency.
FINDINGS & RECOMMENDATIONS
PROVIDE FEEDBACK
Advocate for Data Quality
Next Steps:Develop a set of best practices for communicating with hospitals about ongoing performance.
Develop educational materials (newsletters, letters, reports) for hospital staff and non-hospital stakeholders.
Evaluate expressed concerns over publishing hospital-level reports (e.g., confidentiality, misinterpretation).
FINDINGS & RECOMMENDATIONS
PROVIDE FEEDBACK
Advocate for Data Quality
Finding 2:The hospital administration was rarely identified as recipients of performance reports.
Recommendation:Engage upper-level clinicians and hospital administrators in the merit of providing quality birth data.
FINDINGS & RECOMMENDATIONS
PROVIDE FEEDBACK
Advocate for Data Quality
Next steps:Pursue effective avenues for communicating with higher-level hospital administration.
The subgroup will transition into the “Engaging Hospitals” charge.
FINDINGS & RECOMMENDATIONS
PROVIDE FEEDBACK
The national survey provided information that was not previously available.
Serves as a spring board for initiatives at the jurisdictional and birth facility level. StandardizationEducationCommunication
Supporting the overall initiative to develop a national model for improving birth data quality.
SUMMARY
91% of jurisdictions want to do more quality review.
Our subgroup is striving to provide tools to all jurisdictions to reach that goal.
Thank you to all jurisdictions who participated in the survey.
You are helping us go from Good to
GREAT!
CONCLUSIONS
Sukhjeet Ahuja (NAPHSIS)
Karyn Backus (CT)
Bruce Cohen (MA)
Isabel le Horon (Chair) (MD)
Renata Howland (NYC)
Michel le Osterman
(NCHS)
Elaine Tretter (MD)
BIRTH DATA QUALITY WORKGROUP
PRENATAL CARE ITEMS
SUBGROUP
To assess the quality of prenatal care data items collected on the U.S. Standard Certificate of Live Birth; and
Recommend changes for improvement
CHARGE
BackgroundData uses
History of collecting PNC data
Data quality
Barriers to the collection of accurate data
Survey of jurisdictions
LAST YEAR
Further review of survey findings and follow up with selected jurisdictions
Review of Guide to Completing the Certificate of Live Birth
Survey of MCH Experts
Development of Recommendations
THIS YEAR
Date of first prenatal care visit
Date of last prenatal care visit
Number of prenatal care visits
PNC DATA ITEMS
Last year—data collection
This year—telephone follow up with 11 jurisdictions Efforts in placeEffectiveness of efforts
SURVEY
Prepared by NCHS (with assistance from NAPHSIS, birth information specialists, and clinical experts)
Purpose—to assist facility birth registrars in providing complete, accurate data
Contains: Definitions Instructions Sources of information Key words/abbreviations
REVIEW OF GUIDE TO COMPLETING THE CERTIFICATE OF LIVE BIRTH
Queried MCH data collection and research experts concerning “date of last prenatal care visit”
SURVEY OF MATERNAL AND CHILD HEALTH EXPERTS
1. Include edits/edit rules in EBRS2. Require facilities to obtain data from PNC
records3. Encourage PNC data collection from
providers at 35+ weeks, with update following delivery
4. Consider preparing a comprehensive worksheet for PNC providers
5. Recommend that hospitals with EHRs store paper PNC records in central location
RECOMMENDATION 1IMPROVE DATA COLLECTION
1. Visit facilities routinely2. Provide training for new birth
registrars3. Ensure facilities have (and use)
Guidelines4. Promote use of eLearning training
RECOMMENDATION 2IMPROVE TRAINING
1. Hold annual conference for birth registrars
2. Recognize good performance3. Prepare newsletter4. Identify data users and solicit
assistance5. Communicate with PNC providers re:
need for accurate data6. Assist birth registrars to find solutions
to problems
RECOMMENDATION 3IMPROVE COMMUNICATION WITH HOSPITAL
STAFF AND PNC PROVIDERS
Assess data quality regularly and contact facilities for corrected data ASAP
Provide facilities with completeness/accuracy reportsProvide comparison data to encourage improvement
Concentrate on poorest performing facilitiesRecommend strategies for improvementFollow changes in trends
Conduct simple analyses to identify hospitals providing questionable data
RECOMMENDATION 4REVIEW DATA QUALITY AND TAKE
ACTION
Source: Connecticut Department of Public Health
Source: Connecticut Department of Public Health
Source: Connecticut Department of Public Health
Source: Connecticut Department of Public Health
