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Birth & Death Certificate Birth & Death Certificate

Birth & Death Certificate - PowerPoint Presentation

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Birth & Death Certificate - PPT Presentation

Indiana Perinatal Quality Improvement Collaborative Quality Improvement Committee 11132014 Erica Park Nancy Swigonski MD MPH FAAP Kathleen Frogge Program Director 2 You ID: 174113

certificate birth death data birth certificate data death hospital process quality staff state recommendations idrs funeral system registration information

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Slide1

Birth & Death Certificate

Indiana Perinatal Quality Improvement Collaborative – Quality Improvement Committee

11/13/2014

Erica

Park

Nancy

Swigonski

, MD, MPH, FAAP

Kathleen

Frogge

, Program Director 2 Slide2

“You

can design and create, and build the most wonderful place [system] in the world. But it takes people to make the dream a reality.”Walt DisneySlide3

Overall goal: Reduce Indiana’s infant mortality rate

In order to reach overall goal, Indiana needs good data 2 areas of data:Birth certificate Death certificateOverall GOalSlide4

Death Certificate

Indiana Perinatal Quality Improvement Collaborative – Quality Improvement Committee11/13/2014Slide5

Death Certificate ProcessSlide6

Death Certificate Process

1. Funeral home receives a call from the hospital or the parents Slide7

Death Certificate Process

1. Funeral home receives a call from the hospital or the parents 2. If parents decide to use their funeral services, infant will be transferred to the funeral home Slide8

Death Certificate Process

3. Hospital initiates a burial transit permit Fills out Sections A & BSlide9

Death Certificate Process

4. Person who picks up the body fills out more of the permitFills out Sections CSlide10

Death Certificate Process

5. Funeral home completes the permit - fills out Sections D & E3 copies of this permit 1. Health department by the hospital

2. Crematory or cemetery

3. Health department Slide11

Death Certificate Process

6. Funeral director logs onto IDRS to initiate the death certificate – generally within 24-48 hours but may be longer if waiting for the mother’s release from hospitalSlide12

Death Certificate Process

6. Funeral director logs onto IDRS to initiate the death certificate – generally within 24-48 hours but may be longer if waiting for the mother’s release from hospital

7

.

IDRS opens with an initial search

If name is already in the system, it will match the name to the search

If name is not in the system, it will initiate a new death certificate formSlide13

Death Certificate Process

8. Funeral director fills out demographic informationSlide14

Death Certificate Process

8. Funeral director fills out demographic information

9

. Funeral director sends death record to the physician

Physician must be registered in the system

Physician will receive an email notifying him/her that a death certification is in queue

Email includes decedent’s name, date and time of death, place of death, etc.Slide15

Death Certificate Process

10. Physician logs onto IDRS and fills out medical information and certifies the death Slide16

Death Certificate Process

10. Physician logs onto IDRS and fills out medical information and certifies the death

11.

Physician sends the death record back to the funeral director

Funeral director receives a similar email notification Slide17

Death Certificate Process

10. Physician logs onto IDRS and fills out medical information and certifies the death

11.

Physician sends the death record back to the funeral director

Funeral director receives a similar email notification

12.

Funeral director finishes certificate Slide18

Death Certificate Process

Fetal deaths are registered in a separate system Key differences:Fetal death report requires more parent demographic information If the fetus is <20 weeks gestation, the funeral home does not have to report and the

hospital can dispose the body Slide19

Met with funeral director

Discussed the death certificate process and issues with timelinessPhysicians not registered into the system causes delays Time it takes to fill out the death certificate data into IDRS Live birth: ~10 minutesFetal death: ~15-20 minutes

Death Certificate

information gatheringSlide20

N

eonatologist Physicians must be registered into the IDRS – if the attending physician is not registered this could cause delays Recent switch to electronic birth records and lack of training may be causes of delayPhysicians do not know they are able to initiate the death certificate Ultimately these delays cause delays in burial of the baby

Death Certificate

information gatheringSlide21

https://vrqa.isdh.in.gov/inthin/

indextest.htmlDeath Certificate information gatheringSlide22

Key issue is getting physicians registered into IDRS

Physicians can start the death record, but this was unknownOthers can start the death record with the physician later signing with their personal identification number (PIN), but this was unknown

Death Certificate Data - FindingsSlide23

Online Training

Training manuals Indiana = 78 pages CDC = 65 pagesIDRS system not self-explanatoryWebinar link does not work

Death Certificate Data - FindingsSlide24

Where in your hospital/system are there problems with the death certificate process?

