PQCNC: Kamath presentation

8/9/2019 PQCNC: Kamath presentation

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Accuracy at Birth: Improving

Birth Certificate Data

Beena Kamath, MD, MPH

April 27, 2010


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Team

Beena Kamath, MD (Study Lead)

Michael Marcotte, MD (Director, QualityMaternity Medicine, Good Samaritan Hospital)

Roni Christopher (QIC) Edward Donovan, MD (PI-OPQC)

Carolyn Slone, RN (Antepartum)

Jennifer Brodbeck, RN (Labor and Delivery)

Meg James, RN (Manager of Special CareObstetrics)


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Sentinel Event


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Gestational age

Clinical decisions

Research questions

Intervention programs for at risk infants

If the vital statistics are incomplete orinaccurate, risk status, clinical factors, or

outcomes will not adequately reflect thepopulation being studied.


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Birth certificates

From Gould, et al. Incomplete Birth Certificates: A Risk Marker

for Infant Mortality, 2002.


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Measuring Gestational Age

LMP Problems with recall Different menstrual cycles

Ultrasound Compared to references that may not reflect natural variation in

population Measures size, not time (Mustafa, et al., 2001)

Clinical (maturational assessment) Not accurate below 28 weeks gestation (Donovan, et al., 1999) Over-estimates age for preterms, thereby underestimating rates

of prematurity (Alexander, et al., 1992)


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Different results Methods of estimating GA can lead to disparate results, resulting in

systematic biases

Post-term birth rates

Clinical (1.2%) vs. LMP (6.4%)

Wingate, et al., 2007

Ultrasound (1.1%) vs. LMP (10.1%) Dietz, et al., 2007

Rates of prematurity Clinical (7.9%) vs. LMP (9.9%)

Wingate, et al., 2007

Ultrasound (7.9%) vs. LMP (8.7%) Dietz, et al., 2007


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Learning from Observations

(Following the Gestational Age on the Birth Certificate)

Baby born

Delivery log printed fromOB TV

Gestational age transcribed

directly from OB TV to birth

certificate worksheet

What is goingon in OB TV?

Form completed for

State & Federal Govt


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Problems with OB TV

Referral from

Outside OB

Pregnant momarrives to GSH

Is ACOG formAvailable?

Yes

No Alternative methods toconfirm GA: asking

mother herself,

calling practice

Document GA

in OB TV with

best data

NICU record

of GA

Birth certificate

record of GA

OB database

record of

GA

Perinatal Database

record of GA

Since OB TV is the source formultiple repositories of

information, it makes sense to

make sure OB TV is accurate.


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OB TV Screen Shot


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Our AIM

To improve the reliability of gestational agerecorded in OB TV from 25% to 75% for GoodSamaritan Hospital by January 31, 2010 in the

population of women with prenatal care who arepregnant with an infant at least 20 weeksgestation


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ReliabilityatBirth:GestationalA

geRecordinginO

BTrace

0%

20%

40%

60%

80%

100%

120%

09/01/09 (n=24)09/05/09 (n=11)09/09/09 (n=25)09/13/09 (n=13)09/17/09 (n=18)09/21/09 (n=21)09/25/09 (n=17)09/29/09 (n=19)10/03/09 (n=24)10/07/09 (n=25)10/11/09 (n=13)10/15/09 (n=09)10/19/09 (n=23)

10/23/09 (n=26)10/27/09 (n=19)10/31/09 (n=16)11/04/09 (n=20)11/08/09 (n=12)11/12/09 (n=21)11/16/09 (n=27)11/20/09 (n=17)11/24/09 (n=25)11/28/09 (n=16)12/02/09 (n=25)12/06/09 (n=11)12/10/09 (n=19)

12/14/09 (n=21)12/18/09 (n=24)12/22/09 (n=27)12/26/09 (n=05)12/30/09 (n=17)01/03/10 (n=09)01/07/10 (n=19)01/11/10 (n=21)01/15/10 (n=22)01/19/10 (n=18)01/23/10 (n=13)01/27/10 (n=12)01/31/10 (n=08)02/04/10 (n=15)02/08/10 (n=16)02/12/10 (n=17)02/16/10 (n=22)02/23/10 (n=23)

Day(withn

umberofDeliveries)

Percentage of Pregnancy Records with Reliabl

DailyPerce

ntage

MedianCenterline


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Overall Learning/Challenges

Process is complex.

Learning OB TV system and people on theground.

Dealing with attitudes about change. Each community practice has different reasons/

disincentives for not completing ACOG form andsending it in correctly.


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Questions??

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