 Data available to everyone through the DOH Public Website: - Perinatal Data and Statistics - Community Health Assessment Clearinghouse - Prevention Quality Indicators (PQI ) Tool - MCHBG Application   Health data only available to those authorized to use the Health Information Network (HIN) and Health Provider Network (HPN) Data available to Birthing Hospitals – SPDS Data  QI data from SPDS  Data submitted by Hospitals, but not generally available - Data not currently available, either because the data are not accessible or because analysis not yet finalized

  

Statistics and Data MCHBG Application Community Health Assessment



Clearinghouse Prevention Quality Indicators

Live Births

 Table 4a - Live Birth Summary by Mother's Race/Ethnicity, New York State 2007  Table 4b - Live Births by Financial Coverage and Mother's Race/Ethnicity, New York State 2007 (Births Recorded Outside NYC)  Table 4c - Live Births by Financial Coverage and Mother's Race/Ethnicity, New York State 2007 (Births Recorded in NYC)  Table 5a - Live Birth Summary by Mother's Age, New York State 2007

Race1/Ethnicity

C ategory

All Births Total2 Number 252,662

Total Percent White Number

100164,555

White Percent Black Number

100 52,450

Black Percent

100

Other Number

35,324

Other Percent

Hispanic3 Number 100 60,326

Hispanic Percent

100

Sex

Male 129,027 Female 123,630 51.1 84,170 48.9 80,384 51.2 26,580 48.8 25,867 50.7

49.3

18,107 17,217 51.3 30,555 48.7 29,770 50.6

49.3

0 1 0 3 0 0 0 1 0 Not Stated 5

Mother’s Age

10 - 14 193 15 - 17 18 - 19 20 - 24 25 - 29 30 - 34 5,277 12,322 51,543 67,290 66,128 0.1

2.1

86 2,892 4.9

7,166 20.4 31,731 26.6 42,798 26.2 45,151 0.1

1.8

87 1,938 4.4

4,086 19.3 13,400 26 13,699 27.4 10,641 0.2

3.7

7.8

25.5

26.1

20.3

20 443 1,057 6,346 10,699 10,253 0.1

1.3

3 86 2,361 4,619 18 16,011 30.3 16,878 29 12,278 0.1

3.9

7.7

26.5

28 20.4

5,314 15 6,418 10.6

35 - 39 40 - 44 45 + Not Stated 39,457 9,613 811 28 15.6 27,614 3.8

6,549 0.3

0 557 11 16.8

4 0.3

0 6,485 1,961 146 7 12.4

3.7

0.3

0 1,084 104 4 3.1

0.3

0 1,564 108 3 0 2.6

0.2

Maternal and Child Health Services Title V Block Grant Program

Maternal and Child Health Services Title V Block Grant Program

A copy of the latest Maternal and Child Health Services Title V Block Grant Program application (PDF, 2.9MB, 451pg.) is currently only available in Portable Document Format (PDF).

Maternal and Child Health Title V Block Grant Program - 2009 Application / 2007 Annual Report (PDF, 2.9MB, 451pg.)

 Vital Statistics data, including trend information   Program-specific data and information Newborn Screening data   Survey Data, including:  PRAMS    BRFSS SLAITS YRBS National data, such as Current Population Survey & Census.

Births per 1,000 Females Ages 15 - 17 New York State by Region 1997 - 2006

40 30 20 10 0 New York State New York City Rest of State 1997 23.2

31.9

17.6

1998 21.8

29.1

17.1

1999 22.4

30.7

17.3

2000 18.7

24 15.1

2001 16 21.3

12.6

2002 15.7

20.3

12.6

2003 14.9

19.3

12 2004 14.2

18.7

11.3

2005 13.7

17.8

10.9

2006 13.3

17.2

10.8



County Health Indicator Profiles



Community Health Data Set



County Health Assessment Indicator Reports

Data collection, analysis and interpretation of relevant data including:



