It is critical to maintain consistent direct access to electronic maternal and child health (MCH) health data such as birth files, death files, hospital discharge files, and surveys like Pregnancy Risk Assessment Monitoring System (PRAMS), the Behavioral Risk Factor Surveillance System (BRFSS), and the Youth Risk Behavior Surveillance System (YRBSS) to inform Texas MCH program planning, evaluation, and improvement and Title V MCH Block Grant reporting.

The Maternal and Child Health Epidemiology unit (MCHE) has an existing Data Use Agreement (DUA) with:

• The Texas Department of State Health Services (DSHS), Center for Health Statistics (CHS) to link several data sources (i.e., birth and death files),
•  A memorandum of understanding (MOU) with the Texas Health and Human Services Commission (HHSC) to link vital event data with Medicaid administrative data and
• An agreement to link hospital discharge data with birth and death files for the Texas Maternal Mortality and Morbidity Review Committee’s (MMMRC) specific data needs.

Texas has consistent annual access to the following data sources: birth records, death records, hospital discharge data, Medicaid records, PRAMS, and BRFSS. MCHE developes products from these data sources such as the annual Healthy Texas Mothers and Babies (HTMB) Data Book, the annual PRAMS Data Dashboard, bi-annual maternal mortality and TexasAIM legislative reports - a quality improvement project to address maternal safety, and various MCH data-driven dashboards, factsheets, white papers, conference presentations, and journal articles.

MCH (both the MCH policy unit and MCHE) develop logic models around current national and state performance measures. Logic model development includes cross-unit teams to review the 5-Year Needs Assessment data sources, assess those data sources applicability, and discuss MCH-offered programming evaluation plan data gaps. Subsequently, if data gaps are identified, the teams strategizes how, where, and what data may need analysis or collection for the evaluation plan. MCH is developing data management and dissemination plans for all domains.

HTMB Epidemiology Team - MCHE provides data and analytical support for maternal mortality surveillance and reporting. This includes linking provisional and finalized death data with birth and fetal death data for identification of pregnancy-associated deaths and requesting needed medical/delivery records for pregnancy-associated death identification and MMMRC case review.

In July 2020, as part of the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) grant, the team started entering  2019 case cohort data into the Maternal Mortality Review Information Application (MMRIA), a standardized data system available to support essential MMMRC review functions. Additionally, the team expanded the MMMRC’s supplemental documentation to have available during their review processes including a socio-spatial context dashboard that reviews community and environmental indicators  the woman had lived prior to her death, and, if the woman was on Medicaid, a Medicaid coversheet outlining key events, prescription medication claims, and service claims. Having these data points standardized allows for accurate data analysis and clear findings through the review process. MCHE started a vital record quality improvement project by coordinating with the Vital Statistics State Registrar to provide maternal death information identified during the MCHE records review process.

The Texas MMMRC has a maternal health disparities subcommittee. One of the subcommittee’s goals was to create a Discrimination Assessment and Social Determinants of Health (DASH) Facilitated Discussion Tool to enhance the review process  and discussions about discrimination noted in medical records. MCH developed an evaluation plan and recruited other state’s MMRCs to   evaluate this new tool with data collection occurring between Fall 2021 and May 2022.

MCHE provides technical assistance to the TEHDI program to support a Centers for Disease Control and Prevention (CDC) grant-funded data quality improvement project. On a quarterly basis, MCHE links vital event data and program data. The State System Development Initiative (SSDI) Project Director (PD) attended technical assistance meetings and provided statistical programming assistance in support of the grant.

Child and Adolescent Health & Oral Health Epidemiology Team (CAH&OH Epi) - provides data and analytical support for child and adolescent health, children and youth with special health care needs (CYSHCN), and oral health surveillance and reporting. This includes validating and running reports, collecting and analyzing statewide dental screenings’ oral health data, working on the Help Me Grow program assessment and evaluation, and designing and analyzing the biennial CSHCN survey data. Additional data sources are used to drive program decisions including specific modules added to the Texas BRFSS (i.e., adverse childhood experiences) and the Texas YRBSS (i.e., adverse childhood experiences, positive youth development, and preventive health care).

MCH also provides partial funding for the Texas School Physical Activity and Nutrition (SPAN) survey. Texas SPAN is a state-wide surveillance system which monitors the body mass index (BMI) and related variables in Texas children and adolescents in grades 2, 4, 8, and 11 for the 2015-2016 and 2019-2020 school year. The survey focuses on several BMI factors and outcomes including nutrition knowledge, nutrition attitude, physical activity, and dietary behaviors. One state performance measure utilizes this data source. Texas SPAN continued data collection in December  2021 after pausing due to the COVID-19 pandemic.

The Texas Oral Health Improvement Program (OHIP) Basic Screening Survey (BSS) occurs every 3-5 years to collect information about the observed oral health of children, their demographics, and self-reported information on access to care. Texas BSS ended data collection due to the COVID-19 pandemic, but the Texas BSS data collection will be conducted for the 2022-2023 school term.

Challenges

MCHE expanded data capacity through use of national surveys, DUAs, and MOUs. However, challenges in data capacity continue to exist for various MCH subpopulations. Access to Texas data on children aged 1-5 is challenging as school administrative data are not available and there are few national surveys that reach this population. Neighborhood-level data, important for allocating program resources, are difficult to obtain as most surveys are limited to large regions or state-level analyses. Many data sources use administrative data and cannot provide individual stories, a crucial component to understanding the data’s context. Some data systems such as PRAMS, BRFSS, and YRBSS are available in Texas, but these surveys do not reach all MCH populations. This was exacerbated by COVID-19 which created challenges for school-based data collection systems. Additionally, data quality has been a challenge in Texas, but efforts are underway to improve maternal mortality, PRAMS, and TEHDI data.