Conduct routinelyReview both mother and newborn recordsMeet with hospital staff Prepare detailed analysis of findings
Point out areas where improvement is needed Provide instructions for improvement Provide positive as well as negative findings
Provide findings to high level hospital staffConduct follow up audit in 6 months if facility
is performing poorly.Encourage hospitals to do internal auditsLook for outside resources to support audit
RECOMMENDATION 5AUDIT HOSPITAL MEDICAL RECORDS
Raise awareness
Encourage use
RECOMMENDATION 6RAISE AWARENESS OF GUIDELINES
Drop “Date of Last Prenatal Care Visit” from the U.S. Standard Certificate of Live BirthNo body of literature or significant research findings describing use of this data item
Recorded inconsistently across facilities and jurisdictions
IncompleteLittle analytic, research or practical utility
RECOMMENDATION 7CERTIFICATE CHANGE
Establish clear definitionEnlist assistance from clinicians and MCH experts
Test to ensure that new definition improves data quality
If data quality cannot be improved, reevaluate whether item should remain on certificate
RECOMMENDATION 8FOCUS ON IMPROVING “NUMBER OF PRENATAL
CARE VISITS”
Sal ly Almond(Cha i r ) (MN)
Marie Aschl iman(UT )
Karyn Backus(CT )
Lucy England(CDC)
Col leen Fontana(R I )
Mel issa Gambatese(NYC)
Saeed Hamdan(CDC)
Cather ine Haralson(TN)
Kerry L ionadh(OR)
Joyce Mart in(NCHS)
TJ Mathews(NCHS)
Carol Moyer(KS )
Marie Thoma(Cha i r ) (NCHS)
Ela ine Tretter(MD)
BIRTH DATA QUALITY WORKGROUP
LEARNING CREATIONSUBGROUP
e
Birth record timeliness is much improved
Slide 50
WHY CREATE LEARNING?e
PRINCIPAL SOURCE OF PAYMENT FOR DELIVERY: 38-STATE AND THE DISTRICT OF COLUMBIA
REPORTING AREA, 2012
Source: CDC/NCHS, National Vital Statistics System.
Medicaid43.9%
Private insuranc
e46.9%
Self-Pay (uninsured
)4.1%
Other5.1%
AVAILABLE, UNIFORM, USER-FRIENDLY
Some jurisdictions have created own training
Convenience for jurisdictionsConvenience for stakeholdersDisparate registration rolesReduce barriers to timely fi ling
WHAT WILL IT LOOK LIKE?
Scope, format, and audience for eLearning
PROPOSED FORMAT
Two modules:1. Motivation - two tracks
Clinical Clerical
2. Medical - detailed, specific data instructions
MODULE 1 - MOTIVATION
Objectives: Understand public health importance Recognize the significance of complete and
accurate data Identify how my role is critical Benefits me, patients, facilities, &
community
Divided into TWO tracks for clinical & clerical staff
BIRTHS WITH MEDICAID AS THE PRINCIPAL SOURCE OF PAYMENT FOR THE DELIVERY BY
AGE OF MOTHER: REVISED REPORTING AREA, 2012
Source: CDC/NCHS, National Vital Statistics System.
Under 20 20-24 25-29 30-34 35-39 40 and over
0
10
20
30
40
50
60
70
80 75
64.8
41.9
27.9 26.1 26.9
Age of mother
Perc
ent
TECHNICAL DETAILS
Professionally designedInteractiveNavigable Approximately 20-30 min per module
MODULE 2 – MEDICAL
2003 Birth data setHighlighting
specific or troublesome data
IndexedResource links
RESOURCES – THE GUIDE
Guide to Completing the Facility Worksheets
ADDITIONAL RESOURCE LINKS
Professional programs List of medical abbreviationsNCHS - worksheetsCDC
WHAT’S IN IT FOR ME?
CME, CNE, CEU, CECH availableHospital convenienceState convenience
HOW TO PREPARE?
Our next steps….and yours
WHAT’S NEXT?
Promote convenienceConsider requiring
trainingKnow your state-
specific data – supplemental training may be necessary
Plan website or link Share your ideas
Joyce Martin (Chair) (NCHS)
Sukhjeet Ahuja (Chair)
(NAPHSIS)
Karyn Backus (CT)
Mark Flotow(IL)
David Justice(NCHS)
Michel le Osterman
(NCHS)
Phyl l is Reed(WA)
Marie Thoma(NCHS)
Elaine Tretter (MD)
BIRTH DATA QUALITY WORKGROUP
CU T-ITEM SUBGROUP
Recommend items to CUT from the 2003 national standard birth data file because of:
Poor data quality andLack of potential for improvement
NOT to add items to the standard birth certificateNOT to recommend changes that would require modifications to jurisdictional electronic birth systems
No changes to item wording etc. (e.g., not from the current wording “Moderate/heavy” meconium staining to “Thick” meconium staining)
CUT ITEM SUBGROUP CHARGE
Developed “short” list of items (i.e., low hanging fruit) Focus on medical health data items Items of questionable data quality Jurisdictional and NCHS experience Audits and validity studies
Missing from short list Items considered key (i.e., date of LMP) Rare events, e.g., the maternal morbidity and
congenital anomaly items (not enough information).
