Development and Use of Performance Measures
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Development and Use of Performance Measures for Monitoring Women’s Health and Preconception Care: Region IV Network and State Collaboratives. Co-Principal Investigators. Julie DeClerque, DrPH, MPH Ellen Shanahan, MA. Region IV Network for Data Management and Utilization

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Julie declerque drph mph ellen shanahan ma

Development and Use of Performance Measures for Monitoring Women’s Health and Preconception Care: Region IV Network and State Collaboratives

Co-Principal Investigators

Julie DeClerque, DrPH, MPHEllen Shanahan, MA

Region IV Network for Data Management and Utilization

UNC Sheps Center for Health Services Research

Program on Child Health Services


Julie declerque drph mph ellen shanahan ma

Initial Focus on Infant MortalityUS DHHS Health Care Region IV Had Highest Rates

RNDMU Began 1983: Track Indicators to Monitor Trends

  • Initial SPRANS grant 1983 focused on tracking infant mortality

  • Focus shifted in 1990, funding through Title X

  • Added FP indicators, with another wave in 1997 (11 women’s health)

  • FP considered first step in preventing high-risk pregnancies

  • FP service indicators given high priority as basic IM reduction strategy

  • Workshops 2009-2010: focus on women’s health and preconception care


Julie declerque drph mph ellen shanahan ma

RNDMU Data Network Features

  • State collaborative across 8 states of Region IV

  • Title X grantees in each state (10 in all)

  • Longitudinal State and Regional data

  • Over 125 perinatal indicators

  • Data sources:

    • State vital records, including abortion

    • Medicaid deliveries

    • Family planning administrative reports (FPAR)

    • BRFSS / PRAMS

    • Communicable Disease / Immunization Surveillance

    • Guttmacher “in-need” estimates

  • Annual Databookproduced by Sheps Center

  • All tables available on Website in Excel format

  • http://www.shepscenter.unc.edu/data/RNDMU/LongitudinalExcelTables/DataTablesExcel.html


Julie declerque drph mph ellen shanahan ma

Revised Concept Map and Databook Organization

  • Five Domains (Total Indicators: 121)

    • Personal Health and Lifestyle (28)

    • Family Planning (37)

    • Fertility (13)

    • Pregnancy (18)

    • Pregnancy Outcomes (25)


Julie declerque drph mph ellen shanahan ma

  • Highlights from RNDMU Domains I and II

  • Trends over time

  • Indicators of unmet need

  • Example issues, reports, collaboratives


Julie declerque drph mph ellen shanahan ma

Post-partum and Family Planning Visits

Opportunities for Addressing Chronic Conditions

  • Healthy Weight

  • Diabetes

  • Hypertension

  • Asthma

Opportunities for PromotingEffective Birth Spacing

  • Understanding BC methods

  • Side effects

  • Availability of EC

  • Risks and consequences of infection


Overweight and obesity among women in region iv

Overweight and Obesity among Women in Region IV

1998 - 2008

BRFSS Data for Women Age 18-44


Overweight and obese white women age 18 44 1998 2008

Overweight and ObeseWhite Women (Age 18-44)1998 - 2008


Overweight and obese black women age 18 44 1998 2008

Overweight and ObeseBlack Women (Age 18-44)1998 - 2008


Risk behaviors in region iv unhealthy weight

Risk Behaviors in Region IV: Unhealthy Weight

BRFSS Data for Women 18-44: 1998 - 2008

  • Overweight

    • Total: 23% to 28% + 22%

    • Blacks: 30% to 36%+ 20%

    • Whites: 21% to 25%+ 19%

  • Obese

    • Total: 19% to 26%+ 37%

    • Blacks: 29% to 41%+ 41%

    • Whites: 15% to 23%+ 35%


Adequate physical activity region iv

Adequate Physical Activity, Region IV

BRFSS Data for Women 18 – 44. Note: odd numbered years only


Protective behaviors in region iv

Protective Behaviors in Region IV

  • Adequate Physical Activity (change 2001- 2007)

    • Total: 44% to 47%

    • Blacks: 36% to 40%

    • Whites: 47% to 49%

  • Five + Daily Fruits and Vegetables (1998–2008)

    • Total: 22% to 25%

    • Blacks: 15% to 25% -- a notable change

    • Whites: 24% to 24%

BRFSS Data for Women 18-44: 2001 – 2007 for physical activity;

1998 - 2008 for fruit and vegetable consumption


Chronic conditions in region iv

Chronic Conditions in Region IV

BRFSS Data for Women 18-44: 1998 – 2008

  • Diabetes including Gestational Diabetes

    • Total: 4.4% to 6.7%

    • Blacks: 4.6% to 9.0%

    • Whites: 4.5% to 5.9%

  • Almost no racial disparity in 1998

  • 1.5 times greater risk for Black women in 2008


Chronic conditions in region iv1

Chronic Conditions in Region IV

BRFSS Data for Women 18-44: 1999 – 2007, odd-numbered years only

  • Hypertension including Gestational Hypertension

    • Total: 12.3% to 13.7%

    • Blacks: 19.8% to 22.5%

    • Whites: 10.6% to 11.8%

  • 1999: Racial disparity almost double

  • 2007: Almost no change in disparity


Chronic conditions in region iv2

Chronic Conditions in Region IV

  • Current Diagnosis of Asthma

    • Total: 7.8% to 9.8%

    • Blacks: 10.7% to 11.3%

    • Whites: 7.2% to 9.8% -- one third higher over time

  • 2000: Risk 1.5 times greater for Blacks

  • By 2008: Racial disparity decreased from 50% to 15%

  • Mostly due to worsening of White rates

BRFSS Data for Women 18-44: 2000-2008


Women in need of publicly funded fp region iv 1998 2009

Women in Need of Publicly Funded FPRegion IV1998-2009


Region iv title x users in need and not served by title x 2000 2006

Region IV Title X Users In-Need and Not Served by Title X 2000-2006


Julie declerque drph mph ellen shanahan ma

Indicator of Unmet Need: Declining Rates of Healthy (2-5 yr) SpacingOptimal Birth Interval Rates in Region IV1998-2008


