Transcript Slide 1

Overview of National Maternity Data Development Project
AIHW National Perinatal Epidemiology and Statistics Unit
Michelle R Bonello PhD MPH
on behalf of Professor Elizabeth A Sullivan
School of Women’s and Children Health
National Maternity Data Development Project
(NMDDP)

Australian Government Department of Health and Ageing (DoHA)

Australian Institute of Health and Welfare (AIHW)/National Perinatal
Epidemiology and Statistics Unit (NPESU)

National Maternal Data Development Project

2 year project (Phase 1: July 2011 – June 2013)
NMDDP governance
NMDDP Advisory Group
Dr Fadwa Al-Yaman(Chair)
Ms Sue Cornes
Professor Caroline Homer
Ms Ann Kinnear
Dr Michael Nicholl
Professor Jeremy Oats
Professor Michael Permezel
Ms Melinda Petrie
Ms Nicola Stansfield
Ms Masha Somi
Professor Elizabeth Sullivan
AIHW
Chair, National Perinatal Data Development Committee
Clinical expert - midwifery
Australian College of Midwives (ACM)
Clinical expert – obstetrics
Maternity Services Inter-jurisdictional Committee
Royal Australian and New Zealand College of Obstetricians
and Gynaecologists (RANZCOG)
AIHW
DoHA
DoHA
NPESU
Project aim
To develop the collection and availability of nationally
consistent and comprehensive maternal and perinatal
morbidity and mortality data in Australia
Background to NMDDP
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United Nations Millennium Development Goals 2000 – 2015
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Goal 4: Reduce child mortality
•
Goal 5: Improve maternal health, 5.1: reduce by ¾ MMR (1990-2015)
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Council of Australian Governments (COAG) National Indigenous
Reform Agreement (NIRA) – Closing the Gap targets for overcoming
Indigenous disadvantage
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Improving Maternity Services in Australia: The Report of the Maternity
Services Review (Commonwealth of Australia 2009) – informed the
development of the National Maternity Services Plan
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National Maternity Services Plan (AHMC 2011) – provides a strategic
national framework to guide policy and program development over 5
years (2010 to 2015), guiding document for NMDDP
National Maternity Services Plan – Feb 2011
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Australian Health Ministers’ Conference
Focuses on primary maternity services during the antenatal, intrapartum
and six-week postnatal periods for women and babies
The Australian National Maternity Services Plan sets out a five year vision
for maternity care in Australia
Five year vision
Maternity care will be woman centred, reflecting the needs of each woman
within a safe and sustainable quality system. All Australian women will have
access to high-quality, evidence-based, culturally competent maternity care in a
range of settings close to where they live. Provision of such maternity care will
contribute to closing the gap between the health outcomes of Aboriginal and
Torres Strait Islander people and non-Indigenous Australians. Appropriately
trained and qualified maternity health professionals will be available to provide
continuous maternity care to all women
National Maternity Services Plan
Priority 2 – Service delivery:
Action 2.1 Ensure Australian maternity services provide high-quality, evidence-based
maternity care
The initial year
The middle years
The later years
Signs of success
2.1.2 AHMAC
considers the
recommendations of
the National Maternal
Mortality and Morbidity
reporting project.
AHMAC recommends a
national maternal
mortality and morbidity
review process to
ACQSHC for
continuous
improvement of
maternity care.
ACSQHC continues to
work with AHMAC on a
national maternal
mortality and morbidity
review process for
continuous
improvement of
maternity care.
A national maternal
mortality and morbidity
review process is
established.
National maternal and
perinatal mortality and
morbidity reports are
produced.
National systems and
processes will drive
improved performance
in private and public
maternity care.
National Maternity Services Plan
Priority 4 – Infrastructure:
Action 4.1 Ensure all maternity care is provided within a safety and quality system
Action 4.2 Ensure maternity service planning, design and implementation is woman-centred
The initial year
The middle years The later years
Signs of success
4.1.5 The Australian
Government funds the
development of nationally
consistent maternal and
perinatal data collections.