What ideas do you have to make the system better?What methods at your hospital work well?Death certificate process –

brainstormingSlide25

Identify the hospitals with highest number of infant deaths and focus efforts on those first

Register and demonstrate IDRS to physicians during hospital orientationsPreload physicians into the system Pilot a program using staff to initiate the certificate

Death Certificate Data - recommendationsSlide26

Birth Certificate

Indiana Perinatal Quality Improvement Collaborative – Quality Improvement Committee11/13/2014Slide27

Birth certificate Process – TheoreticalSlide28

1a. Mother fills out the Mother’s Worksheet section of the CDC-issued 12 page birth certificate form

Birth certificate Process TheoreticalSlide29

1a. Mother fills out the Mother’s Worksheet section (MWS) of the CDC-issued 12 page birth certificate form

1b. Hospital staff fills out the Facility Worksheet section (FWS) of the CDC-issued 12 page birth certificate formBirth certificate Process TheoreticalSlide30

1a. Mother fills out the Mother’s Worksheet section (MWS) of the CDC-issued 12 page birth certificate form

1b. Hospital staff fills out the Facility Worksheet section (FWS) of the CDC-issued 12 page birth certificate form2. Hospital staff logs onto BDRS

Birth certificate Process TheoreticalSlide31

1a. Mother fills out the Mother’s Worksheet section (MWS) of the CDC-issued 12 page birth certificate form

1b. Hospital staff fills out the Facility Worksheet section (FWS) of the CDC-issued 12 page birth certificate form2. Hospital staff logs onto BDRS

3. Hospital staff uses the CDC-issued 12 page birth certificate form to fill out the electronic birth registration form

Birth certificate Process TheoreticalSlide32

4. County health department receives birth registration data

Birth certificate Process TheoreticalSlide33

4. County health department receives birth registration data

5. State Department of Health receives birth registration dataBirth certificate Process TheoreticalSlide34

4. County health department receives birth registration data

5. State Department of Health receives birth registration data6. CDC receives birth registration data

Birth certificate Process TheoreticalSlide35

Birth Certificate

information gatheringVital Records Training Modules http://in.gov/isdh/25584.htm

For birth clerks, hospital staff that works with IBRS

3 modules on the ISDH website

Each take ~30 minutes to complete

Module 1: Improving the Quality of Birth Certificate Data

Module 2A: All Birth Worksheet Data Matters Part A

Module 2B: All Birth Worksheet Data Matters Part B

Visited hospitals to outline the birth certificate processSlide36

Birth certificate FindingsSlide37

Findings from the hospital visits

CDC-issued 12 page worksheet was “split” into 5 separate worksheetsHospital has 300 births/dayIf no interruptions can get through 20-25 births into the BDRS/day Time it takes to fill out (ideal)Ranges from 15 min–1.5 hours

Birth certificate data - findingsSlide38

The actual process is much more complex than the theoretical process

Obstacles faced by the hospital staff Missing data Takes time to find sources of missing data and contact the mother for information

Birth certificate data - findingsSlide39

The actual process is much more complex than the theoretical process

Obstacles faced by the hospital staff Missing data Takes time to find sources for missing data and contact the mother for information

Variation in data sources

(online, paper)

Which source has the correct information?

Birth certificate data - findingsSlide40

The actual process is much more complex than the theoretical process

Obstacles faced by the hospital staff Missing data Takes time to find sources of missing data and contact the mother for

information

Variation in data sources

(online, paper)

Which source has the correct information?

Availability of external

data

Example: prenatal care if begun in a different hospital

Birth certificate data - findingsSlide41

The actual process is much more complex than the theoretical process

Obstacles faced by the hospital staff Missing data Takes time to find sources of missing data and contact the mother for

information

Variation in data sources

(online, paper)

Which source has the correct information?

Availability of external

data

Example: prenatal care if begun in a different hospital

Changes to the questions and answer choices on the CDC-issued 12 page worksheet

Example: choices for “Mother’s Race”

Birth certificate data - findingsSlide42

Variations of the birth certificate registration process in hospitals

Accuracy of the data must be addressedTimeliness of the data must be addressedBirth certificate ProcessFindingsSlide43

What have other states done?

