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MCHB
NATIONAL "CORE" PERFORMANCE MEASURES
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Select a measure, read
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General Information about developing measures and measuring performance
DISTANCE LEARNING RESOURCES:
Performance & Outcome Measurement: Methods for Setting Annual Targets (presented at CityMatch Urban MCH Leadership Data Use Institute Fall 1999) Dr. Deborah Rosenberg
CityMatch Urban MCH Leadership Data Use Institute Fall 1999
1999 Maternal and Child Health Epidemiology Workshop Dec 1999
Child Health Congress (October 1999) This invitational meeting brought together some of the most distinguished individuals in many fields which ultimately influence children's health and well-being.
New Health Status Indicators in the MCH Block Grant (DataSpeak presented in October 1999)
Healthy People 2000 Progress Review on Maternal and Infant Health (DataSpeak presented in September 1999)
Developing Effective Performance Measures (March 19, 1999, DataSpeak) Drs. Peter Van Dyck, Michael Stoto and Linda Bultman.
Tools for Monitoring the Impact of Health Systems Changes (October 20, 1998, DataSpeak) Dr. Gerry Oliva and her colleagues from the Family Health Outcomes Project at the University of California at San Francisco.
Healthy People 2010: Draft Objectives in Maternal and Infant Health (September 28, 1998, DataSpeak) Deborah Maiese of the Office of Disease Prevention and Health Promotion, Dr. Audrey Nora, Dr. Stell Yu, MCHB
Measuring MCH: The MCH Model Indicators (May 12, 1998, DataSpeak) Dr. Mary Peoples-Sheps
Title V Information System: Tom Vallin, Project Director/ Title V IS, National center for education in MCH, Arlington, Virginia (Presenting at a Needs Assessment Workshop in Salt Lake City Utah, May 1999). Video
MCH Indicators - Welcome, Overview, Key Note Address (Presenting at the CDC Maternal and Infant Epidemiology Conference, December 1998)
Using MCH Data in Performance Measurements: Experience From The Field (Presenting at the CDC Maternal and Infant Epidemiology Conference, December 1998)
Target Population Estimation (Requires Internet Explorer 3.0 and above) This module describes estimating target populations for program planning. It specifically describes estimating populations of children with special health care needs using National survey data. (Training module at MCH Analytic Skills Online). Register for module here.
Risk Adjustment for Children's Services (May 12, 1998, DataSpeak) What is Risk Adjustment? Learn about new risk adjustment methods applied to children, including children with special health care needs.
Performance Measures-Using Data to Influence Policy (Presentation at the 1999 Maternal and Child Health Leadership Conference April 24-25, 1999) Video
Analytic Methods in Maternal and Child Health (Online book in PDF format)
Measure #1: The percent of State SSI beneficiaries less than 16 years old receiving rehabilitative services from the State Children with Special Health Care Needs (CSHCN) Program.
DEFINITION
Numerator: The number of State SSI beneficiaries less than 16 years old receiving rehabilitative services from the State's CSHCN program during the federal fiscal year.
Denominator: The number of SSI beneficiaries less than 16 years old in the State. Units: 100 Text: Percent HEALTHY PEOPLE 2000
OBJECTIVE: Related to Objective 17.20. Increase to 50 the number of States that have service systems for children with or at risk of chronic and disabling conditions, as required by Public Law 101-239.
DATA SOURCE and DATA ISSUES: State CSHCN and Medicaid programs and Federal SSI program.
SIGNIFICANCE: Title V legislative requirements mandate the provision of rehabilitative services for blind and disabled individuals under the age of 16 receiving benefits under the Supplemental Security Income (SSI) Program to the extent medical assistance for such services is not provided by Medicaid. The Title V responsibility for providing and promoting family-centered, community-based care serves as a basis for States to establish a policy whereby all SSI disabled children are eligible to participate in or benefit from the State Title V CSHCN Program.