The Australian Government
facilitates standardised
nationally consistent maternal
and perinatal data collections.
AHMAC agrees and begins
facilitating the capture of
standardised nationally
consistent data items for the
national data collections.
AHMAC facilitates the capture
of nationally consistent data
items for the national data
collections.
The Australian Government
publishes a report on
maternal and perinatal
outcomes.
Nationally consistent
maternal and perinatal data
are collected and reported.
AHMAC agrees to develop
nationally consistent
descriptors and definitions for
the range of models of
maternity care.
AHMAC develops agreed
nationally consistent
descriptors and definitions for
the range of maternity care
available.
There are agreed
descriptors and definitions
of the range of maternity
care available.
4.2.4
Governance structure of AHMC & NHISSC
AHMC
Australian Health Ministers’ Conference
NEHTA
National E-Health
Transition Authority
AHIC
Australian Health
Information Council
Currently under
review; term expired
April 2008
AHMAC
Australian Health Ministers’ Advisory Council
NEHIPC
APHDPC
HPPPC
AHPPC
National E-Health &
Information Principal
Committee
Australian Population
Health Development
Principal Committee
Health Policy Priorities
Principal Committee
Australian Health
Protection Principal
Committee
NHISSC
NAGATSIHID
NHCIOF
National Health
Information
Standards &
Statistics
Committee
National Advisory
Group on
Aboriginal & Torres
Strait Islander
Health Information
Development
National Health
Chief Information
Officers Forum
National E-Health Strategy
Project Steering
Committee
PHIDG
MHSC
Population Health
Information
Development Group
Mental Health
Standing Committee
MHISS
Mental Health
Information Strategy
Subcommittee
National Health
Information Regulatory
Framework (NHIRF)
Working Group
HWPC
CTEPC
Health Workforce
Principal Committee
Clinical, Technical and
Ethical Principal
Committee
Ministers Conference/Advisory
Council/Principal Committee
Standing Committee
Other entities/advisory groups
Sub Committee/Working Groups
COAG indicators: NIRA
Closing the Gap Target 2: Halve the gap in mortality rates for
Indigenous children under 5 within a decade (COAG NIRA: Baseline
performance report for 2008-09)
 Health conditions originating during pregnancy and the first month
after birth are the leading causes of death for Indigenous and
non-Indigenous children under five
 Low birthweight doubled for Indigenous mothers (11.5%)
compared to non-Indigenous mothers (4.5%)
 Over half Indigenous mothers smoked tobacco during pregnancy
(3x rate of non-Indigenous mothers)
 Indigenous women access antenatal visits at lower rates than
non-Indigenous women
NMDDP components
 Maternity Information Matrix
 Scoping and mapping national information
needs; addressing identified needs
 Nomenclature – maternity models of care
 Maternal mortality
NMDDP phases
Three phase project
 Phase one has four parts (2011-2013)
• Part 1 – National information requirements
• Part 2 – Options to meet information needs
• Part 3 – Data development
• Part 4 – Project framework
Maternity Information Matrix (MIM)
 Web-based summary of data items in Australian jurisdictional and
national data collections relevant to maternity care and perinatal
health (health departments, national NCIS, ABS)
 The Australian Government Department of Health and Ageing
identified the need for consistent, comprehensive national maternity
data to monitor progress
 A review of relevant Australian maternal data collections to
determine the depth and breadth of data capture in Australia
 Scope includes national and state and territory (jurisdictional) data
collections from key health, administrative and vital statistics data
collected
 Information for government agencies, researchers, data managers,
interested community
MIM version 2
 MIM updated as part of the NMDDP
 Project component completed
 Final MIMv2 online version released beginning of February 2012
 There has been consistent traffic to the site: In February there were
188 unique visitors for 320 visits and in March there were 176
unique visitors for 247 visits
 MIMv2 facilitated the scoping and mapping component of the
NMDDP
http://www.npesu.com.au/maternityinformation/
Scoping and mapping
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National information needs in maternity care and service provision not fully
scoped and documented previously (recommendation: Maternal and perinatal morbidity
and mortality: a review of data collections in Australia, AIHW 2010)
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WHA members contributed to consultation process (questionnaire)
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Aim to map identified information needs against existing data, using the
MIMv2 to identify areas of incomplete, inconsistent, inaccurate or nonexistent data capture.