What are best practices?Slide44

Birth Quality Workgroup

Recently, the CDC formed a Birth Data Quality Workgroup to survey data quality practices among the State Departments of Health Online survey F

ocused on activities that evaluate and ensure data quality

A

sked about actions in response to data quality findings

46/52 completed the survey (88.4% participation)

Results of the study led to 2 specific recommendations Slide45

Birth Quality

WorkgroupRecommendations1. Data must be evaluated on an ongoing basis Importance of rapid cyclingRecommend quick response to poor data quality from birth facilities – weekly or monthly vs. quarterly or yearly Slide46

Birth Quality Workgroup Recommendations

2. Effective communication of data quality is necessary1. Concrete feedback2. Increase awareness about the merit of data quality3. Provide regular trainings and newsletters

4. Publish reports about performance to increase transparency

5. Connect with upper-level clinicians and hospital administrationsSlide47

Birth Certificate

findings from other states

State

Recommendations/Actions

Washington

“Why Quality Data is Important and Help to Improve Your

Data” guide; website comparing data quality of facilities

Ohio

Real time auditing; development

of a new standardized H&P to contain all necessary points

California

Increased regional trainings; development of a CMQCC Maternal Data CenterSlide48

State of Washington

The State of Washington has developed a Birth Data Quality Query System (BDQQ) webpage on their State Department of Health website “The BDQQ is a tool to help you improve your birth data quality”The BDQQ system provides hospital profiles of “percent unknown” for selected items on the birth certificate Slide49

State of Washington

There are 4 possible ways to look at the data for each birth facility using the BDQQ system: 1. “Average % Unknown” compared to facilities of similar birth volume

There are 4 possible ways to look at the data for each birth facility using the BDQQ system:

1. “Average % Unknown” compared to facilities of similar birth volumeSlide50

State of Washington

2. “% Unknown” of certain birth data items compared to stateSlide51

State of Washington

3. “% Unknown” of certain birth data items over timeSlide52

State of Washington

4. “Average % Unknown” compared to WA state over time State also has a PDF link on this site to their guide

Guide explains the reports and the birth certificate in layman’s termsSlide53

State of Ohio

Ohio Perinatal Quality Collaborative (OPQC) and the Ohio Department of Health Vital Statistics performed a study focusing on 4 phases of birth data registrationPhase I: Completing the electronic health record Algorithms to flag incomplete charts

Empowering nursing staff

Increased teaching of hospital staffSlide54

State of Ohio

Phase II: Empowering staffNurses encouraged to contact OB providers if data was missing Emphasized safety benefits to hospital staff peer-to-peerSlide55

State of Ohio

Phase III: Real Time AuditingNursing supervisors began real time auditing for incomplete medical record Pregnancy card created for each pregnant

women

Phase IV: Real Time Auditing Continued and Expanded to High Risk Groups Slide56

State of California

California Maternal Quality Care Collaborative (CMQCC) development of a California Maternal Data Center (CMDC)CMDC is a statewide data center that collects and reports timely maternity metrics (including data quality) in a way that is “low cost, low burden, and high value for hospitals”

Similar to Washington, but with more detail

CMDC is overseen by a multi-stakeholder Steering Committee composed of clinicians, hospitals, payers, purchasers, consumer organizations, and relevant state agenciesSlide57

State of California

Demonstration site link: https://demo.datacenter.cmqcc.org/hospitals/1

Demonstration site link:

https://demo.datacenter.cmqcc.org/hospitals/1Slide58

What

are the steps that are taken to fill out the birth certificate?Who provides information? What sources are used to fill out the birth certificate (paper, electronic)?

What

if you are unable to find

information?

W

hat

steps do you then take?

Are

there any specific areas on the birth data registration form that are particularly difficult, unclear or usually not able to be filled out? Why is it

difficult?

 

How

long does it take

to complete a

birth certificate

registration

form?

How long does a fairly “straightforward” birth take versus a more complicated one?

How many births are

entered in

1 day?

How many births per week are

entered?

How long from the time of birth to entry into the system (average and range)?

How

long have

you or the person who usually fills out birth

certificate

information been doing this job?

Are

you/they

hired specifically as a birth clerk or do

you/they

have other duties also?

What other duties?

How many hours per day are dedicated specifically birth data entry?

 

What

training did

you/they

receive regarding birth certificate?

Have

you/they

used the birth certificate data training modules on the Indiana State Department of Health website?

If so, did

you/they

find it helpful?

birth certificate process –

what is the process in your hospital?Slide59

Where in your hospital/system are there problems with the birth certificate process?