DISTANCE LEARNING RESOURCES:
SSI recipients receiving services from Title V, Performance Measure # 1: "The percent of State SSI beneficiaries less than 16 years old receiving rehabilitative services from the State CSHCN Program" Note issues of definition/interpretation of "rehabilitative services" and the methodological issues of breaking out < 16 year olds. Setting targets - does the state want to serve more or fewer of these kids? : John Reiss, Ph.D., Associate Director, Institute for Child Health Policy, University of Florida. (Presenting at a Needs Assessment Workshop in Salt Lake City Utah, May 1999). Video
Measure #2: The degree to which the State Children with Special Health Care Needs (CSHCN) Program provides or pays for specialty and subspecialty services, including care coordination, not otherwise accessible or affordable to its clients GOAL To provide and pay for services, including care coordination, for State specific subpopulations of CSHCN who are uninsured, under-insured, or under-served.
DEFINITION: A checklist of 9 specialty and subspecialty services, provided or paid for, through State CSHCN Programs is below. Please check those provided for or paid by the CSHCN Program that were not otherwise accessible or affordable. Please keep the completed checklist attached. The answer is 0-9. Units: 0-9 Text: Scale
Medical and surgical subspecialty services
OT, PT services
Speech, hearing, and language services
Respiratory services
Durable medical equipment and supplies
Home health care
Nutrition services
Care coordination
Early intervention servicesHEALTHY PEOPLE 2000 OBJECTIVE: Related to Objective 17.20. Increase to 50 the number of States that have service systems for children with or at risk of chronic and disabling conditions, as required by Public Law 101-239.
DATA SOURCE and DATA ISSUES: The State CSHCN Program.
SIGNIFICANCE: The State CSHCN Programs have traditionally provided and/or financed specialty and subspecialty care which is otherwise not accessible or available to subpopulations and has functioned as the payor of last resort for medical, habilitative and rehabilitative services, and equipment and assistive technology for segments of the CSHCN population. The legislation also mandates the direct involvement of State CSHCN Programs in the design and implementation of care coordination programs and the actual provision of care coordination services, as determined by the States. This function is particularly critical given current changes in coverage resulting from managed care arrangements. SSI changes will, at least temporarily, cause many children to lose Medicaid benefits and other welfare reform measures, which are expected to increase these numbers.
Measure #3: The percent of Children with Special Health Care Needs (CSHCN) in the State who have a "medical/health home".
GOAL: To have a "medical/health home" for all Children with Special Health Care Needs in the State. MEASURE The percent of Children with Special Health Care Needs who have a "medical/health home."
DEFINITION
Numerator: The number of children in the State with Special Health Care Needs* (CSHCN) who have a "medical/health home," during the federal fiscal year.
Denominator: The number of children in the State with Special Health Care Needs in the federal fiscal year. Units: 100 Text: Percent
HEALTHY PEOPLE 2000 OBJECTIVE: Related to Objective 17.20 Increase to 50 the number of States that have service systems for children with or at risk of chronic and disabling conditions, as required by Public Law 101-239. DATA SOURCE and DATA ISSUES The State CSHCN program and the American Academy of Pediatrics (AAP). Available methods include NACHRI, QuICK (Stein, 1993), and NHIS (synthetic estimates).
SIGNIFICANCE The MCHB uses the American Academy of Pediatrics (AAP) definition of "medical/health home." The AAP believes that the medical care of infants, children, and adolescents ideally should be accessible, continuous, comprehensive, family centered, coordinated, and compassionate. It should be delivered or directed by well-trained physicians who are able to manage or facilitate essentially all aspects of pediatric care. The physician should be known to the child and family and should be able to develop a relationship of mutual responsibility and trust with them. These characteristics define the "medical/health home" and describe the care that has traditionally been provided by pediatricians in an office setting. In contrast, care provided through emergency departments, walk-in clinics, and other urgent -care facilities is often less effective and more costly. (American Academy of Pediatrics, Volume 90, Number 5, November 1992)
DISTANCE LEARNING RESOURCES:
Medical Home Performance Measure #3 "The percent of CSHCN in the State who have a "medical/health home": Gil Buchanan, Medical Director, Children's medical Services, Arkansas ) (Presenting at a Needs Assessment Workshop in Salt Lake City Utah, May 1999). Video
Facilitated Discussion for above. Video
The Medical Home for Children with Special Health Care Needs (Presentation at the 1999 Maternal and Child Health Leadership Conference April 24-25, 1999) Video
Measure #4: Percent of newborns in the State with at least one screening for each of PKU, hypothyroidism, galactosemia, hemoglobinopathies [(e.g. the sickle cell disease) (combined)].
