Maternity Framework Antenatal Access Target and Outcome Measures Data Theme Work Stream Women and Children’s Health Information Programme Lindsay Mathie Project & Information Manager Etta Shanks Senior Information Analyst
Dec 31, 2015
Maternity FrameworkAntenatal Access Target and
Outcome Measures
Data Theme Work StreamWomen and Children’s Health Information
Programme
Lindsay Mathie
Project & Information Manager
Etta Shanks
Senior Information Analyst
Proposed Target – Current Situation
Antenatal Access Target -• Data from Scottish Morbidity Record 02 (SMR02)• Key components
–The record is submitted by 6 weeks following the end of the month of discharge
–‘Date of Booking’ field (will be Mandatory from 1st April 2012)
–‘Gestation at Time of Delivery’ field (Mandatory)–Using both these fields ‘Gestation at Time of
Booking’ can be calculated
SMR02 Submissions
• In October 2010 ISD notified all Health Boards of the definitional enhancement to ‘Date of Booking’– the ‘Date of history taking appointment’ as
recorded on the ‘Demographic information and EDD’ page in SWHMR Pregnancy Record page 2
Why we need to pursue these actions with SG support?
Submission backlogs across Scotland (for the last 3 months of data available)
Aug 2011 3,349
Sep 2011 3,782
Oct 2011 4,479
All Health Boards
8,000
6,000
4,000
2,000
0
2,000
4,000
6,000
8,000
10,000
Nov-09
Dec-09
Jan-10
Feb-10
Mar-10
Apr-10
May-10
Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Month of discharge
Nu
mb
er
of
rec
ord
s
Submitted within 6 week target Submitted after 6 week target Estimated current backlog
Number of SMR02 records submitted by the target date of 6 weeks following the end of the month of discharge
Quality
• Of the SMR02 forms submitted in 2010, and where all necessary fields were completed, we could derive a figure for 82% completion of ‘Date of Booking’
• A large number of records have been with ‘not known’
• An example: Gestation at booking calculated in NHS Fife (9%), NHS Forth Valley (30%) and NHS Shetland (38%)
• SMR02 Data Quality Project in 2009 identified:– In some sites date of booking be recorded in SWHMR but not
transferred to SMR02 – Findings and recommendation fed back to hospitals (a web report
is available)
• ISD can provide reports and analysis to help support you in managing your local performance – what information would be useful for you?
0 10 20 30 40 50 60 70 80 90
NHS Ayrshire & Arran
NHS Borders
NHS Dumfries & Galloway
NHS FIfe
NHS Forth Valley
NHS Grampian
NHS GG&C
NHS Highland
NHS Lanarkshire
NHS Lothian
NHS Orkney
NHS Shetland
NHS Tayside
NHS Western Isles
Proportion of patients booking <= 12 weeks gestation, 2010, by Health Board of Residence
Proportion of patients booking <= 12 weeks gestation, Scotland, 2010, by SIMD Quintile
0
10
20
30
40
50
60
1 - MostDeprived
2 3 4 5 - LeastDeprived
Developing a Set of Quality Measures for
Maternity Care in Scotland
Policy Aims
• Improve early access to antenatal services to support mothers-to-be to breastfeed, improving maternal and infant nutrition, reduce harm from smoking, alcohol and drugs, and improve healthy birth weight.
Proposed measures
• Access, HEAT Target
At least 80% of pregnant women in each SIMD quintile will have booked for antenatal care by the 12th week of gestation by March 2015
– Data currently recorded on SMR02• Check that all units are recording properly• Encourage prompt completion of SMR02• Monitor data and set up routine analysis and
reporting (quarterly)
Proposed Outcome Measures
Examples…• Breast feeding• Maternal and Infant nutrition• Smoking• Alcohol & drugs• Improvement in birth weight• Continuity of Carer
Institute for Healthcare Improvement Framework (adapted)
• Measure title and Source (rationale)• Type of measure (outcome/process etc)• Why do we need it?• Definition• Exclusions (e.g. where it would be inappropriate)• Stratifiers (e.g. age, deprivation, ethnicity,
disability etc)• Data collection method• Analysis and presentation
Other Initiatives• Implementation of Patient Management Systems• National Screening Initiatives
– Pregnancy– Newborn– Universal Hearing Screening– Congenital Anomalies
• Child Health Screening– Childhood Immunisations– Breastfeeding– Child Healthy Weight
• Other targets, indicators and initiatives– Alcohol & Drugs – Sexual Health– Patient Safety– Smoking Cessation– Stillbirth & Caesarean section groups– Scottish Woman Held Maternity Record– Scottish Birth Record and Neonatal systems– Older Peoples Agenda– Mental Health incl. Child and Adolescent Mental Health
The way through the complexity
• Find the right balance:– What we want to measure– What is measurable
• Are we already measuring it?– What makes sense in analysis
• e.g. sufficient numbers– What the service will tolerate
ISD’s role
• Engage data providers and other stakeholders
• Assure the measure makes sense
• Tease out all the relevant definitions
• Work out how to get the data
• Collate the data
• Analyse and help to interpret resulting information
How will we get there…..
• Agree scope, plan and timescales by end of March 2012
• Project to run until March 2016
• Governance - including principles, deliverables & outputs, plans for communication & engagement
• Agree development and phased implementation approach with stakeholders
• Define and agree the Measures with stakeholders