What works well in your hospital? What ideas do you have to make the system better?

birth certificate process –

brainstormingSlide60

1. Provide feedback

Distribute a list of variables that commonly have errors to hospital administrationBirth Certificate Data Recommendations: 4 categoriesSlide61

1. Provide feedback

Distribute a list of variables that commonly have errors to hospital administrationNotify hospital administrative and clinical leadership about the deficiencies in vital records processBirth Certificate Data Recommendations: 4 categoriesSlide62

1. Provide feedback

Distribute a list of variables that commonly have errors to hospital administrationNotify hospital administrative and clinical leadership about the deficiencies in vital records processUse a website to publish performance reports to increase transparency

Birth Certificate Data Recommendations: 4 categoriesSlide63

1. Provide feedback

Distribute a list of variables that commonly have errors to hospital administrationNotify hospital administrative and clinical leadership about the deficiencies in vital records processUse a website to publish performance reports to increase transparency

Increase vital records staff to be able to give more immediate feedback

Birth Certificate Data Recommendations: 4 categoriesSlide64

2. Provide training incentives

Recommend hospitals to include completion of training modules in performance review Birth Certificate Data Recommendations: 4 categoriesSlide65

2. Provide training incentives

Recommend hospitals to include completion of training modules in performance review Provide regular trainings and newsletters for birth registration staffBirth Certificate Data Recommendations: 4 categoriesSlide66

2. Provide training incentives

Recommend hospitals to include completion of training modules in performance review Provide regular trainings and newsletters for birth registration staffDevelop a post test and/or a Certificate of Completion for staff completing modules

Birth Certificate Data Recommendations: 4 categoriesSlide67

2. Provide training incentives

Recommend hospitals to include completion of training modules in performance review Provide regular trainings and newsletters for birth registration staffDevelop a post test and/or a Certificate of Completion for staff completing modules Pursue CEUs for nurses and CMEs for physicians for completing birth certificate training modules

Birth Certificate Data Recommendations: 4 categoriesSlide68

3

. New systems improvements Add definitions of fetal death and live birth on the electronic birth and death registration systemsBirth Certificate Data Recommendations: 4 categoriesSlide69

3

. New systems improvements Add definitions of fetal death and live birth on the electronic birth and death registration systemsAdd a drop down box with causes of death on the screen that match the CDC codes Birth Certificate Data Recommendations: 4 categoriesSlide70

3

. New systems improvements Add definitions of fetal death and live birth on the electronic birth and death registration systemsAdd a drop down box with causes of death on the screen that match the CDC codes Allow staff to receive email re: death certificate at the same time as the physician

Birth Certificate Data Recommendations: 4 categoriesSlide71

4. Extend roles

and approachesCommunicate to physicians that they should register in IDRS and that they can initiate the death record Birth Certificate Data Recommendations: 4 categoriesSlide72

4. Demonstrate and implement

Communicate to physicians that they should register in IDRS and that they can initiate the death record Encourage hospitals to have physicians register in the IDRS during hospital orientationBirth Certificate Data Recommendations: 4 categoriesSlide73

4. Demonstrate and implement

Communicate to physicians that they should register in IDRS and that they can initiate the death record Encourage hospitals to have physicians register in the IDRS during hospital orientationCommunicate that staff (nurses, clerical staff) can be authorized and trained to complete initial data that is then confirmed by the physician and submitted

Birth Certificate Data Recommendations: 4 categoriesSlide74

4. Demonstrate and implement

Communicate to physicians that they should register in IDRS and that they can initiate the death record Encourage hospitals to have physicians register in the IDRS during hospital orientationCommunicate that staff (nurses, clerical staff) can be authorized and trained to complete initial data that is then confirmed by the physician and submitted

Communicate that the hospital can initiate the prenatal birth record

Birth Certificate Data Recommendations: 4 categoriesSlide75

“Not every change is an improvement, but every improvement is a change; you can’t do anything better unless you can manage to do it differently. You’ve got to let yourself do better than other people.”

Eliezer Yudkowsky

Steps Towards Effective ChangeSlide76

Indiana does very well in the completion of birth and death certificate data

However, improvements can still be made to improve the quality of the dataIn order for Indiana to successfully reduce the infant mortality rate, the state must have good quality birth and death certificate data SummarySlide77

References

Ahuja S, Bakus K, Crawford G, Fontana C, Gambatese M,

Jessen

A, Justice D, Madsen-Straight A, Martin J,

Pagnano

S, Reed P,

Thoma

M,

Tretter

E,

Wishart

L. Efforts to improve

b

irth data quality: results from a survey of data quality practices among US vital records jurisdictions. Hyattsville, MD: National Center for Health Statistics. 2014.

Ford S, White B. Summary of birth certificate data collection challenges: lessons learned from Ohio and other states. Columbus, OH: BEACON Ohio Department of Health. 2012.

Birth data

q

uality

q

uery

s

ystem. 2014. Washington State Department of Health. Retrieved July 20,

2014 from https://fortress.wa.gov/doh/bdqq/

bdqq.aspx.

Main E, Castles A, Murphy B. Partnering for maternal data quality improvement. California Maternal Quality Care Collaborative. 2013.