GOAL: To assure that all newborns with preventable mental retardation and other non-reversible consequences of selected genetic disorders (PKU, congenital hypothyroidism, galactosemia and hemoglobinopathies) are identified as early as possible in the newborn period.
DEFINITION
Numerator: The number of occurrent births in the State receiving at least one screen for each of PKU, hypothyroidism, galactosemia, and hemoglobinopathies [(e.g., the sickle cell diseases) (combined)].
Denominator: The number of occurrent births in the State. Units: 100 Text: Percent.
HEALTHY PEOPLE 2000 OBJECTIVE: Objective 14.15 Increase to at least 95% the proportion of newborns screened by State-sponsored programs for genetic disorders and other disabling conditions.
DATA SOURCE and DATA ISSUES: State data system for newborn screening, CORN newborn screening annual report, and the birth registry.
SIGNIFICANCE: Newborn screening for PKU, hypothyroidism and galactosemia is one of the major public health success stories with a significant social and cost benefit. Preventable mental retardation, growth stunting and other illnesses are averted through early diagnosis and treatment of those with a confirmed diagnosis. It is crucial that the State's commitment to newborn screening is maintained and accompanied by a commitment for treatment and follow-up of diagnosed newborns.
Measure #5: Percent of 19-35 month olds who have received the full schedule of age-appropriate immunizations against measles, mumps, rubella, polio, diptheria, tetanus, pertussis, H. influenza, and hepatitis B.
GOAL: To avert all cases of vaccine-preventable morbidity and mortality in children.
DEFINITION
Numerator: Number of resident children who have received the complete immunization schedule for DTP/DTAP, OPV, measles, mumps, rubella, H influenza and hepatitis B before their second birthday. Complete immunization status is generally considered to be: · four DTP vaccinations (or an initial DTP followed by at least three DTP and/or DT) by the child's second birthday; · three polio (IPV or OPV) vaccinations by the child's second birthday; · one MMR between the child's first and second birthdays; · three H influenza type b vaccinations; and · three hepatitis B vaccinations.
Denominator: Number of resident children aged 2 years. Units: 100 Text: Percent
HEALTHY PEOPLE 2000 OBJECTIVE: Revised Objective 20.11 90% of children will have completed the full immunization schedule through age 2 (19-35 months).
DATA SOURCE and DATA ISSUES: State Immunization Registry, CDC National Immunization Survey, State vital records, and Bureau of Census Population estimates.
SIGNIFICANCE: Infectious diseases remain important causes of preventable illness in the United States despite significant reductions in incidence in the past 100 years. Vaccines are among the safest and most effective preventive measures.
Measure #6: The birth rate (per 1,000) for teenagers aged 15 though 17 years at the time of delivery.
GOAL: To lower the birth rate among teenagers, especially those aged 15 through 17 years.
DEFINITION
Numerator: Number of live births to teenagers aged 15-17 years of age in the calendar year.
Denominator: Number of females aged 15 through 17 years in the calendar year . Units: 1000 Text: Rate per thousand
HEALTHY PEOPLE 2000 OBJECTIVE: Related Objective 5.1 Reduce pregnancies among females aged 15-17 to no more than 50 per 1,000 females aged 15-17.
DATA SOURCE and DATA ISSUES: Vital records are the source of data on mother's age and births. Population numbers are available from the census.
SIGNIFICANCE: DHHS is making teen pregnancies a priority goal (a major threat to healthy and productive lives) in their 1997 strategic plan. Teen parenting is associated with the lack of high school completion and initiating a cycle of poverty for mothers.
DISTANCE LEARNING RESOURCES:
Learn how to calculate Cumulative Teen Pregnancy at thenSkillbytes section of MCH Data Skills Online.
Measure #7: Percent of third grade children who have one or more sealed permanent molar teeth.
GOAL To prevent pit and fissure tooth decay (dental caries).
DEFINITION
Numerator: Number of third grade children who have a protective sealant on at least one permanent molar tooth.
Denominator: Number of third grade children in the State during the year. Units: 100 Text: Percent
HEALTHY PEOPLE 2000 OBJECTIVE Objective 13.8. Increase to at least 50 percent the proportion of children who have received protective sealants on the occlusal (chewing) surfaces of permanent molar teeth.