Field survey of jurisdictions for input on short list, other items of concern, and improvement potential
FIRST STEPS - WHICH ITEMS TO REVIEW?
Special thanks
to
Sukhjeet Ahuja
for developing the survey
and leading this eff ort
SURVEY OF
JURISDICTIONS TO
IDENTIFY BIRTH ITEMS
OF POOR DATA QUALITY
Input from the jurisdictions on “short” list of potential items to cut from the national birth file
Asked about specific data items known to have poor quality based on information from sources previously mentioned:Validity studiesInput from BDQW membersInquiries from jurisdictions to NCHS
SURVEY GOAL
Prenatal care Date of last prenatal care
visit Total # of prenatal visits
Risk Factors in This Pregnancy Other previous poor
pregnancy outcomes Previous preterm birth
Obstetric Procedures External cephalic version Tocolysis
Onset of Labor Premature rupture of
membranes Precipitous labor, <3 hours Prolonged labor, >=20
hours
Characteristics of Labor and Delivery Steroids received by
mother Antibiotics received by
mother Moderate/heavy meconium
staining Fetal intolerance of labor
Abnormal Conditions of the Newborn Assisted ventilation
required for >6 hours Assisted ventilation
required immediately following delivery
ITEMS
NAPHSIS sent out via SurveyMonkey
Sent to NAPHSIS “Primary Contacts”
March 2014Target: Revised Jurisdictions
METHODS
30 responses
2 unrevised
2 submitted 2 responses (diff erent staff )
26 revised jurisdictions(including 2 territories)
* 52% of revised 2014 births *
RESPONSE
93% have assessed data qualityEach item assessed by at least 12 jurisdictions (43%)
When is data quality assessed?At regular intervals (every 6 months, annually)
When data quality starts to decline (more missing data, out of range data)
Soon after adoption of the 2003 revision
DATA QUALITY ASSESSMENT
0
20
40
60Top 3 Assessment Methods
Percent
HOW IS DATA QUALITY ASSESSED?
0
30
60
90
Items of most concern
Perc
ent
ITEMS OF POOR DATA QUALITY
“Other” items listed more than onceDate of last menstrual periodGestational diabetesPregnancy-induced hypertension Date of first prenatal care visit Mother received WIC food during this pregnancy
ITEMS OF POOR DATA QUALITY
Impr
oved
trai
ning
Clear
er in
stru
ctio
ns
Bette
r defi
nitio
n0
1020304050607080
Average % of “yes” responses
Perc
ent
For all items:
Improved training>
Clearer instructions
>Better definition
POSSIBLE IMPROVEMENT
Has been very helpful
Used in subgroup deliberations on items
Decision-making process and Recommendations
USEFUL INFORMATION
DECISION-MAKING- PROCESS
Date of last PNC visit Total # of prenatal care visits
Previous preterm birth (Risk Factors in this Pregnancy) Other poor pregnancy outcomes (Risk Factors in this Pregnancy)
Tocolysis (Obstetric procedures) External cephalic version (Obstetric procedures)
Fetal intolerance of labor (Characteristics of L&D) Steroids received by mother (Characteristics of L&D) Moderate/heavy meconium staining (Characteristics of L&D) Antibiotics received by mother during labor (Characteristics of
L&D)
Precipitous labor (Onset of Labor) Prolonged labor (Onset of Labor) Premature rupture of the membranes (Onset of Labor)
Assisted ventilation following delivery (Abnormal conditions newborn)
Assisted ventilation > 6 hrs (Abnormal conditions newborn)
CUT ITEM SHORT LIST
DECISION MAKING PROCESS
Criteria
Rankings
High
Medium
Low
Extremely low
Clear interpretati
on
Potential for
improvement
Consistent w/ BC items
Public Health
usefulness
Data quality
CRITERIA
1/ Item title is unambiguous and can be interpreted by birth information specialist without need for specific clinical expertise or higher level training
2/ Item wording in hospital records is consistent with birth certificate item
3/ Assumes acceptable data quality.
