The BMCFH Data and Surveillance Section provides critical data for Title V program activities, including the needs assessment, performance measure reporting/monitoring, and program evaluation for data-driven programming. In addition to providing research and epidemiologic expertise to programs across the BMCFH, data capacity efforts include MCH surveillance, surveys, and other data initiatives.

MCH Surveillance

The Pregnancy Associated Mortality Review (PAMR) Program reviews all pregnancy associated deaths in Ohio. Once maternal deaths have been identified by the Bureau of Vital Statistics, PAMR nurse abstractors request relevant medical, law enforcement and social service records to compile case summaries. These summaries are reviewed by a multidisciplinary committee who completes a “Committee Decision Forms” which reflects the consensus opinion related to preventability, contributing factors and recommendations to prevent future deaths. Data are entered into a Centers for Disease Control and Prevention (CDC) centrally hosted database (MMRIA). ODH has a Data Sharing Agreement in place with CDC which allows Ohio data to be combined with other states to provide a more comprehensive view of maternal mortality in the United States. PAMR was officially established in 2019 in Ohio Revised Code Chapter 3738.  The rules (Ohio Administrative Code 3701-66), which describe the operation of the program, became effective on October 25, 2021.

Fetal Infant Mortality Review (FIMR) is conducted in ten Ohio Equity Institute counties across the state. These urban counties have the highest Black infant mortality rates in Ohio. ODH provides funding to assist these counties to identify fetal deaths and conduct maternal interviews and case reviews by a Case Review Team (CRT). The CRT develops recommendations which are presented to the Case Action Team (CAT) who work to implement prevention initiatives in their community.

Child Fatality Review (CFR) is required by statute to be conducted by each of Ohio’s 88 counties. All deaths to children under the age of 18 are reviewed by a multidisciplinary team of local experts and prevention initiatives are recommended. Case data are entered into a database hosted by the National Center for Fatality Review and Prevention. Annually, ODH downloads Ohio data and prepares a comprehensive report that is disseminated to the Governor, legislators and other interested parties and is posted on the ODH web site.

As existing surveillance systems are not designed to monitor opiate abuse and the health outcome for women, children, and young families. Ohio is currently developing a new perinatal substance use surveillance system in Ohio by using multiple existing data sources. In addition, in response to the COVID-19 pandemic, data collection has been expanded for maternal populations through additional questions on Ohio Study of Associated Risks of Stillbirth (Ohio SOARS) and Ohio Pregnancy Assessment Survey (OPAS) and linking of birth certificate data to the Ohio Disease Reporting System. This data will be used to understand the impact of the pandemic on Ohio’s MCH population.

Surveys

The Ohio Pregnancy Assessment Survey (OPAS) is Ohio’s PRAMS-like survey. OPAS began in 2016 after Ohio had participated in PRAMS from 1999-2015. By implementing our own survey, and leveraging MEDTAPP funding, OPAS provided county-level estimates for Ohio’s 3 largest counties for the first time, a feature unavailable through PRAMS. Furthermore, OPAS sample sizes have continued to increase to around 4,000-5,000 respondents, compared with around 600 respondents in PRAMS. Ongoing implementation of OPAS through State Fiscal Year 2022 (SFY 23) continues as a collaboration funded by ODH and ODM and administered by The Ohio State University Government Resource Center (GRC).

As a separate, but related surveillance activity, ODH initiated implementation of a stillbirth survey in SFY19. The methodology is identical to the Ohio Pregnancy Assessment Survey, but the target population is fetal death certificates rather than live birth certificates. The survey was first fielded in 2020 and the first data was received in November 2021. Ohio SOARS survey will provide ODH with critical, timely, and relevant population-based data to better understand maternal experiences and behaviors prior to, during, and immediately following pregnancy among women who have recently experienced a stillbirth to inform targeted interventions to prevent stillbirth.

The Ohio Fatherhood Survey (OFS) started fielding for the first time in June 2022.  OFS is an initiative of ODH and the Ohio Department of Medicaid (ODM) that asks fathers about their experiences before and after their child is born. It is representative of fathers of children born in Ohio and asks questions about the transition to fatherhood. It is based on the methodology of PRAMS and PRAMS for Dads, which was piloted in Georgia in 2018-2019.  Ohio will be one of the first states to hear directly from fathers, helping pave the way for insights into actionable changes that can support their health during the postpartum period.