DATA SOURCE and DATA ISSUES This requires primary data collection, such as examination or screening of a representative sample of school children.
SIGNIFICANCE Dental caries affects two-thirds of children by the time they are 15 years of age. Developmental irregularities, called pits and fissures, are the sites of 80-90% of childhood caries. Sealants selectively protect these vulnerable sites, which are found mostly in permanent molar teeth. Targeting sealants to those at greatest risk for caries has been shown to increase their cost-effectiveness. Although sealants have the potential to combine with fluorides to prevent almost all childhood tooth decay, they have been under-utilized. In addition to being an excellent service in preventing tooth decay, sealants may also be a surrogate indicator of dental access, oral health promotion and preventive activities, and a suitable means to assess the linkages that exist between the public and private services delivery system. Public managed sealant programs are usually school-based or school-linked and target underserved children thus providing entre to other services. It has been stated on several occasions that dental sealants are the oral health equivalent of immunization.
DISTANCE LEARNING RESOURCES:
Oral Health Performance Indicator 7 "Percent of third grade children who have received protective sealant on at least one permanent molar tooth":Cathy Wasserman, Epidemiolegist, Washington State Department of Health. (Presenting at a Needs Assessment Workshop in Salt Lake City Utah, May 1999). Video
Measure #8: The rate of deaths to children aged 1-14 caused by motor vehicle crashes per 100,000 children.
GOAL To reduce the number of deaths to children aged 1-14 caused by motor vehicle crashes.
DEFINITION
Numerator: Number of deaths to children aged 1-14 caused by motor vehicle crashes. This includes all occupant, pedestrian, motorcycle, bicycle, etc. deaths caused by motor vehicles.
Denominator: All children in the State aged 1-14. Units: 100,000 Text: Rate per hundred thousand
HEALTHY PEOPLE 2000 OBJECTIVE Objective 9.3a Reduce deaths to children aged 14 and younger caused by motor vehicle crashes to no more than 3.5 per 100,000 children aged 1-14.
DATA SOURCE and DATA ISSUES Fatal Accident Reporting System (FARS), U.S. Department of Transportation and Vital Statistics Systems are sources of the data.
SIGNIFICANCE About 50% of all deaths to children aged 1-14 are due to injuries, and around 80% of these are from motor vehicle crashes. Injuries are the leading cause of mortality in this age group and they are one of the most significant health problems affecting the Nation's children.
DISTANCE LEARNING RESOURCES:
Violence and Drunk Driving: State-Specific Cost Estimates to Promote Prevention (December 8, 1998, DataSpeak) Dr. Ted Miller, President of the National Public Services Research Institute.
Confronting Injury and Violence: Effective Prevention Strategies Implementing an effective injury prevention program can be challenging but life-saving. Given the country's growing focus on reducing intentional and unintentional injuries and death for children and youth, the Maternal and Child Health Bureau developed two Title V performance measures aimed at injury and/or violence. This informative workshop will be divided into two panels: one discussing motor vehicle-related deaths and the other on suicide deaths. Speakers on each panel will provide national and state perspectives on effective prevention strategies and highlight effective programs aimed at improving outcomes in states. Information on technical assistance and resources available to states to assure quality and evaluate such programs will be provided at the conclusion of the session. (March 1999, AMCHP Conference)
Measure #9: Percentage of mothers who breastfeed their infants at hospital dischage
GOAL To increase the percentage of mothers who breastfeed their infants at hospital discharge.
DEFINITION
Numerator: The number of mothers in the State who exclusively* breastfeed their infant at hospital discharge.
Denominator: Number of occurrent births in the State in the calendar year. Units: 100 Text: Percent
HEALTHY PEOPLE 2000 OBJECTIVE Objective 2.11 Increase to at least 75% the proportion of mothers who breastfeed their babies in the early postpartum period and to at least 50% the proportion who continue breastfeeding until 5 to 6 months old.
DATA SOURCE and DATA ISSUES Ross Laboratories Mothers Survey; State WIC data, USDA; State Pediatric Nutrition Surveillance System, CDC.
