THE THE NEWNEW BIRTH CERTIFICATE BIRTH CERTIFICATE

Making Making

vital statisticsvital statistics

more vitalmore vital

Centers for Disease Control and PreventionCenters for Disease Control and Prevention

National Center for Health StatisticsNational Center for Health Statistics

Division of Vital StatisticsDivision of Vital Statistics

Reproductive Statistics BranchReproductive Statistics Branch

Development of theDevelopment of theRevised Birth CertificateRevised Birth Certificate

The U.S. Standard Certificate of Live Birth is The U.S. Standard Certificate of Live Birth is revised about every 10 years. The last revision revised about every 10 years. The last revision was in 1989.was in 1989.

– Process began with consensus of the States that Process began with consensus of the States that revision was neededrevision was needed

– In 1998, NCHS/CDC assembled an expert panel to In 1998, NCHS/CDC assembled an expert panel to evaluate the current certificate and recommend evaluate the current certificate and recommend changeschanges

The Revision ProcessThe Revision Process

The Panel to Evaluate the U.S. Certificates and Reports:The Panel to Evaluate the U.S. Certificates and Reports:– State vital registration and statistics executivesState vital registration and statistics executives - - Patricia Patricia

W. Potrzebowski (Chair), PA; Donald Berry, DE; Carol V. Getts, MI; W. Potrzebowski (Chair), PA; Donald Berry, DE; Carol V. Getts, MI; Karen Grady, NH; Dorothy S. Harshbarger, AL; Michael R. Lavoie, Karen Grady, NH; Dorothy S. Harshbarger, AL; Michael R. Lavoie, GA; A.Torrey McLean, NC; Barry Nangle, UT; Alvin T. Onaka, HI; GA; A.Torrey McLean, NC; Barry Nangle, UT; Alvin T. Onaka, HI; Lorne A. Phillips, KS; Steven Schwartz, NYCLorne A. Phillips, KS; Steven Schwartz, NYC

– Researchers and representativesResearchers and representatives of data providers and user of data providers and user organizationsorganizations - (e.g., AAP, ACNM, ACOG, AHA, AHIMA, AMA) - (e.g., AAP, ACNM, ACOG, AHA, AHIMA, AMA)

In a series of meetings over 16 months, the Panel In a series of meetings over 16 months, the Panel reviewed survey responses, literature and testimony reviewed survey responses, literature and testimony from other experts and private citizensfrom other experts and private citizens

The Panel’s RecommendationsThe Panel’s Recommendations

Improve data qualityImprove data quality- Standardized worksheets (Tested prior to - Standardized worksheets (Tested prior to

implementation)implementation)- Standardized electronic systems- Standardized electronic systems

Add/delete/modify individual items Add/delete/modify individual items

Standardized WorksheetsStandardized Worksheets

To encourage To encourage collection from the collection from the best sources, two best sources, two worksheets have worksheets have been developed and been developed and testedtested

– Mother’s Worksheet Mother’s Worksheet

– Facility Worksheet Facility Worksheet

Mother’s WorksheetMother’s Worksheet

Data directly from Data directly from the motherthe mother (e.g., race, (e.g., race, education, cigarette smoking, WIC)education, cigarette smoking, WIC)

– Tested on women with Tested on women with a recent live birtha recent live birth

– Slight modifications Slight modifications made made

– Overall, mother’s Overall, mother’s worksheet worked wellworksheet worked well

– Companion brochureCompanion brochure

Facility Worksheet Facility Worksheet

Data directly from the Data directly from the medical recordsmedical records (e.g., (e.g., pregnancy risk factors, method of delivery)pregnancy risk factors, method of delivery)– Tested in hospitals Tested in hospitals – Hospital staff completed the worksheet using Hospital staff completed the worksheet using

medical recordsmedical records– Outside expert reviewed responses for accuracyOutside expert reviewed responses for accuracy– Several items modified or deleted Several items modified or deleted – Testing generally showed that the facility worksheet Testing generally showed that the facility worksheet

could be completed efficiently and accuratelycould be completed efficiently and accurately

