State Systems Development Initiative (SSDI) and the MCH Block Grant
The goals of the MA SSDI program are to: 1) Build and expand MCH data capacity to support Title V activities and contribute to data-driven decision making in MCH programs including assessment, planning, implementation and evaluation; 2) Advance the development and use of linked MCH datasets; and 3) Support surveillance systems development to address data needs related to neonatal abstinence syndrome (NAS). MA has experienced a 450% increase in opioid-related deaths since 2000. The majority of this increase has occurred recently; the death rate doubled from 11/100,000 in 2012 to 30.5/100,000 in 2016, but declined to 29.7 in 2017 and 29.1 in 2018. The rate for 2019 is 29/100,000, an estimated 5% decline since 2016. The opioid epidemic has affected every community in the state and MDPH continues to work with stakeholders to better understand the scope and nature of the epidemic.
A Title V priority during the 2015-2020 reporting cycle was to address perinatal substance use. To support this priority, the SSDI program worked collaboratively with internal and external stakeholders and created a statewide NAS dashboard of key metrics to monitor progress on aspects of care for families affected by perinatal substance use. Protocols for data reporting were developed across the care continuum for substance exposed newborns and newborns with NAS. The creation of the NAS dashboard builds upon the robust collaborations and data systems in the state and will help develop new data capabilities. The aim is to achieve population-level improvements in health outcomes by engaging clinical providers, public health, and community agencies in a unique collaboration that combines clinical care, quality improvement, public heath, community support, and population-level measurement.
The SSDI program has also been closely involved with programming and monitoring for the oral health priority from the 2015-2020 reporting cycle. To improve oral health screenings during pregnancy, the SSDI Director worked with oral health stakeholders and champions to create an Oral Health Steering Committee for the development of the MA Perinatal Oral Health Practice Guidelines for Pregnancy and Early Childhood. The guidelines were released in 2016 and the SSDI Director continues to support statewide ongoing implementation through her participation in dental events. For example, in January 2020 she presented to dentists and dental hygienists at the Yankee Dental Congress in Boston as part of the Interprofessional Symposium.
Access to MCH Data for the MCH Block Grant
Through the BFHN Office of Data Translation (ODT), Title V has direct, annual access to timely, electronic MCH data that inform and support Title V programming, assessment and monitoring. ODT’s role is to provide statistical information for needs assessment, performance management, quality improvement, and decision support throughout BFHN using data analytics, survey work, and evaluation studies. The ODT Director is also the SSDI Director and Pregnancy Risk Assessment Monitoring System (PRAMS) Director.
Pregnancy Risk Assessment Monitoring System
ODT manages PRAMS, a critical source of data for Title V performance measure reporting. For example, PRAMS data have been used annually to monitor NPM 5 (safe sleep) and NPM 13A (dental visit during pregnancy), and in the 2020-2025 reporting cycle will be used to monitor key objectives related to maternal mental health and substance use. Central to the new substance use prevention action plan is revising the PRAMS survey to improve the measurement of tobacco, marijuana, and alcohol use during pregnancy.
In FY18 the PRAMS team received CDC funding to add additional questions on perinatal substance use and maternal disabilities to the PRAMS survey, and to conduct a call-back survey of mothers who report using substances in the perinatal period. While there are rich programmatic and administrative data available in Massachusetts, there are no population-based survey data on opioid use and misuse before, during, and shortly after pregnancy. Therefore, the addition of a set of opioid supplemental questions to the PRAMS survey will allow Massachusetts to assess maternal behaviors and experiences related to the use of opioids and to understand their effect on the health of both the mother and infant. Data from the opioid call-back survey will support and enhance state surveillance systems to better identify community needs and policy gaps. PRAMS data on maternal opioid use, reason for use, interactions with health care providers related to prescribing and counseling, and need for and access to treatment services will inform current opioid initiatives and programs focused on the MCH population in Massachusetts.
MDPH worked with CDC PRAMS to improve the timeliness of PRAMS and received weighed PRAMS 2018 data in the summer of 2019, which was unprecedented. The SSDI Director also worked with the Registry of Vital Statistics to establish data use agreements to improve access to real time birth and death records for ODT staff to support Title V programing and monitoring. ODT staff now have access to preliminary 2019 data, which are the most up-to-date data available.