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Designed to contribute to an improved national collection
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Will assist with monitoring and evaluating maternity services and outcomes
in Australia so that improvements can be made to health systems and
processes to facilitate better outcomes for mothers and their babies
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From scoping exercise, list of priority data items are being developed
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Sets agenda for subsequent stages of the project
Scoping and mapping - options to meet
information needs
Assessing ways of meeting the identified and prioritised
information needs
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changes to existing perinatal data collections
data linkage
data development
looking at service provider burden
assessing feasibility of addressing data deficiencies and gaps
prioritising items for data development
end phase 1 will develop project framework that will help build
a business case for carrying the work forward
Nomenclature – maternity models of care
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Develop a coherent system of nomenclature that will encompass the
range of models of maternity care in practice throughout Australia
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The Maternity Services Review (Commonwealth of Australia, 2009)
estimated over 90% of women in Australia receive care through one of
four overarching models:
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1.
private maternity care
2.
public hospital care
3.
combined maternity care, with both private and public components
4.
shared care, in which GPs and GPs with obstetric qualifications
contribute components of antenatal and intrapartum care
Maternity data in Australia: a review of sources and gaps (Walker et al
2004) highlighted lack of standardised terminology and definitions for
identifying and differentiating models of maternity care in Australia
where variations in service delivery exist between institutions and
jurisdictions
Nomenclature – maternity models of care
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Contributes directly to the Plan Priority Action 4.1 that the
implementation of innovative and progressive models of maternity care
around Australia is supported by a comprehensive evidence base and
operates within a sound safety and quality system

Contributes directly to the Plan Priority Action 4.2.4 that there are
agreed descriptors and definitions of the range of maternity care
available
 Good quality maternity information is required to monitor changing
practice and ensure that the outcomes for mothers and babies are
maintained
 Development of standard nomenclature or taxonomy for maternity
models of care not previously attempted in Australia or internationally
Nomenclature – maternity models of care
method
 Preliminary stages of project component
 Guided by Models of Care Working Party
 Review of current and proposed policy and practice documents to
delineate and describe the defining features of each model of maternity
care
 Develop data framework to be used as the basis for developing a
classification system to provide standardised categories of maternity
models of care
 Consultation phase on data framework – stakeholders, content experts
 Framework developed into draft Models of Care Classification System
(including data values)
 Models of Care Classification System distributed for wider consultation
on a national basis
Maternal mortality
 Contributes directly to the Plan Priority Action 2.1.2 that:
• maternal mortality review process is established
• maternal mortality reports are produced
• national systems and processes will drive improved performance in
private and public maternity care
 Internationally, maternal mortality used to compare maternal health
outcomes between countries and is used as an indicator of society’s
health care services
 Detailed examination of these deaths can inform policy and improve
practice in antenatal and obstetric care
Maternal mortality – project components
Two components and deliverables:
1. Maternal mortality report: Maternal Deaths In Australia 20062010 and prospective national data collection form
2. Maternal mortality data linkage study: Mothers who die: a
national population study of mothers dying in pregnancy and in
the first year after birth – data linkage
National Maternal Mortality Advisory Committee to re-convened
advise project
Classification of maternal death
Maternal death
The death of a women while pregnant or within 42 days of termination of pregnancy,
irrespective of the duration and the site of the pregnancy, from any cause related to or
aggravated by the pregnancy or its management, but not from accidental or incidental
causes (WHO 1992)
Direct obstetric death
those resulting from obstetric complications of the pregnant state (pregnancy, labour and
puerperium) from interventions, omissions, incorrect treatment, or from chain of events resulting
from any of the above
Indirect obstetric death
those resulting from previous existing disease or disease that developed during pregnancy and
which was not due to direct obstetric cause, but was aggravated by the physiologic effects of
pregnancy
Obstetric death of unspecified cause (unclassified)
maternal death from unspecified or undetermined cause occurring during pregnancy, labour and
delivery or the puerperium
Incidental death (coincidental: UK, Netherlands, NZ)
death from unrelated causes which happen to occur in pregnancy or the puerperium (e.g. MVA).
