State Systems Development Initiative (SSDI)

As part of the ongoing epidemiologic support, SSDI continues to assist with: refining the 5-year State Action Plan, Evidence-based or -informed Strategy Measures (ESMs) and State Performance Measures (SPMs), setting annual objectives (linear forecasts) for each of the National Performance Measures (NPMs) and SPMs, 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/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 2016-2020. These can be found at: http://www.kdheks.gov/c-f/mch.htm.

Kansas was one of two states, among 51 states and jurisdictions that participated in the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN), that sought methods to more effectively analyze the infant mortality rate (IMR) for subsets of the populations with an infrequent number of deaths. Kansas found the statistical process control (SPC) charts useful to look at data in an exploratory way and raised questions to see if there was anything worth exploring further. Led by the National Institute for Children’s Health Quality (NICHQ), which SSDI contributed, a manuscript Using infant mortality data to improve maternal and child health programs: An application of statistical process control techniques for rare events has been published in Maternal and Child Health Journal: https://doi.org/10.1007/s10995-018-02710-3. Additionally, a multi-state collaborative project with the National Birth Defects Prevention Network, which SSDI contributed, investigating Gastroschisis Trends and Ecologic Link to Opioid Prescription Rates - United States, 2006–2015 has been published in the Morbidity and Mortality Weekly Report: https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6802a2-H.pdf.

SSDI completed the 2017 Kansas Perinatal Community Collaboratives (KPCCs) program evaluation reports for the 11 sites and statewide: Clay, Crawford, Dickinson, Geary, Lyon, Montgomery, Reno, Riley, Saline, Sedgwick and Wyandotte counties. These reports summarize findings from the pre- and post-surveys and follow-up health outcome questionnaires. KPCCs, in collaboration with local communities and the broader network of local health care and community service providers, are involved in an on-going process of developing perinatal collaboratives utilizing March of Dimes Becoming a Mom/Comenzando Bien® as a consistent and proven prenatal care education curriculum. The model brings prenatal education and care together. Birth outcome data reveals improvements in preterm delivery, low birthweight, and breastfeeding initiation. Most notable is the Infant Mortality Rate (IMR) per 1,000 live births (5-year average) from pre-implementation to post-implementation in the counties of our two longest running KPCC sites. IMR in these two counties has significantly decreased since the inception of local perinatal community collaboratives. The Saline County IMR decreased from 9.0 (95% CI 6.3-12.3) in 2005-2009 to 5.5 (95% CI 3.4-8.5) in 2013-2017. The Geary County IMR decreased significantly from 11.9 (95% CI 8.6-16.0) in 2005-2009 to 5.7 (95% CI 3.8-8.2) in 2013-2017.

In April 2018, the Bureau of Epidemiology and Public Health Informatics (BEPHI) - Vital and Health Statistics Data Analysis Section re-established annual linkage of birth records to Medicaid (mother-infant dyads) and hospital discharge data (mothers only; no mother-infant dyads, due to limited identifying information for the infant in the hospital discharge data). The BEPHI - Vital and Health Statistics Data Analysis Section also made a linkage possible between birth records and WIC eligibility files which is performed on an as needed basis.

Other Epidemiology & Data Analysis Capacity

Lawrence J. Panas, PhD, MCH Epi, was recruited July 2018. His major responsibilities involve analysis of data collected through DAISEY, the web-based shared measurement data system. Specifically he evaluates the Perinatal Community Collaboratives (local models working to improve maternal and infant health outcomes in the pregnancy and postpartum periods). A large portion of his work is also dedicated to the Title V-Medicaid partnership as far as utilizing data to improve outcomes.

James Francis, MPH, Data Analyst, was recruited March 2019. He serves as point of contact for the data housed in multiple systems, some shared by several programs; prepares maternal and child health, family planning, and other program data for reporting and collaborates with program directors, epidemiologists and team members; extracts clean data from systems of record, review, and finalize for progress reports, performance reports, and other narrative and measure reporting; and more.

Data-Driven Approach & Commitment to Capacity Building: DAISEY

The 2015 launch of DAISEY supports Title V’s vision for shared measurement/data collection and integrated community-level MCH initiatives. Increased data capacity allows the program to demonstrate the impact of coordinated, essential MCH services on improved outcomes. DAISEY is available free to all local providers as the required centralized collection system for MCH services. Eight state-level programs are utilizing DAISEY for data collection and reporting, including Title V. In 2017-2018, DAISEY’s data and analytics infrastructure were enhanced to further support KDHE’s vision for integrated and coordinated community-level maternal and child health initiatives. Focus shifted from implementation to using data to drive decisions and quality MCH services. Customized, visual reports in DAISEY allow users and KDHE to review data quality, meet compliance reporting, and implement program improvements through review of clients served, services provided, and referrals made. DAISEY reports help local agencies and KDHE easily demonstrate the need for MCH services and to share the impact of their programs at the community, regional, and statewide level. KDHE and KU staff provide extensive training and technical assistance, and a DAISEY Helpdesk is available for system users. A website was developed to provide a centralized access point. Users as of June 2019 are 1,126 (representing 91 grantees and 159 organizations). The largest growth has been MCH and Family Planning (+30), followed by Healthy Start (+13), MIECHV (+11), and LYFTE (+10). A new module and set of users was added in 2019, the Kansas Perinatal Quality Collaborative (KPQC) (+27).

DAISEY Solutions Website (http://daiseysolution.com/kdhe/) & Sample Report

Integrated Referral & Intake System (IRIS)
http://connectwithiris.org/knowledgebase/introduction-to-iris/

Title V is partnering with KU to implement IRIS, a web-based community referral system to support best practices in social service referral and coordination among community partners. Its primary purpose is to enable service providers to make, receive, track, and respond to referrals. Data collected will provide insight into what’s working and not working at the local level for families as far as connecting to needed services. Read more in the Child Health Section.

Implementation status and utilization August 31, 2019

MCH Community Check Box: Monitoring the State Action Plan

developed by the KU Center for Community Health and Development (http://communityhealth.ku.edu)

Title V captures, characterizes, and communicates what we are doing across the state in the MCH Check Box. The information collected is used for learning, improved collaboration, quality improvement, monitoring the extent to which state and local partners are building capacity and taking action to address the plan priorities and measures, and how these activities may be influencing key indicators such as maternal and infant mortality. The team has used the tool since May 2017. Sensemaking sessions take place quarterly with the Title V state and KU team. The graphs below detail the extent to which efforts are focused on priority areas and performance measures as well as through what means or essential MCH service.

BFH invested in the development of a shared collaborative SharePoint application within the Community Check Box, commonly referred to as the WorkStation. This tool is being used to enhance training and technical assistance while also increasing statewide connections and collaboration amongst program staff and grantees.

Screenshot of the MCH WorkStation – Main Page https://www.myctb.org/wst/KansasMCH/cf

Screenshot of the MCH WorkStation - MCH Shared Documents Page

Screenshot of the MCH Workstation - Discussion Board Page