Since the mid-1990’s, Maryland’s State Systems Development Initiative (SSDI) Project has focused on the following: improving epidemiologic and data capacity at the State level, strengthening the State’s ability to monitor and report on Title V performance measures and indicators, and improving State and local capacity to assess and prioritize needs, develop annual plans, and monitor program performance.

Maryland has implemented a variety of strategies including recruitment of staff with expertise in epidemiology and database development, identification of data sources and proxy measures for monitoring Title V supported programs, completion of Title V needs assessments, and enhanced collaboration with the Maryland Vital Statistics Administration (VSA) to improve data linkages with surveys and surveillance systems for identification of MCH health disparities and program development.

There have been recent noteworthy developments in achieving the goal of direct, annual access to timely electronic maternal and child health data. First, MDH has continued to use a portion of SSDI funds to support an administrative specialist position at Maryland’s VSA to increase data support capacity within the office. This has resulted in the developmental and approval of data use agreements (DUA) for annual access to de-identified record level birth and death certificate data to be shared with MCHB’s Office of Quality Initiatives. Receipt of these data led to the production and subsequent update a comprehensive Perinatal Periods of Risk (PPOR) analysis and the creation of census tract level risk maps to help coordinate and enhance local program design to improve preconception and maternal health across the state. The PPOR analysis and VSA data were also used to create jurisdiction-level Fetal and Infant Mortality Review (FIMR) profiles which inform about fetal and infant deaths, and areas to focus prevention efforts aimed at reducing rates and addressing disparities. These data have also been used to produce an MCH Indicators Monitoring System that was developed to track Maryland’s NOM and NPM data annually by jurisdiction and race. This system has been shared with MCHB staff to improve awareness and knowledge of progress in these areas. These data were also linked to Birth Defects Reporting and Information System (BDRIS) data to allow for analysis of maternal preconception and prenatal health factors as they relate to birth defects. Second, access to provisional hospital discharge data has been instrumental in tracking neonatal abstinence syndrome (NAS), severe maternal morbidity (SMM), and various other child and adolescent health outcomes (i.e. asthma, injuries, near-miss suicide attempts). This data is provided on a quarterly basis which keeps analyses up to date.  Third, data from the Pregnancy Risk Assessment Monitoring System (PRAMS) has been used for multiple focus briefs, including in-depth statistical analyses of intimate partner violence, pre-pregnancy obesity, and maternal opiate use, and their effects on pregnancy and birth outcomes. The addition of an epidemiologist with SSDI funds supports the analysis of each of these data sources in addition to the Child Fatality Review (CFR) and Maternal Mortality Review (MMR) case review data to further support Title V needs assessment and performance measure reporting. The SSDI epidemiologist also provides data support for the state’s CDC SUID (Sudden Unexplained Infant Death) Case Registry grant, which aims to strengthen public health surveillance of SUID in Maryland through the efforts of the State CFR team. Additionally, data provided by the MDH Center for Sexually Transmitted Infection (STI) Prevention, as well as the Center for HIV Surveillance, were used to generate progress reports about the Maryland Personal Responsibility Education Program (PREP), to determine whether PREP interventions benefitted jurisdictions where mini-grants were awarded in 2010.