Demographics of the population



Health status of the population related to the problem



Availability, accessibility and acceptability of needed resources

    Also includes, under Maternal and Infant Health:  Spontaneous fetal deaths 20+ weeks  Infant, neonatal and postneonatal mortality  Low and very low birthweight  Births by gestational age at delivery Early and late/no prenatal care Maternal mortality Newborn drug related discharges

    Under Family Planning, includes:  Pregnancy rates by age (total, and by groups for teens)  Birth rates by age (total and by groups for teens) Teen births Abortion rates Out of wedlock births

For all of these indicators, data available:  Rates by County and Region   Mapping of rates by County Comparison graph of rates by County

PQI Website Finding the Site …

PQI Website

PQI Website Entry Page … Links

PQI Website Entry Page … Links (2)

PQI Website Main Page … Drill-Down (3)

PQI Website Main Page … Compare



Statistics and Data Page

( www.nyhealth.gov/statistics ) 

SPARCS ( www.nyhealth.gov/statistics/sparcs )



Vital Statistics ( www.nyhealth.gov/vital_statistics/index.htm

)



MCHBG Application (particularly Needs Assessment) ( http://www.nyhealth.gov/community/infants_children/ maternal_and_child_health_services/)

Websites / Resources cont.

:



Community Health Assessment Clearinghouse

( www.nyhealth.gov/statistics/chac ) 

Community Health Data Set ( www.nyhealth.gov/statistics/chac/chds.htm

)



County Health Assessment Indicator Reports ( www.nyhealth.gov/statistics/chac/chai/index.htm

)



County Health Indicator Profiles ( www.nyhealth.gov/statistics/chip/index.htm

)

 

Data Retrieval –

SPARCS

Data Tables -- Zip code-based perinatal data

Data Available to Birthing Hospitals:

Statewide Perinatal Data System (SPDS)

• The Core Module of the SPDS includes a ll items on the electronic birth certificate, such as:  Maternal and paternal demographic information  Information on prenatal care received  Maternal history and conditions  Method of delivery  Baby’s information, such as gender, birthweight, gestational age at delivery, Apgar Scores, feeding status at discharge, etc.

      Statistical summary of key indicators 2 delivery method reports Risk factors/Complications/Outcomes Perinatal outcomes by birth weight Statistical summary by insurance type Healthy People 2010 comparisons

 Month to date (MTD) and year to date (YTD) counts and percentages for key indicators such as:  multiple births   early/late prenatal care Medicaid and no insurance     primary and repeat cesarean births low birth weight NICU admission breast-feeding

   Delivery Method Statistics, Part A MTD, quarterly, and YTD counts and percentages detailing delivery route and method  Delivery Method Statistics, Part B MTD and YTD counts and percentages of dominant indications for cesarean and operative vaginal births, and anesthesia used for vaginal and C-section births

MTD and YTD counts and percentages for select Indicators such as:  diabetes  hypertension  fetal genetic testing  medicinal induction and augmentation of labor   births occurring prematurely births with serious congenital anomalies

   Perinatal Outcomes by Birth Weight -- MTD and YTD counts and percentages of live births and infant deaths by birth weight category Statistical Summary by Type of Insurance

--

YTD counts and percentages for indicators, broken out by Medicaid (HMO/Other), private (HMO/Other) or other insurance Healthy People 2010 -- Comparison of hospital or RPC performance to year 2010 goals for select indicators, such as maternal complications, adequacy of prenatal care, first birth c-section rate among low risk women, alcohol, cigarette, and illicit drug abstinence during pregnancy

 “Quality Improvement” or “QI” items (summaries under development)  Content of prenatal care         Maternal depression Exercise during pregnancy Oral health during pregnancy Pregnancy planned/or not Genetic testing Infertility treatments Indications for vacuum/forceps delivery Other items not officially part of the Birth Certificate  These data are not protected by law, and can be summarized and provided to interested parties.

