Iowa’s Barriers to Prenatal Care Project

Ongoing since 1992, the purpose of this project is to obtain brief, accurate information about women delivering babies in Iowa hospitals. Specifically, the project seeks to learn about women’s experiences getting prenatal or delivery care during their current pregnancy. Other information is included which may be pertinent to health planners or those concerned with the systematic development of health care services. This project is a cooperative venture of all Iowa’s maternity hospitals, the University of Northern Iowa Center for Social and Behavioral Research, and the Iowa Department of Public Health. The Robert Wood Johnson Foundation funded the first three years of this project. The current funding is provided by the Iowa Department of Public Health. The Director is Dr. Mary Losch, University of Northern Iowa Center for Social and Behavioral Research. The Coordinator for the project is Rodney Muilenburg.

The questionnaire is distributed to all maternity hospitals across the state of Iowa (currently about 65). Nursing staff or those responsible for obtaining birth certificate information in the obstetrics unit are responsible for approaching all birth mothers prior to dismissal to request their participation in the study. The questionnaire takes approximately ten minutes to complete. Completed questionnaires are returned to the University of Northern Iowa Center for Social and Behavioral Research for data entry and analysis. Returns are made monthly, weekly, or biweekly depending on the number of births per week in a given hospital. Except in the case of a mother who is too ill to complete the questionnaire, all mothers are eligible to be recruited for participation.

PRAMS

PRAMS was initiated in 1987 to help state health departments establish and maintain an epidemiologic surveillance system of selected maternal behaviors and experiences. PRAMS was started at a time when the US infant mortality rate was no longer declining as rapidly as it had in past years and the prevalence of low birthweight was showing little change. Maternal behaviors such as alcohol and tobacco use and limited use of prenatal care and pediatric care were contributing to the slow rate of decline. PRAMS was designed to supplement data from vital records and to generate data for planning and assessing perinatal health programs in each participating state.

Iowa PRAMS has identified 10 research priorities based on the maternal and child health priorities as determined through the Title V and Title X needs assessment processes for Iowa, as well as Healthy People 2020 objectives.

• Enhance data collection and dissemination efforts to promote evidence-based decision making in planning, policy, evaluation, allocation and accountability
• Reduce infant morbidity and mortality
• Improve pregnancy planning and spacing and prevent unintended pregnancy
• Incorporate mental health into relevant preventive health efforts within MCH programs
• Improve rates of breastfeeding
• Decrease the use of tobacco in pregnant women and new mothers
• Explore the prevalence of maternal alcohol use and binge drinking
• Improve access to preventive and restorative dental care for low-income pregnant women
• Reduce racial disparities in maternal and child health outcomes
• Apply the Life Course Model to help women obtain optimum health

BRFSS

The Behavioral Risk Factor Surveillance System (BRFSS) is a yearly survey that measures changes in the health of people in Iowa. It is the largest continuously running telephone survey in the world. All 50 states, the District of Columbia and three U.S. territories, conduct the survey under the direction of the Centers for Disease Control and Prevention (CDC). The Iowa BRFSS is an important tool for data-driven decision making in the public health community.

Iowa BRFSS survey data is used to design, implement, and support public health activities with the goal of reducing chronic diseases and other leading causes of death for Iowans. Programs within BFH financially support the module for Mental Health and Adverse Childhood Experiences. Title V staff utilize this information for multiple NPMs and SPMs plan development.

signifycommunity

The BFH and Oral Health Center continue to integrate program data including care coordination, referral management, risk assessment, practice management, billing, and client and population level reporting. The data systems consolidated/integrated to the new system, signifycommunity (formerly TAVConnect), are the Child and Adolescent Reporting System (CAReS), Women’s Health Information System (WHIS) and Ahler’s family planning data system.

This data system is a collaboration between multiple programs within HPCDP and within the state. The Omnibus Agreement with DHS is one of the funding mechanisms braided together along with multiple within BFH.

Iowa’s Integrated Data System for Decision Making (i2d2)

Iowa has invested in developing and refining an integrated data system since 2015. The development team gained considerable momentum in 2019 with federal support from the Administration for Children and Families (Preschool Development Grant) and state support from the Iowa Department of Public Health.

What is I2D2?

• supports cycles of inquiry
• addresses state priority issues
• identifies gaps in current public service system networks
• enhances cross-system programming efforts
• promotes data-informed decisions

I2D2 Commits to Priorities for the Long-Term

• I2D2 works with stakeholders to assess effectiveness and identify shortcomings in reaching Iowa's goals through a process that uses data to inspire dialogue that informs decision-making.
• I2D2 integrates data already collected by agencies in a safe, secure, scientifically rigorous system designed for policy analysis.
• I2D2 integrates people as stakeholders stewards of data to gather collective insight and translate findings into actionable intelligence.
• I2D2 integrates data insights with executive leader and program manager decision-making to advance a statewide culture of evidence-based services to improve outcomes.

Enhancing Effectiveness and Efficiency for Decision-Makers

• I2D2 gives agencies the power to improve policies and programs with cross-system data.
• I2D2 standardizes legal processes to ensure all protections are in place and reduce the need to revisit comprehensive data sharing provisions with each use.
• I2D2 prioritizes data security by minimizing data sharing and enforcing strict user-based role access protocols.
• I2D2 fosters collaboration and maximizes efficiency by relieving the burden on agency staff to coordinate cross-agency responses to data requests.

I2D2 brings together the rigor and strength of Iowa State University with the policy experience and insight of Early Childhood Iowa – a statewide organization dedicated to providing early care, education, health, and human services for children zero through five. Through this partnership, I2D2 puts the state’s most informed, passionate, and data-driven resources to work ensuring all Iowa children are successful from birth.