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Implications for Improving Fetal Death Vital Statistics: Connecting Reporters’ Self-Identified Practices and Barriers to Third Trimester Fetal Death Data Quality in New York City

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Abstract

Objectives Perinatal mortality prevention strategies that target fetal deaths often utilize vital records data sets shown to contain critical quality deficiencies. To understand the causes of deficient data, we linked survey responses of fetal death reporters with facility fetal death data quality indicators. Methods In 2011, we surveyed the person most responsible for fetal death reporting at New York City healthcare facilities on their attitudes, barriers, and practices regarding reporting. We compared responses by 2 facility data quality indicators (data completeness and ill-defined cause of fetal death) for third trimester fetal death registrations using Chi squared tests. Results Thirty-nine of 50 facilities completed full questionnaires (78 % response rate); responding facilities reported 84 % (n = 11,891) of all 2011 fetal deaths, including 329 third trimester fetal deaths. Facilities citing ≥1 reporting barrier were approximately five times more likely to have incomplete third trimester registrations than facilities citing no substantial barriers (37.5 vs 7.9 %; RR 4.7; 95 % CI [1.6–14.2]). Reported barriers included onerous reporting requirements (n = 10; 26 %) and competing physician priorities (n = 11; 28 %). Facilities citing difficulty involving physicians in reporting were more likely to report fetal deaths with nonspecific cause-of-death information (70.9 vs 56.6 %; RR 1.3; 95 % CI [1.1–1.5]). Conclusions Self-reported challenges correlate with completeness and accuracy of reported fetal death data, suggesting that such barriers are likely contributing to low quality data. We identified several improvement opportunities, including in-depth training and reducing the information collected, especially for early fetal deaths (<20 weeks’ gestation), the majority of events reported.

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Acknowledgments

We thank the Bureau of Maternal, Infant and Reproductive Health at the New York City Department of Health and Mental Hygiene for their advisement on this work.

Author information

Authors and Affiliations

  1. Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, 125 Worth St., Room 219B, CN-7, New York, NY, 10013, USA

    Erica Lee, Amita Toprani, Elizabeth Begier, Richard Genovese, Ann Madsen & Melissa Gambatese

  2. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA

    Amita Toprani

Authors
  1. Erica Lee
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  2. Amita Toprani
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  3. Elizabeth Begier
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  4. Richard Genovese
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  5. Ann Madsen
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  6. Melissa Gambatese
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Corresponding author

Correspondence to Erica Lee.

Additional information

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Appendix: Content Based Survey Questions Given to Fetal Death Data Providers to Assess Their Knowledge, Attitudes, and Practices Regarding Fetal Death Reporting, New York City, 2011

Appendix: Content Based Survey Questions Given to Fetal Death Data Providers to Assess Their Knowledge, Attitudes, and Practices Regarding Fetal Death Reporting, New York City, 2011

Reporting requirements and use of data

  1. 1.

    The New York City Health Code mandates reporting of spontaneous terminations of pregnancy (STOPs) to the New York City Department of Health and Mental Hygiene (DOHMH) for terminations occurring at what gestational age?

24 weeks or greater

8 weeks or greater

20 weeks or greater

All gestational ages

12 weeks or greater

 
  1. 2.

    Please review the following scenarios and select the ones that should be reported to the DOHMH as STOPs based on your current understanding of the health code. (Choose all that apply)

A patient with a documented positive pregnancy test presents with a decline in human chorionic gonadotropin (hCG) levels. A visible product of conception is expelled.

A patient with a documented positive pregnancy test presents with a decline in hCG levels. No product of conception is expelled or extracted.

A patient without documentation of a positive pregnancy test presents with expulsion of a visible product of conception.

A patient with a documented positive pregnancy test presents with vaginal bleeding. There is no decline in hCG levels. No product of conception is expelled or extracted.

  1. 3.

    For pregnancy terminations occurring after 20 weeks gestation, how often do you find it difficult to determine whether to file a certificate of spontaneous termination of pregnancy or a certificate of live birth?

Always

Sometimes (between 25 and 49 % of cases)

Usually (between 75 and 99 % of cases)

Rarely (less than 25 % of cases)

Frequently (between 50 and 74 % of cases)

Never

  1. 4.

    Classifying a late gestational age event as a “spontaneous termination of pregnancy” or an “infant death” can have different emotional or financial impacts on the patient and family and may impose different administrative burdens on the health care provider. How often do you think that one or more of these factors are considered when determining which certificate to file for a late gestational age event (i.e. 20 weeks or later)?

