State Systems Development Initiative (SSDI) Overview

The SSDI Project Director, lead MCH Epidemiologist since 2003, and the other epidemiological supports (e.g., second MCH Epidemiologist, Data Analysts) provide extensive support throughout the statewide MCH needs assessment process and ongoing throughout the five-year plan period. Specifically, the SSDI Grant provides capacity and support to improve our ability to share and link MCH data to drive public health practice and programming. Cross-program data sharing provides the foundation for special projects, and data analysis allows program staff to determine the efficacy of program activities. Published products and data analyses can be found at https://www.kdhe.ks.gov/626/Maternal-Child-Health-Block-Grant.

As part of the ongoing epidemiologic support, the SSDI grant and project director continue to assist with:

SSDI Contributions to Linked MCH Datasets

Kansas has the capacity to access data in a timely manner and link data from multiple sources to support MCH programs (e.g., birth, death, Medicaid, WIC, hospital discharge, newborn metabolic screening, newborn hearing screening, birth defects, Behavioral Risk Factor Surveillance System [BRFSS], Youth Risk Behavioral Survey [YRBS]). There is annual linkage of birth to infant death, Medicaid (mother-infant dyads), WIC, hospital discharge (mothers only; no mother-infant dyads, due to limited identifying information for the infant), birth defects, newborn metabolic screening, and newborn hearing screening data. Newborn metabolic screening, newborn hearing screening, and birth defects information systems (including Kansas Health Information Network - KHIN) are integrated into one electronic system called Auris, which is linked with birth records and receives automated daily birth record information (selected variables). This provides an opportunity to address longitudinal research questions or track and follow children across multiple programs over time. The Kansas State Department of Education and KDHE’s Bureau of Health Promotion (BHP), in partnership with local school districts, conduct the YRBS. KDHE’s BHP conducts BRFSS.

As evidenced by information on Form 12, Title V has access to data from:

• Vital Records (birth and death)
• Medicaid
• WIC
• Newborn Screening (bloodspot, hearing, heart)
• Hospital Discharge
• Pregnancy Risk Assessment Monitoring System (PRAMS)

SSDI Role in Title V Assessment, Monitoring, & Reporting

Participation in the Title V performance measurement framework provides a solid foundation for Title V assessment and monitoring and supports the annual reporting expectations. Kansas strives to implement the following expanded assessment, monitoring, reporting, and evaluation activities. Much of this work is led by the SSDI Project Director, with support from the other members of the epidemiological and MCH teams.

Evidence-Based or -Informed Strategy Measures (ESMs): Kansas has selected to establish ESMs for each of the state’s national and state performance measures (NPMs/SPMs). The SSDI Project Director and MCH Epidemiologist conduct a thorough review of the ESM’s and utilizes the ESM Evidence Checklist for each to determine the evidence base for the measure. Additionally, for each ESM, the quantifying outputs are examined, and a baseline value is identified to assure that it is feasible to adequately monitor and measure for improvement. In the coming year(s) Kansas Title V intends to continue expanding on the use of ESMs and establish internal ESMs for the majority (if not all) of the objectives outlined in the State Action Plan (SAP). This aligns with a long-term goal to establish a formal evaluation for the Title V program in Kansas.

Monitoring Activities: Title V utilizes the Community Check Box (CCB) Evaluation System to support efforts around monitoring and evaluation. The SSDI Project Director and MCH Epidemiologist assure up-to-date indicator data is in the CCB to support trend analysis and our internal team “sense making” activities. The added capacity of the SSDI Grant allows for more intentional and strategic assessment of our accomplishments and programmatic activities and what impact this has on our long-term outcomes. In addition to state program staff entering into the CCB, a select group of Title V contract partners have been asked to begin entering their contract activities for monitoring. It is desired that other grantees will begin entering their activities into the CCB in the coming year(s). This will provide a more cohesive and complete picture and allow for more robust monitoring of objectives as related to grant activities. More information on this initiative can be found in the Other MCH Data Capacity Efforts narrative. As part of the state’s monitoring efforts, the SSDI Project Director and MCH Epidemiologist produce a “Data Snapshot” to visibly show the trends associated with all national outcome and performance measures and the alignment with measurements in the Medicaid system.

