Priority: Data sharing and collaboration

SPM 3: The extent to which data equity principles have been implemented in SD MCH data projects

2021-2025 Objectives and Strategies:

Objective: Increase the extent to which data equity principles have been implemented in SD MCH data projects from 54.2% in 2021 to 59.6% in 2025.

Proposed strategies

3.1 Provide access to timely data to internal partners and policy makers to support evidence-based decision making

         Maternal and Child Health Indicators Monitoring (OCFS Internal Dashboard)

The Office of Child and Family Services developed an internal data dashboard with indicators of Maternal and Child Health in South Dakota, with the purpose of carrying out the Strategic Community Outreach and Outcomes Plan (SCOOP)[1]. The dashboard was last updated in March 2022; findings displayed in the dashboard are most likely outdated and need review.

During the next reporting period, the MCH epi team will update to the dashboard. After dashboard is updated, the MCH epi team will work to advertise the dashboard to our internal partners and SD policy makers. The MCH epi team will also identify items of dashboard that may be automatically updated based on real-time data, develop, and implement automation. The goal is to maintain the internal dashboard as current as possible, to serve as a source for evidence-based decisions.

         Bright Start Report Indicators

A report of Bright Start Indicators will be produced. The report will be designed with the primary goal of providing nursing teams with regular feedback for their annual Continuous Quality Improvement projects. Additionally, it will be used to identify data quality issues, particularly those that impact program outcome measures reported to funders. While data quality improvement and monitoring comprise the primary goal, the data will include all clients in the program— both those within the Nurse Family Partnership (NFP) model, and those served within the Bright Start Program, but outside of the NFP model. Previously, data was only available for NFP clients, but with the inclusion of non-NFP client data in the report, contents of the report will be used to inform Medicaid and support their policy making process.

3.2 Provide access to relevant data to external partners and communities to support community-level initiatives for prevention.

         Maternal mortality report

The number of maternal deaths in South Dakota is relatively small (less than 10 cases a year); because of that, it is challenging to produce county-level data without risking identification of the decedent. On the other hand, county-level data is necessary in order to identify priorities for preventive interventions at community-level. To address that need and the challenge, a report about Maternal Mortality in South Dakota will be produced covering a longer span of time (10 years).

         Infant mortality report

The number of infants deaths reviewed by the Child Death Review (CDR) committee in South Dakota is also relatively small (less than 30 cases a year). Our goal is to produce an infant mortality report that covers the same period as that of the maternal mortality for the reasons discussed above.

         PedNSS/PNSS report

WIC collects health and nutrition data on its participants through the Pediatric Nutrition Surveillance System (PedNSS) and Pregnancy Nutrition Surveillance System (PNSS). For example, PedNSS indicators include rates on breastfeeding and obesity for infant and child participants, along with Pregnancy BMI, frequency of smoking, and multivitamin consumption for PNSS indicators. This data has not been consistently disseminated internally nor externally.

         Dissemination of data

Once completed, both the maternal and infant mortality reports will be presented together to communities and external partners in all regions of SD. We also plan to disseminate the findings from PedNSS and PNSS report with communities and external partners.

3.3 Make the application of data equity principles a required element of epidemiologic reports produced by OCFS so that communities, internal and external partners can use it in their own efforts to advance equity.

         Standardize data requests

The Office of Child and Family Services is the steward of a wealth of data that could be used by both internal and external partners as evidence for well-informed decision making. Currently, we don’t have a standard process in place that those partners can use to request the aforementioned data, so a lot of the access depends upon contact via e-mail. We want to implement a standardized electronic form for data requests, so that both external and internal partners can communicate with us about their data needs in a fast, efficient way, and we can keep track of the requests, to make sure that they are attended to in a timely manner. We aim to ensure data integrity by implementing that form.

         Qualitative data analysis of risk factors, social determinants of health, and preventive measures of maternal and infant mortality

The Maternal Mortality Review Committee (MMRC) has completed the review of three years of cases of maternal deaths. Those reviews contain a wealth of information about risk factors, social determinants of health and possible preventive interventions. The Maternal Mortality Report will also include a qualitative analysis of those items from MMRC reviews. In going through the cases analyzed by the Child Death Review (CDR) Committee, we noticed that some of the underlying risk factors and recommendations were similar to the cases reviewed by MMRC. We will also produce a qualitative data analysis of the risk factors, social determinants of health, and preventive interventions of the CDR committees' reviews. Our final objective is to compare findings from both reports, identify overlapping items, and prioritize those overlapping items (risk factors, social determinants of health, preventive interventions) for action in South Dakota.

         Pregnancy Care Risk Assessment Data

OCFS launched a new electronic health record for all the services in its community health offices across the state, including the pregnancy care program. A new risk assessment was added that captures a variety of data on social determinants of health. During the next reporting period the OCFS data team plans to analyze this data by race and geography to understand the main factors affecting OCFS clients.

         Update MCH data briefs

The MCH epidemiologist will continue to submit MCH data such as new PRAMS reports to the SD Department of Health (SDDOH) Newsletter and SDDOH Public Health Bulletin. The MCH epidemiologist will identify other possible sources of data (e.g.: Federal Available Data, Maternity Care Desert) that can be used to identify inequities in South Dakota and include data from those sources in the next data briefs.

3.4 Increase collaboration around American Indian data between state and tribal partners

Over the past reporting period, the SPM 2 workgroup decided to be more intentional about data collaboration and sharing with Tribal partners cross South Dakota. A new strategy was added to address this need.