Cases included in reports, only direct and indirect counted for statistical analysis (not ICD 10
classification)
Late maternal death
Late maternal death (included in ICD 10)
the death of a woman from direct or indirect obstetric causes more than 42 days but
less than one year after termination of pregnancy (WHO 1992)
Direct obstetric death
those resulting from obstetric complications of the pregnant state (pregnancy, labour and
puerperium) from interventions, omissions, incorrect treatment, or from chain of events resulting
from any of the above
Indirect obstetric death
those resulting from previous existing disease or disease that developed during pregnancy and
which was not due to direct obstetric cause, but was aggravated by the physiologic effects of
pregnancy
Re-classification of maternal suicide
World Health Organisation
Classify suicide in pregnancy, deaths from puerperal psychosis and postpartum
depression in the category of direct maternal death (Pattinson et al 2009)
There is no internationally recognised standard definition or criteria for coding of maternal
deaths
Psychiatric illness is one of the leading causes of maternal death in
Australia
In line with recommendations from the 1997-99 Confidential Enquiries into Maternal
Deaths in the UK (National Institute for Clinical Excellence (NICE) report) Australia has
classified these deaths as indirect since the 1997-99 triennium
Reclassification of suicide significantly impact maternal mortality ratio in Australia
Future direction
Consultation with WHO, UK, NZ, NMMAC to develop most appropriate classification
system for the Australian setting whilst still enabling benchmarking internationally. Work
continuing
Maternal mortality in Australia
 Maternity care in Australia is one of the safest in the with world with
a low maternal mortality rate compared to Organisation for
Economic Co-operation and Development (OECD) nations (the Plan
2011)
 Advances in medical technology keeping patients alive for longer
(late maternal death)
 Between 2000-02 one in every 8,975 women in Australia died within
6 weeks of giving birth or terminating a pregnancy
 Indigenous women rate four times higher
 Women giving birth at older age (Laws et al 2009) and higher rates of
co-morbidities (obesity, diabetes, hypertension, ART) (Wang et al 2007)
Ratios of maternal mortality
Australia, 1982-1984 to 2003-2005
12
10
8
Total deaths
6
Direct deaths
Indirect deaths
4
2
0
1982-1984
1985-1987
1988-1990
1991-1993
1994-1996
1997-1999
2000-2002
2003-2005
Maternal mortality - report
Maternal Deaths in Australia 2006-2010 report
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Quantitative
Qualitative: inclusion of perturbated vignettes, case studies (UK, NZ) to
facilitate learning outcomes
Retrospective NMDR 2006-2010
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Historically
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AIHW published 3 triennial reports on maternal deaths in Australia on adhoc
basis subject to funding (last report 2008 (2003-2005))
relied on collation of information from State and Territory Maternal Mortality
Committees
many states and territories conduct confidential enquiries with varying methods
and legislation – comparisons difficult
statistical analysis based on small numbers with limited statistical power
National standardisation of maternal mortality reporting
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Nationally consistent confidential maternal mortality enquiry system
Prospective NMDR - 2012
Maternal mortality – data linkage
Mothers who die: a national population study of mothers dying in
pregnancy and in the first year after birth – data linkage
 Ascertainment of maternal and late maternal deaths
•
limited research to validate reporting maternal deaths in Australia