 Medicaid Client Identification Numbers (CINs) While this information is collected, it is not available to other than the Office of Health Insurance Programs  NYC Vital Statistics – NYC Vital Statistics data are collected as part of a separate vital statistics registration area, and are therefore only available with special permission from the NYCDOHMH Office of Vital Statistics or in summary form through DOH.

 Fetal Death information confidential information.

: Fetal death certificates, and therefore information, are protected by special public health law (PHL Title 10. Section 35.3 Fetal death; (a) The information contained on a fetal death certificate shall be disclosed by the State Commissioner of Health only to the mother, her lawful representative, and to authorized personnel of the Department.

(b) The confidential information for medical and health use only furnished with a fetal death certificate shall not be copied and shall not be detached except as herein provided.

Analyses are proceeding on a number of topics, and data will be presented at the annual NYSPA meeting in June:  Very low birthweight analysis   C-section analysis SPDS data and information on updates to system    NICU data and information on updates to system QI indicators Etc.



Examples include:

  

March of Dimes National Center for Health Statistics Annie E. Casey Foundation

 State-specific information on perinatal health,       including:  Perinatal overview  Births Preterm births Birthweight Prenatal care Infant mortality Singleton vs Multiple births Delivery method

         Smoking/alcohol/drugs Obesity Infections Health Insurance Newborn screening Folic acid Population MCH programs Birth defects

    Some trend information Cross tabs – e.g., low birthweight by maternal age Data posted up through 2005 so far See: http://www.marchofdimes.com/peristats/

  DOH sends Vital Statistics data to NCHS     NCHS posts data on their web site  Low birthweight and preterm births  Total and by county and subgroups (race/ethnicity, mother’s age) Method of delivery Risk factors Prenatal care Trends

   Ability to define your own variables (data warehouse) 2006 data posted – but data go back to 1990 See: http://www.cdc.gov/nchs/

   Child-focused site Kids Count Data Center – Choose state and even city, for:  Low birthweight infants   Infant mortality Teen births by age group Go to: http://www.aecf.org

Child Health Information Integration CHI

2

20% 26% 46% Already Integrated Some or All CHIS Planning to Integrate in Next Year Planning to Integrate in Next Three Years 8%

States Efforts to Integrate Child Health Information Systems

Data Source: Public Health Informatics Institute (unpublished data) Response from 39 states

  Most states are integrating data from additional early childhood programs such as WIC, early intervention programs and Medicaid.

 Integrated information systems for two or three program areas The most common registry system that is integrated starts with an Immunization Information System (IIS).

 IIS have a longer history of development and  standardization, and, as such, are further along in integration efforts. As of December 2006, 65% of all children <6 years of age in the US are participating in IIS

   Master person index (MPI)  Single biggest step a public health agency can take towards making its information bases more accessible to authorized providers and families. There are various architectural designs available to organizations that seek to integrate person-centric records into an integrated system.  Demonstrate that regardless of an agency's legacy systems it is possible to create a single record of information held by a public health agency and to deliver that record to a requestor on demand The five core programs of early childhood for creating a consolidated record, child health profile.

 A concept developed and promoted by the Genetic Services Branch of HRSA\MCHB. These include: vital records, immunization, lead screening, newborn hearing and newborn dried bloodspot screening

Vision for Child Health Information Integration (CHI

2

)



Physician with Patient

 Immunizations  Lead  Newborn screening  WIC services  Pharmacy history  Early intervention program services  Pharmacy utilization  EmedNY HIE  CDC HIE  NICU Module  

PH Program Manager

 Follow up kids with conditions of public health interest (lead)  Quality monitoring  Monitor population health

PH Administrator

 Program monitoring and administration  Reimbursement  

PH Researcher

 Conduct studies to create generalizable knowledge

Patients/Families

 Assurance of complete medical history  Maximize care  Minimize unnecessary or dangerous care

 Vital registration  Electronic birth and death registration  249,000 birth cohort (NYC: 118,600 NYS: 130,400)  NYC separate vital registration jurisdiction  Statewide Perinatal Data System (SPDS)  Registries  Immunization (NYS & NYC) – statute effective 1/08; NYS outside NYC to become universal  Lead (NYS & NYC) – all blood leads reportable  Congenital malformations (NYS) – 10,000/year  Environmental Public Health Tracking System (EPHT) – track environmental exposures.

