State System Development Initiative (SSDI)

Alaska’s State System Development Initiative (SSDI) funding supports the work of the MCH Epidemiology Unit in WCFH. Alaska’s first two SSDI goals 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.

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. A primary function of the RA is to calculate and collect MCH indicator data and make results available and accessible to a diverse audience. The SSDI Director helps to maintain the Section’s data sharing agreements, promotes MCH Epidemiology workforce capacity, supports data linkage and 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, conduct ongoing monitoring of performance measures, and 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.

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 to conduct probabilistic linkages. 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. The SSDI Director also led efforts over the past two years to create standardized code to link Medicaid records with pregnancy-associated services with death certificate data to improve the identification of maternal deaths missed through standard notification processes. The Unit is also now assisting HAVRS by taking the lead in conducting regular annual linkages of Medicaid data to birth certificates to identify birth records for Medicaid-covered individuals.

Over the past year, several MCH Epi Unit staff continued participation in the Association of State and Territorial Health Officials (ASTHO) and CDC-supported Linking PRAMS and Clinical Outcomes Data Multi-Jurisdiction Learning Community project.

One MCH dataset that has previously not been regularly accessed by the Unit is the immunization registry (called VacTrAK). The Immunization Program is housed in the Section of Epidemiology and recently entered into a data use agreement with WCFH to link VacTrAK records into the ALCANLink project. Driven by the persistently low vaccination rates among children in Alaska, the VacTrAK program sought methods for better understanding the factors associated with these low rates which facilitated the partnership with ALCANLink. The VacTrAK data have now been linked into ALCANLink, validation efforts are underway, and an analysis plan has been constructed. The initial analyses will focus on describing the pre-birth household, and early childhood characteristics that are associated with delayed or skipped vaccinations, with a particular emphasis on school aged children. Secondary analyses will assess school attendance with vaccine history.  

To increase public and program access for data-driven decision making, the Unit has focused SSDI-funded efforts on making MCH data available online. As a result of a cyberattack in May 2021, the Alaska Indicator Based Information System (Alaska IBIS) was permanently taken offline. The cyber incident prompted the MCH Epi Unit to begin transitioning the IBIS Indicator Reports over to an ArcGIS Online data hub. The Alaska MCH Indicators Data Hub had a soft launch at the February 2022 MCH and Immunization conference when it was publicly shared by the Chief Medical Officer. The Research Analyst continues to maintain and update the data and information on this site. Indicators now available on the Hub include infant mortality (overall, neonatal, and post-neonatal rates), low birth weight and very low birthweight, preterm and very preterm birth, teen births, timing and adequacy of prenatal care, tobacco use during pregnancy, Cesarean section among all deliveries and among persons with low-risk pregnancies, and resident births and fertility rates. In general, each indicator dashboard includes trend data as well as results by Medicaid status, region of residence, maternal race, ethnicity, and age.

Since early 2017, the MCH Indicators RA 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 Alaska 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, 86% with sub-state regional data, and updates these on the Data Center. In 2022, the RA conducted an extensive review and assessment of state-generated indicators on the KIDS COUNT Data Center. This resulted in the removal of nine indicators that were no longer relevant and the addition of six new indicators.  Other major changes involved (1) a shift in geographic area to school districts for indicators related to education and risky behaviors, as well as (2) the addition of hyperlinks to the MCH Indicators hub site and CUBS visualization tool where appropriate.

During FFY21, Alaska’s third SSDI goal was updated due to changes in funding. The federal ECCS grant, which funded most of the time the RA spent supporting quality improvement activities, ended in July 2021. Thus, activities conducted by the RA to support ECCS under Alaska’s original Goal 3 also ended at this time. In August 2021, Alaska’s SSDI program was awarded supplemental funding to provide data support for quality improvement activities of the Alaska Perinatal Quality Collaborative (AKPQC) and its initiatives under the Alliance for Innovation in Maternal Health. Goal 3 was thus revised for FY22 (and FY23) to reflect providing data support for the AKPQC. The supplemental funding has been used to support time of the SSDI Director to provide leadership on the PQC administrative team within WCFH, as well as a short-term contract for a Data Manager to complete the creation of the online AKPQC Data Hub where facilities submit and view initiative data. The AKPQC Data Hub also includes additional birth certificate data on many medical risks and outcomes, to supplement the MCH Indicators Dashboard.

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 RA updated data and information on the online Alaska MCH Indicators Dashboard (https://mch-indicators2-alaska-dhss.hub.arcgis.com/).
• The SSDI Director and RAIII worked together to provide data support for quality improvement initiatives of the Alaska Perinatal Quality Collaborative, including updating birth certificate and HFDR data on the online Data Hub for the AKPQC. (Located at https://akpqc-alaska-dhss.hub.arcgis.com/). The Data Hub includes both publicly accessible dashboards as well as private dashboards for participating facilities to view their own data.

The SSDI Director worked with the Senior MCH Epidemiologist to refine and publish an R Shiny app for making a de-identified Phase 5 CUBS dataset available in an online query-based system.

• The Research Analyst organized a brief presentation to the Healthy Alaskans 2030 advisory team on improvements in data collection and analyses that affect the monitoring of progress toward three health objectives. As part of this presentation, the SSDI Director reviewed recent changes in the CUBS survey instrument and Research Unit Manager from Health Analytics and Vital Records described better methods for calculating gestation. 
• The Research Analyst created a presentation on Child and Adolescent Mortality data for the Alaska Children’s Trust in May 2023.
• The SSDI Director shared an update on key MCH Indicator data at the December 2022 PQC Steering Committee meeting. This presentation was later recycled and refreshed with provisional data from 2022 and presented by the RA at the MCDR-PQC Summit in April 2023, as well as again by the SSDI Director at the Alaska Hospital and Healthcare Association (AHHA) Chief Nursing Officer meeting in April 2023.
• The SSDI Director presented CUBS data trends, with a focus on 2020 and 2021 pandemic impacts on families, at a roundtable at the Alaska Public Health Association conference in January 2023.
• The SSDI Director was lead author on a data brief about the Costs Associated with NAS (published in March 2023).
• The SSDI Director was a co-author, along with other MCH Epi Unit staff, on a study using linked PRAMS and CUBS data that was published in the American Journal of Preventive Medicine titled, “Changes in Household Challenges and Subsequent Child Welfare Report.”
• The SSDI Director was a co-author along with staff from the Section of Chronic Disease Prevention and Health Promotion on a study using CUBS data that was published in Health Promotion Practice titled, “Alaska’s Play Every Day Campaign Encourages Parents to Serve Healthy Drinks to Young Children.”