Pregnancy to Early Life Longitudinal Data System and All Payer Claims Database
MA has also developed the Pregnancy to Early Life Longitudinal (PELL) data system. The core linkage consists of live birth certificates and fetal death reports, provided by vital statistics, and linked annually by the SSDI program to their corresponding birth and delivery inpatient hospital discharge records. PELL also incorporates non-delivery inpatient hospital discharges, emergency department, observational stay and program participation data. Program participation data from Early Intervention (EI), birth defects, WIC, newborn hearing screening, and home visiting are among the data that have been or are in the process of being linked. PELL was also a source of data for the 2015-2020 SPM on the percent of infants diagnosed with NAS who receive EI services. A key feature of PELL is its ability to examine the very earliest exposures across the life course and track MCH outcomes longitudinally.
During FY19, ODT/SSDI linked PELL with the MA All Payer Claims Database (APCD) starting with 2010–2016 claims data. The linkage will be repeated annually through 2021 and will allow BFHN to refine its measurement of health outcomes among deliveries by providing information on health conditions and their associated costs (including outpatient medical visits and dental visits) among a larger segment of the population. This linkage will allow for systematic examination of health care costs among women during and after pregnancy and among children.
MDPH is collaborating with Tufts University on a quasi-experimental evaluation of MA MIECHV programs spanning the continuum of home visiting services in Massachusetts, including the evidence-based home visiting models Healthy Families America and Parents as Teachers, as well as Welcome Family, a universal one-time postpartum home visit program, and the Early Intervention Parenting Partnerships Program, a home-grown multidisciplinary team-based home visiting program. The evaluation uses linked secondary data from home visiting program management information systems; electronic birth and death certificates, fetal death reports, and data on hospital discharges, Emergency Department visits and observational stays within the PELL Data System, APCD healthcare claims data, and EI program data. These linked data will be used to examine short- and longer-term impacts of home visiting programs on maternal and infant health and development outcomes and timeliness of linkages to EI services.
Public Health Data Warehouse
The newly established MDPH Public Health Data Warehouse (PHD), described in the Overview of the State, will provide access to timely, linked, multi-year data from across state government to enable analysis of health priorities and trends. Following an initial focus on opiate overdoses, the MDPH Commissioner identified MCH as the top public health priority for study. Her vision is to generate actionable information that will help address inequities in MCH outcomes. Through public and private partnerships the PHD team has identified key MCH questions related to maternal morbidity and mortality, preterm birth and infant mortality, and adolescent health and wellness. Data linkage and analyses to inform program and policy decision-making are underway. The SSDI Director is co-leading this effort in collaboration with staff from the Office of Population Health.
Additional Epidemiological and Data Enhancement Activities
Building MCH data capacity
BFHN has had a CDC MCH Epidemiology Program assignee since October 2012. Her main focus is to build MCH capacity at the state level and use epidemiologic research and scientific information to inform MCH programs and policies. The CDC assignee works closely with the ODT/SSDI Director to recruit fellows and trainees from CDC-sponsored programs and to leverage training opportunities offered by CDC for the benefit of MDPH staff. For over a decade ODT has consistently had CDC/CSTE Applied Epidemiology Fellows who provide high-quality epidemiologic support while learning the practical application of epidemiology on the job. The CDC assignee and CSTE fellows in collaboration with BFHN epidemiologists play important roles in the Title V and MA MIECHV Needs Assessments and annual reporting. MA MIECHV is also submitting an application to host a CDC Public Health Associate beginning in October 2020.
The CDC MCH epidemiology assignee and CSTE Fellows, along with MCH program staff, have participated in the CDC/Harvard School of Public Health Program evaluation practicum five out of the past six years. During January 2019, the MA MIECHV Program participated in the practicum focusing on developing an evaluation framework for the Parents as Teachers Recovery Coach Overlay. This practicum is a unique training and experiential opportunity for staff to enhance their skills in program evaluation. In addition, MDPH provides practicum project opportunities and mentorship for several student interns from local schools of public health every year, and student interns have played important roles in previous Title V Needs Assessments.
COVID-19
Little is known about the effect of COVID-19 on pregnant women and infants, and there are no recommendations specific to pregnant women regarding the evaluation or management of COVID-19. MDPH is planning to implement the CDC COVID-19 Pregnancy Module, a surveillance system to collect supplemental information on pregnant women with laboratory evidence of COVID-19 and their neonates. This effort will leverage the flexibility of the existing active birth defects surveillance system in Massachusetts, building upon previous work to enhance the system to monitor outcomes for pregnant women with Zika infection. The data collected will help describe risk for severe illness or adverse outcomes among pregnant women with COVID-19 infection up to delivery, and their newborns, to inform public health guidance and risk communication messages.
To Top
Narrative Search