Always

Sometimes (between 25 and 49 % of cases)

Usually (between 75 and 99 % of cases)

Rarely (less than 25 % of cases)

Frequently (between 50 and 74 % of cases)

Never

  1. 5.

    Do you know how the data you report are used by DOHMH?

Yes.

No and I am interested in receiving more information about how the data are used.

No and I am not interested in receiving more information about how the data are used.

  1. 6.

    Please indicate whether each of the following statements about the data collected by DOHMH is true or false:

The data are used to calculate pregnancy rates for New York City.

The data are used to better understand reproductive health issues faced by women in New York City.

The data are used to help the Department of Health choose priority areas for public health programs and services.

New York City is mandated to collect information about pregnancy terminations by the United States federal government.

  1. 7.

    How important do you consider the collection and reporting of data about spontaneous terminations of pregnancy?

Very important

Of minor importance

Somewhat important

Not at all important

Data collection and reporting process

  1. 8.

    On average, how much time (in minutes) does it take you to file a certificate of spontaneous termination of pregnancy, either on paper or in the Electronic Vital Events Registration System (EVERS)?

[free text]

  1. 9.

    Approximately how many people are involved in collecting, compiling and recording the information required to register STOPs at your facility? Please include physicians, nurses, information management staff, administrative staff, and others as appropriate).

[free text]

  1. 10.

    Currently, there is a STOP worksheet available on the DOHMH website that can be used to help you collect and enter the data into EVERS. How often do you use this STOP worksheet?

Always

Sometimes (between 25 and 49 % of cases)

Usually (between 75 and 99 % of cases)

Rarely (less than 25 % of cases)

Frequently (between 50 and 74 % of cases)

Never

  1. 11.

    Does your facility file STOPs electronically?

Yes

No

  1. 12.

    In your opinion, how does the process of filing STOPs electronically compare to the process of filing on paper?

Filing electronically is easier than filing on paper.

Filing electronically is neither easier nor more difficult than filing on paper.

Filing electronically is more difficult than filing on paper.

  1. 13.

    In your opinion, how does the length of time required to file STOPs electronically compare to that of filing on paper?

Filing electronically takes less time than filing on paper.

Filing electronically takes the same amount of time as filing on paper.

Filing electronically takes more time than filing on paper.

  1. 14.

    In January of 2011, changes were made to the Certificate of Spontaneous Termination of Pregnancy to include the “Cause/Conditions Contributing to Fetal Death” section. Which of the following statements best describes your opinion of the revised questions?

The revised questions are clearer and easier to understand than the questions they replaced.

The revised questions and the questions they replaced are about the same in terms of clarity and ease of understanding.

The revised questions are less clear and harder to understand than the questions they replaced.

I was not aware that changes were made to the certificate.

Resources and barriers

  1. 15.

    What additional resources or improvements would allow you to file STOPs more efficiently? (Choose all that apply)

Increased operating hours of the DOHMH EVERS Help Desk.

Additional in-person trainings at the DOHMH offices related to the use of the EVERS (e.g. How to override system edits).

Additional web-based trainings related to use of the EVERS.

In-person trainings at the DOHMH offices related to correctly completing questions on the Certificate of Spontaneous Termination of Pregnancy.

In-person trainings at your facility related to correctly completing questions on the Certificate of Spontaneous Termination of Pregnancy (e.g. How to complete the Race and Ancestry questions).

Web-based trainings related to correctly completing questions on the Certificate of Spontaneous Termination of Pregnancy.

A direct linkage between my electronic medical records system and EVERS to allow automated filing.

Other (please specify): [free text]

  1. 16.

    Which of the following is the greatest barrier you face to accurate and timely reporting of spontaneous terminations at your facility? (Choose one)

There are too many questions to answer for each patient.

The wording of the questions is confusing.

It is not clear where to find the information I need to answer the questions.

The electronic reporting system is difficult to use.

The information I need to answer the questions is not available from the medical record.

There are no significant barriers to accurate and timely reporting of STOPs.

Other (please specify): [free text]

  1. 17.

    General comments, ideas and suggestions for improvements will be greatly appreciated. Please include them here.

[free text]

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Lee, E., Toprani, A., Begier, E. et al. Implications for Improving Fetal Death Vital Statistics: Connecting Reporters’ Self-Identified Practices and Barriers to Third Trimester Fetal Death Data Quality in New York City. Matern Child Health J 20, 337–346 (2016). https://doi.org/10.1007/s10995-015-1833-8

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  • DOI: https://doi.org/10.1007/s10995-015-1833-8

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