SIGNIFICANCE The advantages of breastfeeding are indisputable and include nutritional immunological and psychological benefits to both infant and mother, as well as economic benefits. *Exclusively is defined as vitamins, minerals, water, juice, cultural feeds given infrequently in addition to breastfeeds. Source: Labbok and Krasovec, "Toward Consistency in Breastfeeding Definitions" in Studies in Family Planning 1990; 21, 4:226-230
Measure #10: Percentage of newborns who have been screened for hearing impairment before hospital discharge
GOAL To reduce the morbidity associated with hearing impairment through early detection.
DEFINITION
Numerator: The number of infants in the State whose hearing has been screened before hospital discharge by either tests of otoacoustic emissions or auditory brainstem responses.
Denominator: Number of births in the State in the calendar year. Units: 100 Text: Percent
HEALTHY PEOPLE 2000 OBJECTIVE Objective 17.6 Reduce significant hearing impairment to a prevalence of no more than 82 per 1,000 people. Objective 17.16 Reduce the average age at which children with significant hearing impairment are identified to no more than 12 months.
DATA SOURCE and DATA ISSUES State birth certificates, new born hearing registries, tests of otoacoustic emissions and auditory brainstem responses.
SIGNIFICANCE The advantages of early detection of hearing impairments are indisputable and include necessary follow-up of free and appropriate enrollment in habilitation and education programs. *Hearing impairment covers the range of hearing deficits from mild loss in one ear to profound loss in both ears. Generally, inability to hear sounds at levels softer (less intense) than 20 decibels (dB) constitutes abnormal hearing. Significant hearing impairment is defined as having hearing thresholds for speech poorer than 25 dB. However, impairment (that is, deafness in one or both ears or any trouble hearing in one or both ears) will be used as a proxy measure for significant hearing impairment. -Disabilities and Chronic Disabling Conditions Objectives, Healthy People 2000 Review, 1997, p. 163.
Measure #11: Percentage of CSHCN in the State CSHCN program who have a source of insurance, including Medicaid, for primary care, specialty care, and enabling services.
GOAL To assure a source of insurance, including Medicaid, for primary and specialty care required to meet the needs of Children with Special Health Care Needs (CSHCN).
DEFINITION
Numerator: The number of CSHCN in the State CSHCN program who have a source of insurance, including Medicaid, to cover the costs of primary, specialty, and enabling services during the reporting period. This may be measured by valid sampling techniques.
Denominator: The number of Children with Special Health Care Needs covered by the State program. Units: 100 Text: Percent
HEALTHY PEOPLE 2000 OBJECTIVE Related to Objective 17.20. Increase to 50 the number of States that have service systems for children with or at risk of chronic and disabling conditions, as required by Public Law 101-239.
DATA SOURCE and DATA ISSUES The State CSHCN Program.
SIGNIFICANCE CSHCN are disproportionately low-income, and because of this, they are at higher risk for being uninsured. Moreover, because their needs for health services extend beyond those required by healthy children, they are more likely to incur catastrophic expenses. Since children are more likely to obtain health care if they are insured, this measure is an important indicator of access to care.
Measure #12: Percent of children without health insurance
GOAL To ensure access to needed and continuous health care services for children. MEASURE Percent of children without health insurance.
DEFINITION
Numerator: Number of children under 18 in the State who are not covered by any private or public health insurance (including Medicaid or risk pools) at some time during the reporting year.
Denominator: Number of children in the State under 18 (estimated by Census in March). Units: 100 Text: Percent
HEALTHY PEOPLE 2000 OBJECTIVE No HP 2000 Objective.
DATA SOURCE and DATA ISSUES There is no current uniform source of data at the State level, but data may be available by State estimate beginning in 1997 from the March CPS, U.S. Bureau of the Census. States need to choose among existing estimating techniques and use one consistently.
SIGNIFICANCE There is a well-documented association between insurance status and utilization of health care services among adults. Less is known about the utilization of services in children. A 1996 study by the Harvard School of Public Health, The Henry J. Kaiser Foundation and the National Opinion Research Center, found the uninsured are four times more likely to have an episode of needing and not getting medical care. As noted in the 1997 "Families USA Report", children without health insurance have an average of 1 less visit per year and receive less treatment than insured children with similar problems.