Data quality
Public Health
usefulness3
Potential for
improvement
Clear interpretatio
n1
Consistent w/ BC items
Improve
Watch
Cut
POSSIBLE OUTCOMES
Watch = Information currently available suggests the item is problematic, but not enough information available for final decision
Published studiesNCHS/State hospital medical records compared w/ BC
NCHS/State birth information specialist interviews
Other studies on revised birth data (very limited)
Workgroup member experienceE.g. Maryland audits
NCHS experience Jurisdictional and researcher queriesObserved consistent data issues
NAPHSIS survey on jurisdictional experience
PRIMARY SOURCES USED FOR REVIEW
Criteria
Meconium staining
Previous preterm birth
ProlongedLabor =>20 hrs
Data quality EL EL L*
Clear interpretation L H M
Consistent w/ BC items
EL/L H M
Potential for improvement
EL M/H M/H
Potential PH usefulness
EL/L H L/M
Recommendation
MATRIX
*Limited information available on data quality.
BirthsRECOMMENDATIONS
Total number of prenatal care visits
Previous preterm birth
Precipitous labor (<3 hours)
Premature rupture of the membranes (=>12 hours)
Antibiotics received by mother during labor
IMPROVE
Prolonged labor (=>20 hours)
WATCH
Date of last prenatal visit
Other poor pregnancy outcomes
Moderate/heavy meconium straining
Fetal intolerance of labor
Recommendations approved by the
Good to Great Group!
CUT
Note: Items previously cut from the standard = are attempted forceps delivery, attempted vacuum deliveryand non-vertex presentation.
Fetal DeathsRECOMMENDATIONS
CutDate of last prenatal visitOther poor pregnancy outcomes
Improve?Previous preterm birthTotal # of prenatal care visits
NOTE: Moderate/heavy meconium staining, fetal intolerance of labor and prolonged labor are not included on U.S. Standard Report of Fetal death
RECOMMENDATIONSFETAL DEATHS
NEXT STEPS
The birth data quality workgroup will continue to review birth certificate items to ID poorly performing items
Plan to complete the short list review within next 2 months
Follow-up on items on “watch” list (additional info available?)
Re-examine certificate for additional potential items to review
List (“first wave”?) of items to cut from national fi le by November 2014
NEXT STEPS
Beginning with 2015 data year, NCHS will no longer require data be sent on the cut items
NCHS will not review items and will disable all validations and verifications from our processing so that states will not receive feedback on the cut items
Jurisdictional discretion as to whether to continue to collect these items!
NCHS will continue to accept data for the dropped items i.e., no need to modify fi les sent to NCHS
NEXT STEPS IMPLEMENTATION
The cut items will not be included in national birth and fetal death data sets beginning with the 2015 fi le
Items will be dropped from the standard worksheets and Facility Guidebook
NCHS will place a notice on the NCHS revision website explaining the change
NEXT STEPSIMPLEMENTATION
For items not cut, recommend improvements to definitions and instructions where appropriate via:
E-learning training and Facility Guidebook – improved instructions
Special approaches – e.g., more detailed instructions (e.g. gestational age and source of payment
More audits and validity studies to monitor improvement and aid decisions for next r e v i s i o n
NEXT STEPS IMPROVING ITEMS
We have learned a lot from this process and intend to use this knowledge to foster
continual improvement and meaningful change in vital statistics birth and fetal
data.
Thank you!
Co-chairs Isabelle Horon (MD), David Justice (NCHS), Joyce Martin
(NCHS)
MEMBERS
Members Sukhjeet Ahuja
(NAPHSIS) Sally Almond (MN) Marie Aschliman (UT) Karyn Backus (CT) Mary Chase (CO) Bruce Cohen (MA) Greg Crawford (KS) Victoria Daher (CA) Claudia Fabian (IL) Mark Flotow (IL) Coleen Fontana (RI) Jean Hreczan (DE) Melissa Gambatese
(NYC)
Karen Hampton (OR) Catherine Haralson
(TN) Sarah Hargand (OR) Aldona Herrndorf (CA) Cindy Hooley (VT) Renata Howland (NYC) Andrew Jessen (AK) Kerry Lionadh (OR) Terri Mack (CA) Ann Madsen Straight
(NYC) Lloyd Mueller (CT) Laura Ninneman (WI)
Michelle Osterman (NCHS)
Sharon Pagnano (MA) John Paulson (OH) Mariah Pokorny (SD) Phyllis Reed (WA) Matthew Rowe (WY) Margarita Segundo
(CO) Joann Steele (FL) Shae Sutton (SC) Marie Thoma (NCHS) Elaine Tretter (MD) Louise Wishart (DE)
SubgroupsHospital reports/Engaging hospitals
Karyn Backus (CT), Colleen Fontana (RI)Prenatal care data
Isabelle Horon (MD)New subgroups
E-learning training for hospital staff Sally Almond (MN), Marie Thoma (NCHS)
Identify items to drop from the national birth data file Sukhjeet Ahuja (NAPHSIS), Joyce Martin (NCHS)
Future subgroupsFetal death expert panel
PRIORITIES
Breakfast meetingTuesday @ 7:30amWillow Room
Grab breakfast and come join in the fun!
JOIN US!