Evaluation: In partnership with the University of Kansas Center for Community Health and Development (KU-CCHD), who specializes in supporting community health through collaborative research and evaluation, Title V has established an agreement for the KU-CCHD to assist in implementing a MCH Monitoring & Evaluation (M&E) System, using the MCH CCB, which includes a formal evaluation plan and report associated with each of the objectives in the Title V State Action Plan. The SSDI Project Director, MCH Epidemiologist and other MCH epidemiological and program staff will determine specific outcome measurements for each of the objectives.

Title V staff participated in a workshop hosted by KU-CCHD that included foundational information that focused on helping staff better understand evaluation and what it can mean for Title V and MCH programming moving forward. The overall objective was to begin framing our own formal evaluation plan. The workshop content included: evaluation design, applying evaluation principles, describing measures of success, describing improvements and change, identifying key stakeholders.

The KU-CCHD team supports Title V in establishing a formal evaluation plan utilizing the “Evaluating the Initiative” toolkit in the Community Toolbox, designed to help community programs develop an evaluation. The KU-CCHD will adapt as needed and work with our team in the coming year(s), specifically aligning with the intent and purpose of the SSDI Grant and engaging the SSDI Project Director to support long-term evaluation efforts for the Kansas Title V Block Grant.

Key SSDI & Title V Activities

The Kansas SSDI team, composed of the SSDI Project Director, MCH Epidemiologist, and Data Analyst, actively participate during MCH Leadership (monthly), MCH Coordination (monthly), and KMCHC (quarterly) meetings to provide emerging, persisting or ongoing needs in response to staff requests and related to our own projects and local requests for data, what we learned about the measures over the course of the year related to the needs assessment, and any priorities shifting. SSDI provides capacity and support in the following data initiatives to enhance the Title V access to other MCH health data that can inform programming, assessment, and monitoring during and between formal needs assessment periods.

Block Grant & Ongoing Needs Assessment: As part of the ongoing epidemiologic support, SSDI continues to assist with: refining the 5-year State Action Plan, ESMs and SPMs, setting annual objectives (linear forecasts) for each NPM and SPM, writing trend analysis, highlighting major statistical findings and providing interpretation, developing funding formula for the MCH Block Grant allocation to local health departments and grantees, and preparing the resources and tools to increase knowledge and understanding about the Kansas Title V MCH federal-state partnership, services, block grant, and the state’s priority issues for 2021-2025. SSDI shares data and sets the stage as to the current state of MCH in Kansas; using the MCH measurement framework, discusses about the trend and current status for NOMs, NPMs, ESMs and SPMs; and identifies where we need to pay attention to the negative as well as opportunities to improve.

Maternal Morbidity & Mortality: With epidemiological support from SSDI and staff support from the CDC ERASE Maternal Mortality grant, Title V will publish the second annual report for maternal mortality, including severe maternal morbidity (SMM). Three infographics (SMM, pregnancy-associated deaths, and pregnancy-related deaths) and an easy to read, two-page Kansas Maternal Mortality Review Committee (KMMRC) Annual Report Summary will be developed. Published products can be found at https://kmmrc.org/reports/.

Kansas Perinatal Community Collaborative (KPCC) Annual Reports: The MCH Epidemiologist completed the 2021 Becoming a Mom® State Aggregate Report in Spring 2023. The goals of this process were to:

1. link the KPCC data to Kansas resident live birth data by birth year, to establish a cohort of births for comparison (unlike previous linkages, which linked based on BaM completion year and did not compare to non-KPCC births occurring during the same timeframe);
2. identify data quality of KPCC outcomes data when supplemented with available birth record data;
3. compare safe sleep estimates from the KPCC data to those from the state’s PRAMS data;
4. compare risk factors and adverse birth outcomes among linked KPCC births, to all other births in 2021.