Based on feedback from ODH youth survey forums and experience during the 2015 and 2017 Youth Risk Behavior Survey (YRBS) cycles, ODH combined YRBS and the Youth Tobacco Survey (YTS) for the Fall 2019 administration cycle, branding the survey as the YRBS/YTS. Combining the YRBS/YTS allowed the bureau and the ODH Tobacco Program to leverage resources and utilize a team approach to plan and conduct the survey, instead of separately administering two surveys to twice as many schools. This partnership allowed ODH to garner more support externally which ultimately led to greater participation from schools and resulting in 2019 weighted data for both the high school and middle school populations and allowed for middle school data to be collected for the first time for YRBS. Combining the YRBS/YTS for both middle schools and high schools continued for the 2021 administration, with results not yet released by the CDC as of July 2022.

The National Survey for Children’s Health (NSCH) provides data on multiple, intersecting aspects of children’s lives– including physical and mental health, access to quality health care, and the child’s family, neighborhood, school, and social context.  The NSCH provides data for many Title V National Performance Measures (NPM) and National Outcome Measures (NOM). ODH contracted with the US Census Bureau to sample additional addresses in Ohio for the 2021 and 2022 NSCH.  We are currently in the process of establishing a contract to oversample the 2023 NSCH.  The oversamples will allow ODH to have more precise estimates on key indicators monitored by the Title V block grant as well as allow for getting estimates for certain sub-populations. Specifically, the additional samples are designed to increase the number of Black and Hispanic households that are surveyed to get better estimates for those populations. Additionally, the larger sample may allow us to get estimates stratified by income, education, disability status, etc. Accurate data on vulnerable populations is vital to our efforts at improving health equity.  In 2021, 1,542 interviews were complete.  Of those, 136 were Black/African American, 96 were Hispanic and 367 were Children with Special Health Care Needs (CSHCN).

Other Data Initiatives

The InnovateOhio Platform (IOP) is an initiative lead by Ohio’s Lieutenant Governor to provide integrated and scalable capabilities that enable state agencies to become more customer-centric and data-driven. Through collaboration and innovation, the InnovateOhio Platform creates an integrated customer experience that brings higher-quality services to the public – ultimately making Ohio a better place to live, work, and do business. The Ohio Department of Health was one of the first state agencies to post data on the IOP. The Bureau of Maternal, Child, and Family Health currently has 69 data sets available for public consumption through the IOP. Forty-six (46) of those data sets had never been publicly available before. Additionally, 43 data sets include data visualization, i.e., charts and graphs to help illustrate the data.

Beginning in 2020 WIC expanded collaboration with Ohio Department of Medicaid and the Ohio Department of Job and Family Services to increase referrals, data and information sharing, and operational efficiencies related to the WIC program and its eligible population. The WIC, Medicaid, SNAP, and TANF cross-enrollment project uses the InnovateOhio Platform to provide local WIC agencies contacts for potential WIC enrollment. WIC also initiated a pilot program with a county WIC program for local staff to access SNAP/TANF/Medicaid income data to determine adjunctive eligibility to streamline the certification process for staff and families.

The Infant Mortality Research Partnership (IMRP), a collaboration between state agencies, researchers, and subject matter experts, uses big data to gain a better understanding of how to lower infant mortality in Ohio. The IMRP team includes the ODH, ODM, Ohio Department of Higher Education, and university researchers across multiple disciplines such as biostatistics, pediatrics, and geography. ODH continues to be an active partner in IMRP. The current phase of this work: 1) expands upon the spatiotemporal analysis to develop a mapping tool to longitudinally assess changes in preterm birth, low birthweight, and infant mortality over time by census tract; 2) developed a health opportunity index by census tract to align health opportunity with birth outcomes; and 3) used the results of the data analytics to develop a risk calculator to predict one-day mortality, very preterm birth (<32 weeks), or preterm birth (<37 weeks) using clinical data. The results will improve upon and expand the previously developed models that focus on factors that increase risk, such as those related to social and behavioral health or structural and institutional factors. Future plans include field testing the risk calculator within a Maternal-Fetal Medicine clinic to inform edits/refinements of the calculator and incorporation of the calculator into one hospital system electronic health record.

The Statewide Student Identifier (SSID) began as an identifier within the Ohio Department of Education for school-aged children. Since the implementation of SSID, additional state agencies have adopted use of SSID, including assigning an SSID number for children as young as newborns, to facilitate easier data linkage across state agency programs. Within BMCFH, several projects and programs have explored use of such a shared identifier, and the home visiting program will be implementing SSID within the OCHIDS data system.

The Ohio Department of Medicaid provides data to ODH from the Pregnancy Risk Assessment Form (PRAF), which is completed by OB providers, and serves as a significant source of referrals to the ODH home visiting program.