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hospital survey found 34% under-reporting of maternal deaths (Qld)
(King et al 1999)
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pilot linkage study 20% under-reporting of maternal deaths (NSW)
(Cliffe et al 2008)
 Study will evaluate contribution of pregnancy as a risk factor for all
cause mortality and specific causes of death in women at different
reproductive ages
 State and territory perinatal data + National Death Index + National
Coroner’s Information System + STMMC
Maternal mortality – data linkage
 Late maternal deaths not monitored and/or are missed by jurisdictions
due to no efficient process to identify late maternal deaths
 No agreement on value of investigating late maternal deaths
 1997-2002 – 13 late maternal deaths reported nationally (demonstrating
lack of investigation)
 No national study of late maternal deaths conducted in Australia to date
 Data linkage
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provides a new means of maternal death ascertainment
population based
utilises routinely collected and available data
potential to be a sustainable surveillance tool for maternal deaths
 Preliminary phase of project (ethics, data transfer)
NMDDP summary – phase 1
 Project components
• Maternity Information Matrix
• Scoping and mapping information needs; options to meet information
needs; data development work
• Nomenclature – maternity models of care
• Maternal mortality (report and data linkage)
 Collaborative work: DoHA, AIHW, NPESU
 Committees (NMDDP AG, NMMAC, MoCWP)
 Phase 1, approaching the beginning of phase 2
NMDDP – Phase 2
 Phase two – development of a business case to
National Information Standards and Statistics
Committee (NHISSC) for endorsement
 Phase three – Implementation of revised and/or
expanded maternity data collection(s)
Acknowledgements
Funding Australian Government Department of Health and Ageing
AIHW team
Dr Fadwa Al-Yaman
Melinda Petrie
Mary Beneforti
NPESU team
Professor Elizabeth Sullivan
Dr Lisa Hilder
Natasha Donnolley
Stephanie Johnson
Liz Stokes
Committees
NMDDP Advisory Group
NMMAC
MoCWP
References
AHMC (Australian Health Ministers’ Conference) National Maternity Services Plan 2011. Canberra: Australian
Government Department of Health and Ageing
Cliffe S, Black D, Bryant J, Sullivan EA. Maternal deaths in New South Wales Australia: a data linkage project.
Australian and New Zealand Journal of Obstetrics and Gynaecology, 48(3): 255-60, 2008
Council of Australian Governments Reform Council 2010, National Indigenous Reform Agreement: Baseline
performance report for 2008-09, COAG Reform Council, Sydney
King J, Flenady V. Maternal mortality, an under-reported event. Proceedings of the 6th Annual Congress of the Perinatal
Society of Australia and New Zealand: Brisbane, 1999
Laws PJ, Slaytor IK, Sullivan EA. Australia’s mothers and babies 2007. Perinatal statistics series no. 23. AIHW cat. no.
PER 48. Sydney: AIHW NPSU, 2009
Walker J. Maternity data in Australia: a review of sources and gaps. Bulletin no 87.Cat.no.AUS136 Canberra: AIHW
Wang YA, Chambers GM, Dieng M & Sullivan EA 2009. Assisted reproductive technology in Australia and New Zealand
2007. Assisted reproduction technology series no. 13. Cat. no. PER 47. Canberra: AIHW
World Health Organisation, International Statistical Classification of Disease and Related Health Problems. Tenth
Revision. Volume II. Geneva: WHO1992:98-99
Pattinson R, Say L, Paulo Souza J, van den Broek N, Rooney C on behalf of the WHO Working Group on Maternal
Mortality and Morbidity Classification. WHO maternal death and near-miss classifications. Bulletin of the World Health
Organization 2009;87:734-734. http://www.who.int/bulletin/volumes/87/10/09-071001/en/index.html#
Thank you
Questions ?
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