From concept to measurement core state indicators for monitoring preconception health
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From Concept to Measurement: Core State Indicators for Monitoring Preconception Health. William M. Sappenfield, MD, MPH State MCH Epidemiologist Office of Surveillance, Evaluation & Epidemiology Division of Family Health Services . Topics to be Discussed. Purpose Process Product

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From concept to measurement core state indicators for monitoring preconception health l.jpg

From Concept to Measurement:Core State Indicators for Monitoring Preconception Health

William M. Sappenfield, MD, MPH

State MCH Epidemiologist

Office of Surveillance, Evaluation & Epidemiology

Division of Family Health Services


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Topics to be Discussed

  • Purpose

  • Process

  • Product

  • Possibilities


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4 5 6 7 8 9 10 11 12

Central Nervous System

Central Nervous System

Heart

Heart

Arms

Arms

Eyes

Eyes

Legs

Legs

Teeth

Teeth

Palate

Palate

External genitalia

External genitalia

Ear

Ear

Mean Entry into Prenatal Care

Missed Period

We Currently Intervene Too Late

Critical Periods of Fetal Development



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PPOR Analysis of 2000-2002 of data from the 66 largest cities, suggests that preventive action must address maternal health prior to conception and early in pregnancy


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CDC Preconception Efforts cities, suggests that preventive action must address maternal health prior to conception and early in pregnancy

  • Summit

  • Select Panel Meeting

  • Recommendations

  • Supplement

  • Lectures/Speakers’ Bureau

  • Evaluations/Best Practices

  • Workgroups to develop

  • implementation strategies

  • TA to programs

  • Journal publications


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Preconception Health cities, suggests that preventive action must address maternal health prior to conception and early in pregnancy

Concept

Measurement

“How do we measure preconception health?”


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Background cities, suggests that preventive action must address maternal health prior to conception and early in pregnancy

  • FDOH wants to assess, monitor and evaluate preconception health and interventions

  • CA has previously developed a preconception health report including indicators

  • No real consensus exists as to appropriate preconception health measures


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CORE State Preconception Health Indicator Initiative cities, suggests that preventive action must address maternal health prior to conception and early in pregnancy

Purpose

  • 7 states formed the initiative

    • CA, FL, MI, NC, RI, TX & UT

  • Review and evaluate potential indicators

  • Recommend an initial set of available core state indicators


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North Carolina cities, suggests that preventive action must address maternal health prior to conception and early in pregnancy

Alvina Long Valentin RN, MPH

Sarah McCracken Cobb

Texas

Gita Mirchandani, PhD, MPH

Charlotte Brooks, MEd

Utah

Nan Streeter, MS, RN

Lois Bloebaum, MPA

Shaheen Hossain, PhD

California

Moreen Libet, PhD

Kiko Malin, MPH, MSW

Delaware

Charlan Kroelinger, PhD

Florida

Danielle Broussard, PhD

Bill Sappenfield, MD, MPH

Michigan

Violanda Grigorescu, MD, MSPH

Chris Fussman, MS

CORE State Preconception Health Indicator Initiative


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CORE State Preconception Health Indicator Initiative cities, suggests that preventive action must address maternal health prior to conception and early in pregnancy

Assumptions

  • Indicators must be currently measurable on an annual basis(?)—either core or optional component.

  • Indicators need to be population-based and state level.

  • Indicators must be reasonably accurate & useful.

  • Indicators should not be unnecessarily duplicative.

  • Outcomes should not be included as preconception health indicators—previously defined.

  • Adolescents and men need their own set of indicators; therefore not included.


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CORE State Preconception Health Indicator Initiative cities, suggests that preventive action must address maternal health prior to conception and early in pregnancy

Process

  • Identify preconception health domains

  • Review available state data sets for potential indicators using domains

  • Identify potential indicators

  • Evaluate proposed indicators based on 6 criteria

  • Score indicators for selection based on 6 criteria

  • Select and recommend CORE indicators

  • Provide for public review and comment

Expert panel input & comment at decision points


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Domains cities, suggests that preventive action must address maternal health prior to conception and early in pregnancy

General Health Status

Chronic Conditions

Emotional/Social Support

Genetics/Epigenetics

Health Care

Infections

Mental Health

Nutrition/Physical Activity

Reproductive Health / Family Planning

Social Determinants

Tobacco, Alcohol and Substance Use

CORE State Preconception Health Indicator Initiative


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CORE State Preconception Health Indicator Initiative cities, suggests that preventive action must address maternal health prior to conception and early in pregnancy

State Level Data Sets

  • Abortion reporting

  • ART Surveillance System

  • BRFSS

  • Census / Current Population Survey

  • Cancer registry

  • PRAMS

  • Pregnancy Nutrition Surveillance System

  • STI reporting

  • Vital records


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CORE State Preconception Health Indicator Initiative cities, suggests that preventive action must address maternal health prior to conception and early in pregnancy

Indicator Evaluation Criteria

  • Public health importance

  • Policy/program importance

  • Data availability

  • Data quality

  • Indicator complexity


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General Health Status cities, suggests that preventive action must address maternal health prior to conception and early in pregnancy

Chronic Conditions

Emotional/Social Support

Genetics/Epigenetics

Health Care

Infections

Mental Health

Nutrition/Physical Activity

Reproductive Health / Family Planning

Social Determinants

Tobacco, Alcohol and Substance Use

CORE State Preconception Health Indicator Initiative

Propose 45 Indicators in 11 Domains

“Turn to your handout table”


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CORE State Preconception Health Indicators cities, suggests that preventive action must address maternal health prior to conception and early in pregnancy Challenges & Issues

  • Still emerging field

  • Preconception health versus women’s health

  • Adolescents, older women and men

  • True population “at risk”

  • Limited services data by risk factor

  • Initial proposal already has 45 indicators

  • Competing surveillance priorities