Who’s Keeping Score? Changes in the Vital Records and Statistics Infrastructure in the Computer...

Who’s Keeping Score? Changes in the

Vital Records and Statistics Infrastructure in the Computer Age

Daniel J. Friedman

The NAPHSIS/NCHS Collaboration—Past Successes and Future Challenges

Salt Lake City4 June 2007

The NAPHSIS/NCHS CollaborationPast Successes and Future Challenges

Salt Lake City, UT June 3rd – 7th, 2007

Topics

1. Purpose2. Definitions3. Historical perspective 4. Methods5. Findings6. Reflections



But first, thanks to. . .

NAPHSIS executive committee Advisory committee NAPHSIS membership NCHS Former NCHS and NAPHSIS seniors



Purpose

To assess changes in the vital records and statistics infrastructure at state and national levels since ~1980 Performance Uses Resources

Focus primarily upon public health statistics applications of birth and death records, not civil registration



Definitions

Vital records functions include: Registration Certification Issuance Corrections Amendments Quality control and information systems

activities directly supporting vital records



Definitions

Vital statistics functions include: Statistical analysis Compilation of vital records data Quality control and information systems

activities directly supporting vital statistics

Other health statistics functions not included



Definitions

“States”=52 jurisdictions 50 states New York City and Washington, D.C.



Historical perspective

Stages of U.S. vital records and statistics infrastructure

1. Colonial mandating of reporting (1632)2. Central state collection (1842)3. National establishment of registration areas

(1880)4. Integral component of public health structure



Historical perspective

5. Increased computerization and cooperation (1968)

Computerization• ACME (1968)• Computer tapes to NCHS (1971)

Changing relationship between NCHS and states• VSCP (1973)

Enhanced emphasis on analysis• State centers for health statistics (1969)

Expanded use for administrative purposes• SSA EAB (1987)



Methods--Indicators

Quantitative State and national levels Selection via D-S-L indicator decision

funnel



D-S-L indicator decision funnel#1. Potential indicators

#2. Indicators with data available

#3. Indicators with data available and meaningful

a. validb. inter-state

consistencyc. over-time

consistencyd. actionable

#4. Ratio of meaningfulness to data collection effort

#5. Final selected indicators



Methods—Data sources

National Center for Health Statistics Published data Unpublished data

National Library of Medicine—PubMed New York Times archives Delphi survey



Methods—Data sources

Web surveys of state vital records and statistics offices Survey #1

• Assess if states provide or estimate data• 73 indicators• 1980-2005 for six selected years• 28 responding jurisdictions

Survey #2• States provide or estimate data• 31 indicators• 1980-2005, with selected years varying among questions• 31 responding jurisdictions



Methods--Limitations

Gap between needed potential indicators and indicators with data available

Varying Data sources Data quality

• Some self-reported• Actual data• Estimated data

Sample sizes and generalizability Start dates



Findings--Performance

Indicator Births Deaths

#days from event to registration % records electronically transmitted % births with non-stated

--delivery method --birth weight --#prenatal care visits



Findings--Performance


% deaths with ill-defined underlying cause

# states adopting revised standard certificates # calendar days from data year end to NCHS file closure

# days from data year end to publication in state annual report # days from NCHS file closure to publication in NCHS report



Findings--Uses

Indicators Births Deaths

# event registrations # birth certificate amendments processed # certificate copies issued

# National Death Index

--applications submitted --file searches



Findings--Uses


% states making birth or death data available on Web % states making birth or death available through interactive system on Web # special topic reports on births or deaths by state health department # new research applications for individually identifiable birth or death data

# projects with release of individually identifiable birth or death data to government programs for administrative purposes # articles in peer-reviewed journals using birth or death records as data source or sampling frame # New York Times articles citing NCHS and births or deaths



Findings--Resources

Indicator Vital records Vital statistics

# NCHS training courses State health department staffing

NCHS budget

--total --VSCP as % of total budget



Findings--Resources

Indicator

State health department expenditures

--total expenditures for vital records and statistics --expenditures from retained fees --expenditures from federal funds --expenditures for vital records --expenditures for vital statistics



Findings—Central themes

1. Computerization improved performance for both vital records and vital statistics

EBC has helped to improve births performance much more than deaths

2. National system threatened by dramatic decline in implementation of revised standard certificates

3. Administrative and research uses greatly increased

4. Huge increase in uses not accompanied by concomitant increases in resources



Reflections

U.S. vital records Essential Ubiquitous

U.S. vital statistics Essential Ubiquitous



Reflections

BUT. . . minimal attention to

health and well-being of vital records and vital statistics infrastructure



Reflections

Our colleagues in infrastructure improvement Henry Chadwick (1824-1908)

W. Edwards Deming (1900-1993)• “There is no substitute for knowledge”• “You can expect what you inspect”• “A system must be managed. It will not manage itself.”• “The problem is at the top; management is the problem.”



AL—East Standings (May 21st)

Team Won Lost

Boston A lot Not many

Baltimore Some Many

New York Fewer Even more

Toronto Fewer Even more +

Tampa Bay Is this an AL team? They stink




Team Won Lost

Boston Baltimore

New York

Toronto Tampa Bay




Team Won Lost Pct.

Boston 30 13 .698

Baltimore 20 24 .455

New York 19 23 .452

Toronto 19 24 .442

Tampa Bay 18 25 .419



Reflections

HELP WANTED. . . A few good metrics



Reflections

National State

Records Statistics Records Statistics

Performance

Uses

Resources



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