         Engage with Tribal Leaders

The team of OCFS epidemiologists will meet monthly with epidemiologists who work for Tribes and Indian Health Services. During those meetings, data produced by OCFS epidemiologists will be shared and discussed. Moreover, we

will work on engagement with tribal leaders to learn their preferred method of sharing county level data from Tribal land (i.e., PRAMS tribal reports). We will work through existing partnerships and outreach through our health equity coordinator who has frequent meetings with the Tribal Health Directors.

         Tribal data to action

We will work with Great Plains Tribal Leaders Health Board to understand what tools the Tribes need to put data into action and how we can partner with them in their efforts.

3.5 Improve internal capacity to share data via referrals between different OCFS programs

Referrals of clients between different OCFS projects and programs are a pivotal element of the service we provide to South Dakota residents. At the moment, we don't have a uniform process in place to regulate the referrals; moreover, data from the referrals themselves is available for analysis for some, but not all programs, because many of them are done informally or via printed forms. Our goal is to identify the referrals we use and establish a process that facilitates making referrals electronically and allows for data analysis across the board.

         Gather key representatives

Identify key representatives of OCFS programs (WIC, pregnancy care, Bright Start, family planning, and other CHS services) who write referrals as part of their regular work and gather them in a work group.

         Landscape of referrals

The work group will collect information about referrals used between different OCFS programs, for instance: type of referral (internal or external), objective, direction (from which program to which program) whether referral is done in a paper formulary, electronic formulary, or via verbal communication. The objective is to understand the landscape of the referrals used by the different OCFS programs as a grounding step for the standardization of referral process within OCFS.

3.6 Increase Internal capacity for big data linkage

         ASTHO Data Linkage Project

In 2022, SD DOH was  awarded funding and accepted into the ASTHO PRAMS data linkage community cohort. Over the past year, a team of data experts from DOH, Medicaid, South Dakota State University, and Dakota State University worked together to complete the linkage of SD PRAMS to Medicaid claims data for the years 2018-2020. The Health Informatics Analyst will continue this work, with plans to add 2021 data to the dataset and continue the analysis to further explore topics such as the intersection of substance use disorders (SUD) and mental health; access to preconception, prenatal, and postpartum care; access to SUD treatment; and postpartum birth control for the Medicaid population.

         Enhanced maternal death surveillance project

In South Dakota, the identification of maternal deaths is a responsibility of the Office of Vital Records. Currently, pregnancy-associated deaths of South Dakota residents are identified based on the selection of specific options in the pregnancy status checkbox section of the death certificate only. Other recommended methods of identification of pregnancy-associated deaths are not currently in use in South Dakota, for instance:

• Performing data linkage of women who died (as recorded in death certificate) to women who gave birth a year before (as recorded in birth certificates or fetal death certificates) on a regular basis
• Identifying maternal deaths based on specific causes of death (search for key words).

OCFS recently met with the Office of Vital Records and initiated a project to implement those enhanced surveillance methods in South Dakota. Our goal is to the data linkage piece implemented by the end of the next reporting year.

Completed Efforts:

Several activities from the previous state action plan were completed and have been removed from this year’s plan and associated plan for application. These are mentioned below.

Women's Health Report.

The MCH epidemiologist worked with an MPH student to complete a Women’s Health Report card that will be finished during the next reporting period. It highlighted a variety of women’s health indicators.

MCH interns

The MCH Director and MCH epidemiologist advised three MCH student interns this summer. One intern is through the GSEP and the other two through the MCH/Title V program. These interns supported the SCOOP process, specifically in the priority of outreach and evaluation. They completed projects such as qualitative analyses, surveys, literature reviews, process evaluation, tool kits, and training tools.

SCOOP

A Strategic Community Outreach and Outcomes Plan (SCOOP) was completed. It focuses on four main goal areas of breastfeeding, nutrition, outreach and infant mortality.

New Efforts

Medicaid Pregnancy Health Home

The South Dakota State Legislature approved appropriations for a Medicaid Pregnancy Health Home to support increased care coordination for Medicaid eligible women. South Dakota Medicaid and South Dakota Department of Health will collaborate to create and implement this health home. Medicaid clients will be referred to DOH services such as WIC, Bright Start Home Visiting, and Pregnancy Care. The OCFS data team will be working on a referral and data sharing process between health care providers, Medicaid, and DOH programs.

Avera RMOMS grant

Avera hospital system in South Dakota received a HRSA funded Rural Maternity Obstetrics Management System grant that was supported by both South Dakota Medicaid and South Dakota Department of Health. This grant will increase care coordination between all Avera providers and DOH programs. Based on a social determinants of health screening, Avera providers will refer their patients to DOH programs, increasing the utilization of OCFS services. The OCFS data team is working with Avera on data sharing and referral processes, with the long-term goal of system interfaces.

Ongoing Efforts Supported by MCH for Cross-Cutting/Systems Building Domain

PRAMS

SDDOH continues to conduct CDC Pregnancy Risk Assessment Monitoring System (PRAMS) through a contract with South Dakota State University. During the next reporting period SD PRAMS will collect supplemental data on social determinants of health. SD PRAMS will also add a stratum for ethnicity and look at the possibility of calculating county level estimates.

OCFS Electronic Health Record

The Office of Child and Family Services launched a new electronic health record in January 2022. The Health Informatics Analyst continues to oversee the EHR development and launch, deliver technical assistance to staff, create and run reports, and analyze data coming from the EHR. This EHR has data from family planning, nurse visiting, and community health services.

[1] SCOOP is a county level needs assessment and action planning process for all community health offices in South Dakota