DISTANCE LEARNING RESOURCES:
Uninsured Performance Measure # 12 - "Percent of children without health insurance" and Proposed MCH Assessment Indicator "The percent of children without health insurance within the past year": George Delavan, Division Director and Louis M. Haggard, Ph.D., Bureau of Surveillance and Analysis, Utah Department of Health (Presenting at a Needs Assessment Workshop in Salt Lake City Utah, May 1999).
Video : George Delavan
Video : Louis M. Haggard
Video : Facilitated Discussion
Implementing Children's Health Insurance Programs-Lessons We Are Learning (Presentation at the 1999 Maternal and Child Health Leadership Conference April 24-25, 1999) Video
CHIP and Quality Assurance: Key Issues and Lessons Learned (March 1999, AMCHP Conference)
Measure #13: Percent of potentially Medicaid eligible children who have received a paid Medicaid service.
GOAL To enroll all Medicaid eligible children in Medicaid ensuring better access to health care services.
DEFINITION
Numerator: Number of children 1 to 21 years of age who have received a service paid by Medicaid during the federal fiscal year.
Denominator: The estimated number of children 1 to 21 years of age who are potentially eligible, by State definition, for Medicaid at the end of the federal fiscal year. Units: 100 Text: Percent
HEALTHY PEOPLE 2000 OBJECTIVE No HP 2000 Objective.
DATA SOURCE and DATA ISSUES
Numerator: The State Medicaid program counts participation monthly and estimates annual caseload. There are peaks and valleys in participation throughout the year. Most systems do not link the income of the family on the program records, but only the eligibility category (e.g., AFDC, expansion, etc.).
Denominator: States may not have these data readily available and therefore estimates are made by using a variety of data from CPS, State programs, Census, and experience.
SIGNIFICANCE Financial access to health care does not guarantee that all children will enroll and access care, but insured children are more likely to get care. Currently 3 million children are estimated to be eligible non-participants in Medicaid.
DISTANCE LEARNING RESOURCES:
Medicaid eligibles served Performance Measure 13: Percent of potentially Medicaid eligible children who have received a service paid by the Medicaid Program : Jerry Hofer, Management Analyst, South Dakota department of Health. (Presenting at a Needs Assessment Workshop in Salt Lake City Utah, May 1999). Video
Measure #14: The degree to which the State assures family participation in program and policy activities in the State CSHCN program GOAL To ensure family participation in program and policy activities in the State CSHCN program.
MEASURE The State assures family participation in program and policy activities in the State CSHCN program.
DEFINITION Below is a checklist of 6 characteristics that documents family participation. Please check the degree to which the characteristics for the State CSHCN program have been implemented. The answer is 0-18. Please keep the completed checklist attached. Units: 0-18 Text: Scale
HEALTHY PEOPLE 2000 OBJECTIVE Related to objective 17.20. Increase to 50 the number of States that have service systems for children with or at risk of chronic and disabling conditions, as required by Public Law 101-239.
DATA SOURCE and DATA ISSUES The State CSHCN program.
SIGNIFICANCE The last decade has emphasized the central role of families as advisors and participants in policy-making activities. The Omnibus Budget Reconciliation Act of 1989 (OBRA '89) created the legislative mandate that health programs supported by Maternal and Child Health Bureau ( MCHB) would provide and promote family-centered, community-based, coordinated care.
SIX CHARACTERISTICS DOCUMENTING FAMILY PARTICIPATION IN CSHCN PROGRAMS
1. Family members participate on advisory committees or task forces and are offered training, mentoring, and reimbursement, when appropriate.
2. Financial support (financial grants, technical assistance, travel, and child care)is offered for parent activities or parent groups.
3. Family members are involved in the Children with Special Health Care Needs' elements of the MCH Block Grant Application process.
4. Family members are involved in inservice training of CSHCN staff and providers.
5. Family members are hired as paid staff or consultants to the State CSHCN program (a family member is hired for their expertise as a family member).
6. Family members of diverse cultures are involved in all of the above activities.
Measure #15: The percent of very low birth weight infants among all live births.
GOAL To reduce the proportion of infants with very low birth weight.
DEFINITION
Numerator: Number of live births with birth weight less than 1500 grams in the calendar year.