Guide to Completing Facility Guide to Completing Facility WorksheetWorksheet

To assist hospital staff in completing the facility worksheet To assist hospital staff in completing the facility worksheet a comprehensive instruction manual has been developed. a comprehensive instruction manual has been developed. It includes: It includes:

– DefinitionsDefinitions– Preferred sources Preferred sources

within the records within the records – Key words/common Key words/common

abbreviationsabbreviations

Detailed Specification for Electronic Detailed Specification for Electronic SystemsSystems

Detailed specifications for Detailed specifications for each data itemeach data item on on the birth certificate have been developed the birth certificate have been developed – Automatic edits/cross editsAutomatic edits/cross edits– Ability to edit and query at data Ability to edit and query at data

entry entry – Suggested screensSuggested screens– On-line help On-line help – Drop-down menusDrop-down menus– Test decks for vendors/StatesTest decks for vendors/States

New Birth Certificate:New Birth Certificate:New ItemsNew Items

– Fertility therapyFertility therapy– WICWIC– Infections during Infections during

pregnancypregnancy– Maternal morbidityMaternal morbidity– Breast feedingBreast feeding– Principal source of Principal source of

payment for the payment for the deliverydelivery

New Birth Certificate:New Birth Certificate:Modified ItemsModified Items

– Cigarette smoking Cigarette smoking before and during before and during pregnancypregnancy

– Method of deliveryMethod of delivery– Pre-pregnancy Pre-pregnancy

weight, weight at weight, weight at delivery and heightdelivery and height

– Congenital Congenital anomaliesanomalies

The New U.S. Standard The New U.S. Standard Report of Fetal Death:Report of Fetal Death:

The Fetal Death The Fetal Death Report was also Report was also revised with changes revised with changes similar to birthsimilar to birth

- Standardized - Standardized worksheetsworksheets

- Recommendations for - Recommendations for electronic systemselectronic systems

The New Report of Fetal Death: The New Report of Fetal Death: Cause of Fetal DeathCause of Fetal Death

Cause of fetal death Cause of fetal death now captures the now captures the single single initiating causeinitiating cause as well as other as well as other significant causessignificant causes..

Other additions include:Other additions include:– whether autopsy or whether autopsy or

histological placental histological placental examination was performed examination was performed

– if autopsy or histological if autopsy or histological placental examination placental examination results were used in results were used in determining cause of deathdetermining cause of death

ImplementationImplementation

Revision requires comprehensive overhaul of State Revision requires comprehensive overhaul of State electronic vital registration systems electronic vital registration systems (($$$!)$$$!)

– Phased; beginning in 2003 with 4-5 StatesPhased; beginning in 2003 with 4-5 States

– 2 data systems, current & revised for several years2 data systems, current & revised for several years

– NCHS will collect and publish data for bothNCHS will collect and publish data for both

– Some items (e.g., prenatal care, gestational age) may not be Some items (e.g., prenatal care, gestational age) may not be comparable between systemscomparable between systems

Revision Web-siteRevision Web-site

For everything you always wanted to For everything you always wanted to know about the revision but were know about the revision but were afraid to ask…afraid to ask…

www.cdc.gov/nchs/vital_certs_rev.htmwww.cdc.gov/nchs/vital_certs_rev.htm

The Future of Birth StatisticsThe Future of Birth Statistics

The quality of birth and fetal death data will The quality of birth and fetal death data will be greatly enhanced by the recommended be greatly enhanced by the recommended changes to the collection process and to changes to the collection process and to individual data itemsindividual data items

Result: a much Result: a much richer national richer national perinatal data baseperinatal data base

1940 1950 1960 1970 1980 1990 20000

20

40

60

80

100

Birt

h ra

te p

er 1

,000

wom

en a

ged

15-1

9

0

100

200

300

400

500

600

700

Num

ber of births (in thousands)

Number of births

Birth rate

Number of births and birth rates for teenagers aged 15-19 years: United States, 1960-2000