  Statewide public health programs  Newborn Metabolic Screening Program  Newborn hearing screening (aggregate reporting)  Early Intervention (0-3 yrs) – 75,000/year  WIC (pregnant women and 0-5) –  Pregnant women  Infants  Children 1-5 years 123,000 230,000 123,000 Statewide administrative data systems  SPARCS Hospital discharge incl. ED visits  eMedNY Medicaid billing system  PCAP (Medicaid Prenatal Care Assistance Program) data  Managed care encounter data (Medicaid and CHP)

 Maximize the use of the existing information infrastructure  Develop a standard infrastructure that promotes everyday use, access and data sharing   Improve bidirectional communication Employ standards to assure a seamless flow of information

      Children, their families, and society pay the price Δ Preventable illness or even life-long disability Δ Duplicate or incomplete immunizations, screenings, and follow-up Δ Lack of timely, complete and accurate health information Δ Information not shared among health providers, public health, social services, and families Δ Few or no linkages exist among information systems

 Develop integrated data system that:  Benefit private practice  Reduce medical errors (misdiagnosis, prescription interactions, fewer accidental deaths)  Improve quality of care (more timely and accurate patient information for diagnosis and treatment)  Reduce complexity of billing and claiming  Provide feedback to clinicians  Assist in quality improvement and assurance

 Develop integrated data system that  Collect individual level data for major activities such as Newborn Hearing Screening or School Based Health Centers  Provide seamless flow of information between jurisdictions  Link events of public health significance in child life (e.g. immunizations, lead tests, EI services, asthma events)  Integrate location data to assess environmental risks

CHI

2

Scope Implications for DOH Planning

 Development of an integrated environment within DOH that fosters the creation of application and infrastructure standards following federal and state guidelines  Formalized project management approach utilizing project sponsors, establishment of an advisory executive team, identification and involvement of stakeholders through the use of functional teams  Importance of good communication in an integrated environment for planning and efficiency

     Bi-directional informational flow Leverage existing infrastructure, utilize existing national standards and provide for the privacy and data security of participants as required.

Design should start small and grow – phased approach Flexibility with integration of applications and the ability to change frequently utilizing middleware approach – mapping / translator software product Scalable and extensible to other key NYS projects of interest: Regional Health Information Exchange (aka RHIOs), Electronic Health Record (EHR)

  Federal Strategic Framework for Health Information Technology to assist improved clinical practice  Interconnect clinicians   Personalize care Support public health program and improve population health An infrastructure in New York State to share clinical information among stakeholders on a State/Regional Level.  Patient       Physician Hospitals Nursing homes Insurers Pharmacies Public health entities

   Ensure that the systems used or built ( by providers ) are able to communicate easily with one another, using open architecture and Federal ‘HIT’ standards for interoperability among various stakeholders Ensure data integrity, availability as well as confidentiality and Security as required by the State and HIPAA Establish a process for monitoring quality and outcomes to allow individual institutions, as well as the State, to monitor their performance against state and national benchmarks

*RHIOs = Policy **SHIN-NY = Technology Medicaid CDC SHIN NY** Multiple RHIOs* Diagnostic Centers Patients’ Secure Personal Health Records Managed Care Public Health CDC Biosurveillance and Public Health Investigation Project NYS DOH UPHN

SHIN-NY**

Physicians Offices and Clinics Other NYS DOH Databases Immunization and Child Health Local Health Depts.

NYC Health Dept.

Home Health Care and Telemedicine Pharmacies and PBMs Hospitals, Nursing Homes, IDNs, etc CHITA projects

69