Accuracy at Birth: Improving

Birth Certificate Data

Beena Kamath, MD, MPH

April 27, 2010

 Team
• Beena Kamath, MD (Study Lead)
• Michael Marcotte, MD (Director, Quality
Maternity Medicine, Good Samaritan Hospital)
• Roni Christopher (QIC)
• Edward Donovan, MD (PI-OPQC)
• Carolyn Slone, RN (Antepartum)
• Jennifer Brodbeck, RN (Labor and Delivery)
• Meg James, RN (Manager of Special Care
Obstetrics)
Sentinel Event
 Gestational age
• Clinical decisions
• Research questions
• Intervention programs for at risk infants

• If the vital statistics are incomplete or

inaccurate, risk status, clinical factors, or
outcomes will not adequately reflect the
population being studied.
 Birth certificates

From Gould, et al. “Incomplete Birth Certificates: A Risk Marker

for Infant Mortality,” 2002.
 Measuring Gestational Age
• LMP
– Problems with recall
– Different menstrual cycles

• Ultrasound
– Compared to references that may not reflect natural variation in
population
– Measures size, not time (Mustafa, et al., 2001)

• Clinical (maturational assessment)

– Not accurate below 28 weeks gestation (Donovan, et al., 1999)
– Over-estimates age for preterms, thereby underestimating rates
of prematurity (Alexander, et al., 1992)
 Different results
• Methods of estimating GA can lead to disparate results, resulting in
systematic biases

• Post-term birth rates

– Clinical (1.2%) vs. LMP (6.4%)
» Wingate, et al., 2007

– Ultrasound (1.1%) vs. LMP (10.1%)

» Dietz, et al., 2007

• Rates of prematurity
– Clinical (7.9%) vs. LMP (9.9%)
» Wingate, et al., 2007

– Ultrasound (7.9%) vs. LMP (8.7%)

» Dietz, et al., 2007
 Learning from Observations
(Following the Gestational Age on the Birth Certificate)

Baby born

Delivery log printed from

What is going
OB TV on in OB TV?
Gestational age transcribed
directly from OB TV to birth
certificate worksheet

Form completed for

State & Federal Gov’t
 Problems with OB TV
Since OB TV is the source for
Referral from multiple repositories of NICU record
Outside OB information, it makes sense to of GA
make sure OB TV is accurate.

Birth certificate
Document GA record of GA
Pregnant mom
in OB TV with
arrives to GSH
best data
OB database
record of
Yes GA

Is ACOG form
Alternative methods to
Available? No confirm GA: asking Perinatal Database
mother herself, record of GA
calling practice
OB TV Screen Shot
 Our AIM
• To improve the reliability of gestational age
recorded in OB TV from 25% to 75% for Good
Samaritan Hospital by January 31, 2010 in the
population of women with prenatal care who are
pregnant with an infant at least 20 weeks
gestation
 Percentage of Pregnancy Records with Reliable GA

0%
20%
40%
60%
80%
100%
120%

09/01/09 (n=24)
09/05/09 (n=11)
09/09/09 (n=25)
09/13/09 (n=13)
09/17/09 (n=18)
09/21/09 (n=21)
09/25/09 (n=17)
09/29/09 (n=19)
10/03/09 (n=24)
10/07/09 (n=25)
10/11/09 (n=13)
10/15/09 (n=09)
10/19/09 (n=23)
10/23/09 (n=26)
10/27/09 (n=19)

Daily Percentage
10/31/09 (n=16)
11/04/09 (n=20)
11/08/09 (n=12)
11/12/09 (n=21)
11/16/09 (n=27)
11/20/09 (n=17)
11/24/09 (n=25)
11/28/09 (n=16)
12/02/09 (n=25)
12/06/09 (n=11)
12/10/09 (n=19)
12/14/09 (n=21)
12/18/09 (n=24)
12/22/09 (n=27)
12/26/09 (n=05)
12/30/09 (n=17)
01/03/10 (n=09)
01/07/10 (n=19)
01/11/10 (n=21)
01/15/10 (n=22)
Median Centerline

01/19/10 (n=18)
Day (with number of Deliveries)

01/23/10 (n=13)
01/27/10 (n=12)
01/31/10 (n=08)
02/04/10 (n=15)
02/08/10 (n=16)
02/12/10 (n=17)
02/16/10 (n=22)
02/23/10 (n=23)
02/27/10 (n=15)
03/03/10 (n=18)
03/07/10 (n=10)
Reliability at Birth: Gestational Age Recording in OB Trace Vue

03/11/10 (n=14)
03/15/10 (n=20)
03/19/10 (n=16)
Goal (0.9)

03/23/10 (n=26)
03/27/10 (n=14)
03/31/10 (n=18)
04/04/10 (n=20)
04/08/10 (n=15)
 Overall Learning/Challenges

• Process is complex.
• Learning OB TV system and people on the
ground.
• Dealing with attitudes about change.
• Each community practice has different reasons/
disincentives for not completing ACOG form and
sending it in correctly.
Questions??