KPCC Reports and Database Improvements: The MCH Epidemiologist works closely with the University of Kansas’ Data Application and Integration Solutions for the Early Years (DAISEY team), to identify common data issues, develop new questions and fields for DAISEY forms, develop a data cleaning schedule for sites, and provide sites with reports from which they can better understand the outcomes of their programs. Previously, there had also been work to create a Tableau dashboard that allows participant sites to have increased ownership over their data. This dashboard would be based on data provided for the site-specific reports but also include enhancements such as quarterly metrics to allow sites to better use their data for programmatic needs. This work has been on hold due to the complex and changing nature of DAISEY data; however, work on this project is expected to continue into the year 2024 and once developed would allow for more efficient site onboarding and data tracking.

MCH Trend Dashboard: The MCH Epidemiologist is working to create a Tableau dashboard for the Kansas MCH website, which would display trends in the state’s Title V measures. Currently, these are available only through the national Title V website, or from data briefs or tracking tables on the Kansas MCH website. A Tableau dashboard will allow for grantees, staff, and the public to easily see changes in the health status of MCH populations and progress Kansas MCH is making.

Medicaid-Birth Record Linkage: After several trials to link data, and a revision of the states’ Medicaid Management Information System (MMIS), the birth, hospital, and Medicaid data linkage has been completed for five years and will be performed on an ongoing basis. The efforts included reprocessing calendar year 2015 linkages of the three datasets using data from the new Kansas Medicaid Management System. Record linking for calendar years 2016 through 2019 is also complete. Due to staff turnover, the current plan is to evaluate the 2016-2019 record linkage process and carefully document in programs, output, data dictionaries, and reports including retaining statistical program logs, keeping track of the provenance of input datasets, and documenting all decisions made concerning methods and their application. The linked files will enable SSDI and other agency staff to perform analyses to review hospital coverage as well as information from five claims table: (1) pharmacy, (2) inpatient care, (3) professional services, (4) dental, and (5) outpatient. In order to evaluate non-pregnancy related healthcare, the SSDI program has access to eligibility information for females (ages 0 to 55) and males (ages 0 to 22) as well as claims information from the five claims tables. This will enable SSDI to better assess Medicaid-covered health care between pregnancies and post-pregnancy.

Health Study of the 29th and Grove Site – An investigation of birth defects in a community led to greater awareness of how social determinants (SD) adversely influence the life course of its population. Contamination from the area of interest (AOI) was first discovered during investigations conducted in advance of redevelopment of the area. The contaminant of concern (COC) is trichloroethene (TCE). TCE is a solvent commonly used for metal degreasing. Secondary COC is tetrachloroethylene (PCE) from old dry-cleaning sites in the same area. The effects of environmental contamination with TCE and PCE on the birth outcomes in AOI are not yet known. Therefore, the study focused on adverse birth outcomes: birth defects, immune system deficiencies, low birthweight (LBW), and small for gestational age. In-state live birth, stillbirth, and birth defects data among Kansas residents occurring in 2000-2021 were linked with the maternal residential addresses in AOI at the time of delivery for analysis. Data linkage, data linkage quality check, data cleaning, and data analysis were performed using SAS Version 9.4. Joinpoint Trend Analysis Software was used for identifying changes in trends. There were 2,793 properties/addresses in AOI. In 2000-2021, 1,978 live birth, 18 stillbirth, and 155 birth defects records were matched/linked with the addresses in AOI. Overall, no evidence/associations were observed between TCE and PCE exposure and study birth outcomes. However, when comparing the LBW rates, the LBW rates in AOI were persistently significantly higher than Kansas overall. More work will be done to better understand this association and determine what interventions may help reduce or eliminate these disparities.