Alaska’s State System Development Initiative (SSDI) funding supports the work of the MCH Epidemiology Unit in WCFH. Alaska’s three goals for the current SSDI funding cycle are:

1. Build and expand Alaska’s MCH data capacity to support Title V program efforts and contribute to data driven decision making.
2. Advance the development and utilization of linked information systems between key MCH datasets.
3. Provide data support for the Early Childhood Comprehensive Systems (ECCS) Collaborative Improvement and Innovation Network (CoIIN).

SSDI funding pays for approximately 30% of the time of the Research Analyst III (RA) who leads the MCH Indicators Project and 25% of the time of the MCH Epidemiology Unit Manager who also serves as SSDI Director. The primary function of the RA is to calculate and collect MCH indicator data, make results available and accessible to a diverse audience, and provide technical assistance for continuous quality improvement for the Early Child Coordinating System (ECCS) grant-funded activities. The SSDI Director helps to maintain the Section’s data sharing agreements, promotes MCH Epidemiology workforce capacity, supports data dissemination activities, and provides leadership for Title V program assessment, monitoring, and reporting.

MCH Epidemiology Unit staff regularly analyze multiple datasets to inform and support Title V and Section programming, assessment, and monitoring, to conduct ongoing monitoring of performance measures, and to respond to emergent needs. The MCH Epidemiology Unit has a longstanding relationship and formal data sharing agreement with the Health Analytics and Vital Records Section (HAVRS) in DPH. HAVRS provides preliminary (quarterly) and annual birth, death, linked infant death-birth, and fetal death certificate research datasets to WCFH, as well as weekly and monthly data updates for program-specific needs (including reporting new deaths to MCDR and new births to the birth defects registry and newborn screening programs). In addition, HAVRS shares quarterly research datasets from the Alaska Health Facilities Data Reporting system (hospital discharge data). Multiple trained staff in the Unit have direct access to the Alaska Medicaid claims database and newborn screening databases and can create queries and extract data as needed. The Alaska PRAMS program and the Alaska Birth Defects Registry are coordinated out of the MCH Epidemiology Unit and these data are routinely analyzed by multiple epidemiologists in the unit. Although not routinely analyzed by the Unit, access to a WIC research dataset has been granted in the past when requested for specific purposes. The PRAMS and CUBS programs also have real-time access to the WIC system to search for individuals sampled by these surveys to identify new contact information. Among those datasets tracked by SSDI, the immunization registry is the only dataset not regularly accessed by the Unit. The Immunization Program is housed in the Section of Epidemiology and historically does not share datasets with analysts outside of their Section due to concerns about data limitations as well as individual privacy.

The Unit staff are experienced at data linkages and regularly link many of the datasets described above using exact matches of birth certificate number or other information. Special projects involving data linkages are specifically approved in the Data Use Agreement with HAVRS. Most of the linkage work and associated analyses (in particular, the ALCANLink project) are not funded directly by SSDI. However, these are all completed under the direction of and with the support of the SSDI Director/Unit Manager. An ongoing barrier to linking Alaska’s Health Facilities Data Reporting System to other datasets is the lack of personal identifiers in this system. However, over the past year, the CDC PHAP assigned to the Unit (and mentored by the SSDI Director) conducted probabilistic linkages of the HFDR with birth certificates and Medicaid to examine how births with diagnosed NAS overlap (or don’t overlap) between these systems.

To increase public and program access for data-driven decision making, the Unit has focused SSDI-funded efforts on making MCH data available online. Outcomes that are annually updated by the RA III on the Alaska Indicator Based Information System (Alaska IBIS) as full Indicator Reports include infant mortality (overall, neonatal, and post-neonatal rates), low birth weight, very low birthweight, preterm birth, teen births, adequate prenatal care, cigarette smoking during pregnancy, and Cesarean section among women with low-risk pregnancies. The full Reports include trend data as well as results by Medicaid status, region of residence, and maternal race. Some reports also look at maternal age groups (low-risk C-sections & tobacco use), level of education (tobacco use), and marital status (teen births). Unfortunately, the AK IBIS system will not be maintained beyond 2021, so Unit epidemiologists are working with other data stewards in the Division to identify alternative systems for creating online dashboards or data hubs where users can easily find public health data. One system currently being explored is ArcGIS online, which includes a data hub model that is being used by the Division to share information related to COVID-19. The story map capability of ArcGIS online is one format which may lend itself well to sharing MCH Indicator data.

Since early 2017, the MCH Indicators RAIII has also been working with the Alaska Children’s Trust  to update data on the national KIDS COUNT Data Center and incorporate Alaska-specific indicators. This work is partially funded by the Children’s Trust and partially by SSDI. The KIDS COUNT Data Center is another online repository of numerous indicators that can be easily searched and manipulated to pick specific years or regions of the state. The MCH Epi Unit maintains Alaska data for 94 Kids Count indicators, 82% with sub-state regional data, and updates these on the Data Center.

Finally, for the third SSDI goal, the Alaska ECCS program collects data to measure impact of programmatic efforts. The ECCS CoIIN aims to improve population-level developmental health outcomes in children ages 0-3 years. Since 2017, the MCH Indicators RAIII has provided technical assistance to three place-based communities on collecting data that track a variety of system performance measures. Over the past year, this included tracking the effect of COVID-19 on ASQ screenings in Alaska, as well as the ECCS communities. This work to specifically support the federal grant project will end July 31, 2021. Alaska has applied for another round off ECCS funding. If awarded, the new cycle will start on August 1, 2021.

In addition to the online resources previously mentioned, during the past year, the following information products were developed to inform decision making for improved MCH outcomes. This list is limited to products where MCH Epi Unit staff, whose time is partially paid with SSDI funds specifically contributed, or products directly aligned with the SSDI goal of increasing data linkages.

• The MCH Epidemiology Unit coordinated a series of four online surveys to measure the impact of the COVID-19 pandemic on Alaskan families during April/May 2020 and November/December 2020. The results from these surveys were published online in a series of data briefs and shared widely through email, press releases, and presentations. In March and April 2021, the SSDI Director presented results from the fourth survey at the Alaska Early Childhood Coordinating Council Meeting and the Infant and Early Childhood Mental Health Institute.
• Through a partnership with the Alaska Mental Health Board, a temporary Research Analyst III supported the ALCANLink program in the creation of multiple fact sheets, research briefs, and manuscripts using linked data. The RAIII and Senior MCH Epidemiologist co-authored an article published in the peer-reviewed journal Pediatrics in October 2020 titled, Pre-Birth Household Challenges to Predict Adverse Childhood Experiences Score by Age 3.
• The SSDI Director, SSDI RAIII, and CDC PHAP collaborated on an Epidemiology Bulletin published in February 2021 describing increases in preterm birth rates in Alaska over the past 20 years. The PHAP also created a more detailed R Markdown report that was shared internally with providers working in a specific region of the state where recent increases in the preterm birth rate have been most notable. The Title V Director, SSDI Director, and the PHAP met multiple times with this group of providers to discuss the data findings and opportunities and options for addressing factors associated with the increase.
• The SSDI Director and CDC PHAP worked together to provide data support for quality improvement initiatives of the Alaska Perinatal Quality Collaborative throughout the year. In October 2020, the SSDI Director delivered a presentation to the PQC Steering Committee on updates to MCH Indicator data statewide.
• The SSDI RAIII and Oral Health Program manager worked together to create a Fact Sheet using trend and regional data from CUBS on reported tooth decay and first dental visits among 3-years-olds in Alaska.  The fact sheet was distributed at the Alaska Area Dental/Tribal Health Dental Directors’ meeting in November 2020.