Denominator: Total number of live births in the calendar year. Units: 100 Text: Percent
HEALTHY PEOPLE 2000 OBJECTIVE Objective 14.15 Overall Goal: Reduce very low birth weight to no more than l (one) percent of all live births.
DATA SOURCE and DATA ISSUES Birth certificates are the source for low birth weight.
SIGNIFICANCE Prematurity is the leading cause of infant death. Many risk factors have been identified for low birth weight involving younger and older maternal age, poverty, late prenatal care, smoking and substance abuse.
Measure #16: The rate (per 100,000) of suicide deaths among youths aged 15 -19
GOAL To eliminate self-induced, preventable morbidity and mortality.
DEFINITION
Numerator: Number of deaths attributed to suicide among youths aged 15-19.
Denominator: Number of youths aged 15-19. Units: 100,000 Text: Rate per 100,000
HEALTHY PEOPLE 2000 OBJECTIVE Related to Objectives 6.1 and 7.2a Reduce suicides to no more than 8.2 per 100,000 youths aged 15-19.
DATA SOURCE and DATA ISSUES State vital records is the source.
SIGNIFICANCE Suicide is the third leading cause of death in the United States among youths aged 15-19, and in many States it ranks as the second leading cause of death in this population.
Measure #17: Percent of very low birth weight infants delivered at facilities for high-risk deliveries and neonates
GOAL To assure that higher risk mothers and newborns deliver at appropriate level hospitals.
DEFINITION
Numerator: Number of infants with a birth weight less than 1,500 grams born at subspecialty facilities (Level III facility).
Denominator: Total number of infants born with a birth weight of less than 1,500 grams. Units: 100 Text: Percent
HEALTHY PEOPLE 2000 OBJECTIVE Objective 14.14 Increase to at least 90% the proportion of pregnant women and infants who receive risk appropriate care.
DATA SOURCE and DATA ISSUES There is no national data source for this at present. Vital records and hospital discharge records would be sources.
SIGNIFICANCE Very low birth weight infants are more likely to survive and thrive if they are born/cared for in an appropriately staffed and equipped facility with a high volume of high risk admissions. *Note: Level III facilities were originally developed by the National Foundation March of Dimes in the first edition of Improving the Outcome of Pregnancy. The new edition of Improving the Outcome of Pregnancy, and the upcoming 4th edition of ACOG/AAP's Guidelines for Perinatal Care (Summer 1997) classify facilities as basic, specialty and subspecialty. The latter corresponds with Level III facilities and practitioner competencies. Although there is no universally applied scoring level for a high risk pregnancy, the 4th edition of Guidelines will identify some medical criteria for referral to the subspecialty center (e.g., women with severe pulmonary disease). Infants <1500 grams or <32 weeks should be delivered or transferred to a subspecialty center (level III). In addition, women with IUGR, placenta previa, polyhydramnios and those needing immediate complex care should be transferred to deliver at a subspecialty center.
Measure #18: Percent of infants born to pregnant women initiating prenatal care in the first trimester of pregnancy.
GOAL To assure early entrance into prenatal care to enhance pregnancy outcomes.
DEFINITION
Numerator: Number of live births with reported first prenatal visit during the first trimester (before 13 weeks gestation) in the calendar year.
Denominator: Number of live births in the State in the calendar year. Units: 100 Text: Percent
HEALTHY PEOPLE 2000 OBJECTIVE Objective 14.11 Increase to at least 90 percent the proportion of all pregnant women who receive prenatal care in the first trimester of pregnacy.
DATA SOURCE and DATA ISSUES Birth certificate data in the State vital records are available for over 99% of births.
SIGNIFICANCE Early identification of maternal disease and risks for complications of pregnancy or birth are the primary reason for first trimester entry into prenatal care. This can help assure that women with complex problems and women with chronic illness or other risks are seen by specialists. Early high-quality prenatal care is critical to improving pregnancy outcomes.
DISTANCE LEARNING RESOURCES:
Prenatal Care & Case Management (Presenting at the CDC Maternal and Infant Epidemiology Conference, December 1998)
Surveillance of Behavior During Pregnancy (Presenting at the CDC Maternal and Infant Epidemiology Conference, December 1998)