Julie declerque drph mph ellen shanahan ma

Indicator of Unmet Need: Rapid Repeat PregnancyPercent of Live Births (+Fetal Deaths) that were Repeat PregnanciesRegion IV 1998 - 2008 by Age


Julie declerque drph mph ellen shanahan ma

Indicator of Unmet Need:Women Not Trying to Become Pregnant (but) Using No ContraceptionPRAMS 1998-2008


Julie declerque drph mph ellen shanahan ma

Women With a Live Births Using a Contraceptive Method at the Time of Pregnancy Region IV: 1998 – 2008, PRAMS

Indicator of Unmet Need:

Contraceptive Method Failure


Consistency of contraceptive method use during the month before conception us 2001

Consistency of Contraceptive Method Use During the Month before Conception, US 2001

Gold RB, Sonfield A, Richards CL, Frost JJ. Next Steps for America’s Family Planning Program: Leveraging the Potential of Medicaid and Title X in an Evolving Health Care System. New York: Guttmacher Institute, 2009


Female title x users by contraceptive method mix region iv 2005 2009

Female Title X Users by Contraceptive Method Mix Region IV 2005 - 2009

Rates exclude women who were using no method, or who were pregnant, or seeking pregnancy


Indicator of unmet need high of teen pregnancies ending in abortion age 18

Indicator of Unmet Need:High % of Teen Pregnancies Ending in Abortion (Age <18)


Indicator of unmet need high of adult pregnancies also ending in abortion age 18 and over

Indicator of Unmet Need:High % of Adult Pregnancies Also Ending in Abortion (Age 18 and over)


How does region iv compare with us total induced abortion rate age 15 44 per 1 000

How Does Region IV Compare with US Total?Induced Abortion Rate (Age 15-44) per 1,000


Julie declerque drph mph ellen shanahan ma

Reproductive Tract Infections in Region IV Combined Syphilis, Gonorrhea and ChlamydiaFemales (Age 15+) Rate per 100,000

Source: Title X FPAR


Female title x users obtaining a pap test region iv 2005 2009

Female Title X Users Obtaining a Pap TestRegion IV 2005 - 2009


Substance use in region iv

Substance Use in Region IV

BRFSS Data for Women 18-44: 1998 - 2008

  • Change in Smoking Rates (10 years)

    • Total: 27.4% to 21.7% (21% decrease)

    • Blacks: 16.2% to 11.6% (28% decrease)

    • Whites: 30.9 to 26.2% (15% decrease)


Substance use in region iv1

Substance Use in Region IV

BRFSS Data for Women 18-44

2001 – 2008 for heavy drinking; 1999 - 2008 for binge drinking

  • Heavy Drinking (Change 2001- 2008)

    • Total: 4.5% to 3.9%

    • Blacks: 2.6% to 2.7%

    • Whites: 5.1 to 4.2%

  • Binge Drinking (Change 1999-2008)

    • Total: 7.9% to 11.7%

    • Blacks: 5.0% to 7.0%

    • Whites: 8.8% to 13.4%


Family planning clinics as medical home

Family Planning Clinics As Medical Home

  • “More than six in 10 women who obtain care at a FP center consider it as their usual source of medical care.”

  • “The package of basic, preventive sexual and reproductive health services routinely provided in family planning centers—along with contraceptive services and supplies—is essentially the same package of care a private physician offers a woman during her annual gynecologic exam.”

Gold RB, Sonfield A, Richards CL, Frost JJ. Next Steps for America’s Family Planning Program: Leveraging the Potential of Medicaid and Title X in an Evolving Health Care System. New York: Guttmacher Institute, 2009


Change in access to care in region iv 1998 2008

Change in Access to Care in Region IV1998 - 2008

  • Have Current Health Coverage

    • Total: 80% to 80%

    • Blacks: 73% to 76%

    • Whites: 81% to 82%

  • Could Not See Physician Due to Cost

    • Total: 19% to 24%

    • Blacks: 21% to 26%

    • Whites: 18% to 22%

BRFSS Data for Women 18-44, 1998 - 2008


Rndmu resource for multiple issues

RNDMU: Resource for Multiple Issues

Infant mortality and correlated risk factors

High-risk childbearing

Family Planning: Users, Need Met, Indicators of Unmet Need

Latina Health: Many indicators now tracked by Hispanic ethnicity

FP Medicaid Waiver Evaluators: cost-savings due to averted births

Women’s Health and Preconception/Wellness Care

Other: Refining Pregnancy Intention Measures

Surveillance of FP clients presenting for PT or EC


Julie declerque drph mph ellen shanahan ma

Questions?

For more information about RNDMU contact:

[email protected](919) 966-7106

[email protected](919) 966-8445

Please visit us at our website

http://www.shepscenter.unc.edu/data/RNDMU/index.html

Thank you!


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