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Justifying Early Term Deliveries in Louisiana with Vital Statistics Data

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Sunday, November 16, 2014

Rebecca Gurvich, MPH , Medicaid Quality Management, Statistics and Reporting, Louisiana Department of Health and Hospitals, New Orleans, LA
Valery Danilack, MPH , Brown University School of Public Health, Providence, RI
Janet Muri, MBA , National Perinatal Information Center, Inc., Providence, RI
Danielle Berthelot , Registered Health Information Administrator, Health Information Management, Woman's Hospital, Baton Rouge, LA
Nancy Crawford , Medical Staff Services, Woman's Hospital, Baton Rouge, LA
Joan Wightkin, DrPH , School of Public Health, Louisiana State University, New Orleans, LA
Rebekah Gee, MD, MPH, MSHPR , School of Public Health, Louisiana State University, New Orleans, LA
In 2012, the Louisiana Department of Health and Hospitals altered the LA birth certificate to include medical reasons for births before 39 completed weeks’ gestation. We compared the completeness and validity of these data with hospital discharge records.    

We identified births occurring 4/1/2012-9/30/2012 at Woman’s Hospital of Baton Rouge, the largest delivery hospital in LA. We linked maternal delivery and newborn birth data collected by the National Perinatal Information Center with LA birth certificates. Among early term births (37-38 completed weeks’ gestation), we quantified the reasons for early delivery and compared them with ICD-9-CM codes from Woman’s discharge data. 

Among 4353 birth certificates indicating delivery at Woman’s Hospital, we matched 99.8% to corresponding Woman’s data. Among 1293 early term singleton births, the most common reasons for early delivery were spontaneous active labor (57.5%), gestational hypertensive disorders (15.3%), gestational diabetes (8.7%), and premature rupture of membranes (8.1%). Only 2.7% of births indicated “other reason” as the only reason. Most reasons for early delivery had > 80% correspondence with ICD-9-CM codes. Lower correspondence was observed for premature rupture of membranes (35%) and abnormal heart rate or fetal distress (72%).   

There was near-perfect ability to match LA birth certificates with the corresponding Woman’s Hospital record, and the agreement between reasons for early delivery on the birth certificate and ICD-9-CM codes was high. 2.7% should be used as a benchmark for the acceptable frequency of “other reason” reported by hospitals. Louisiana implemented an effective mechanism to identify and justify early deliveries using vital records.

Learning Areas:

Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Demonstrate how states can implement effective mechanisms to identify and substantiate medical reasons for early deliveries using vital records systems. Compare responses from a newly implemented birth certificate supplement to administrative hospital discharge data.

Keyword(s): Maternal and Child Health, Birth Outcomes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Currently, I manage quality improvement initiatives for the medicaid population for the State of Louisiana. Prior to that, I received a Master of Public Health degree from Tulane University School of Public Health and Tropical Medicine.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 2035.0: Poster Session: Infant & Child Health