Perinatal Partnership Program of Eastern & Southeastern Ontario

1. Perinatal Partnership Program of Eastern & Southeastern Ontario “Working Together for Quality Perinatal Care Through Innovation & Partnership”

2. The Niday PerinatalDatabase: A regional, population-based surveillance system via the internet Paula Stewart, MD, FRCPC, Policy & Planning Advisor Jim Bottomley, BScH, MHA, Director Perinatal Systems

3. Perinatal Surveillance System • Partnership: PPPESO, hospitals, public health units (& eastern PHRED), physicians, midwives, CritiCall, Health Information Partnership, Community Health Centres • Working together towards optimal health of mother, baby & families

4. Evolution of the Data System • 1997 - common logbook/definitions • 1998 - computerized data entry program (FoxPro), 16 hospitals • 1999 - Reports: regional; hospital specific; health unit region; new variables (postal code) • 2000 - audit, data used in PPPESO’s program priority setting process, HIP new partner, 2 new hospitals (out of region) adopt system

5. What was working? All 16 hospitals entering data High quality Reports Partners find data useful PPPESO using data for program planning Challenges: Limited access to data by partners, limited report capabilities Extensive tech support Limited capacity of dataentry program (FoxPro) Timeliness of reports Why Change to a Web-based Platform?

6. CritiCall Provincial Resource Registry • Already in use by all Ontario hospitals (also used in B.C.) • Sophisticated, encrypted, secure, internet-based platform • Allows direct, online data entry using web forms • No special hardware or software requirements (Internet Explorer) • Flexible access to data and reports • All technical support via CritiCall

7. Evolution continued • 2001 - Niday Perinatal Database: all births, enhanced, real-time, web-based (CritiCall platform) • web-based data entry & real time reports • hospitals and midwives enter data online (including home births), in-kind, own their data • training and support for users • audits and quality assurance

8. Application • Hospitals, public health units, midwifery practice groups, regional perinatal program (PPPESO), and other agencies (Early Years Centres, CHCs involved in perinatal care.) • Data for planning and evaluation of programs and services (monthly services indicator reports). • Monitor CQI programs. • Facilitates benchmarking with other like hospitals and public health unit regions.

9. Evolution continued • Early Years Challenge grant • 2002-2004 - adoption of the database by other organizations in the province - expansion of variables - new neonatal screen - enhanced reports - links with new Early Years Centers in Ontario

10. Development of Neonatal Indicators • Indicators selected based on criteria: data quality, availability and timelines and public health importance (important influence on health, significant number of people affected, significant impact, potential for improving health) • Collaborative process with regional partners and a provincial expert group.

11. Niday Database Indicator Framework

12. Public Health Variables • Postal Code • Language • Aboriginal • Antenatal Care Provider • # of antenatal visits • Prenatal Classes • Smoking • Intention to Breastfeed • Gestational age • Birthweight • Infant feeding on discharge • Neonatal death • Parkyn Screen • Hearing Screening

17. Report Formats • Frequency Reports * - own data • Comparison Reports * - to aggregate data from similar types of hospitals • Key Indicator Reports * • Annual Regional Report • Hospital Specific Reports (annual) • Public Health Unit Reports (annual) • Midwifery Practice Group Reports (annual) * Web-based

18. Report Samples Frequency Report Among women who have labour induced, proportion who have a cesarean birth, Any Hospital (sample data only) Comparison Report Among women who have a vaginal birth, proportion who have epidural anesthesia, by place of birth (sample data only).

19. Figure 2 Number of women who gave birth and babies bornin the region*, by health unit region, 2002. * hospital births and home births in Eastern and Southeastern Ontario Source: Perinatal Partnership Program of Eastern and Southeastern Ontario, Niday Perinatal Database.

20. Figure 18 Proportion of women who smoked after twenty weeks of pregnancy, by health unit region*, 2000-2002. * Eastern and Southeastern Ontario, home births included as of 2002 Source: Perinatal Partnership Program of Eastern and Southeastern Ontario, Niday Perinatal Database.

21. Figure 4: Proportion of women who gave birth in the region*, by age group and by health unit region, 2002. * hospital births and home births in Eastern and Southeastern Ontario Source: Perinatal Partnership Program of Eastern and Southeastern Ontario, Niday Perinatal Database.

22. Figure 7 Proportion of babies who were born with low birthweight (< 2,500 grams) in the region*, by health unit region, 2000-2002. * Eastern and Southeastern Ontario, home births included as of 2002 Source: Perinatal Partnership Program of Eastern and Southeastern Ontario, Niday Perinatal Database.

23. Figure 8 Proportion of singleton babies who were born with low birthweight (<2,500 grams) in the region*, by health unit region, 2000-2002. * Eastern and Southeastern Ontario, home births included as of 2002 Source: Perinatal Partnership Program of Eastern and Southeastern Ontario, Niday Perinatal Database.

24. Preterm Birth • Proportion of babies born preterm has changed little in past 3 years. (Figure 6) • Proportion of babies who were multiples increased in past 3 years by 17% (Figure 7) • The proportion of preterm births among singleton babies has decreased in the past 3 years (Figure 8) • The proportion of multiples who were born preterm has increased in the past 3 years (Figure 9) • Thus, the lack of overall decrease in preterm birth rates is due to the effect of increasing multiples and increasing preterm birth among those babies.

25. Figure 6 Proportion of babies who were born preterm (less than 37 weeks), living in Eastern and Southeastern Ontario, 2000-2002. Source: Perinatal Partnership Program of Eastern and Southeastern Ontario, Perinatal Database.

26. Figure 7 Number of babies (% of live births) who were multiples), living in Eastern and Southeastern Ontario, 2000-2002. 3.4% 2.9% 3.0% Source: Perinatal Partnership Program of Eastern and Southeastern Ontario, Perinatal Database.

27. Figure 8 Proportion of singleton babies who were born preterm (less than 37 weeks), living in Eastern and Southeastern Ontario, 2000-2002. Source: Perinatal Partnership Program of Eastern and Southeastern Ontario, Perinatal Database.

28. Figure 9 Proportion of multiples who were born preterm (less than 37 weeks), living in Eastern and Southeastern Ontario, 2000-2002. Source: Perinatal Partnership Program of Eastern and Southeastern Ontario, Perinatal Database.

29. Provincial Role Out • During 2002-2003, the database has been adopted by: • 24 hospitals in greater Toronto area • Central West: 1 site • Northern: 4 sites • Central: 1 site • Central East: 3 sites, 1 midwifery practice • approximately 75% of Ontario births

30. Lessons Learned • It is possible to develop a regional data system that is cost efficient, timely, accurate and useful • Winning conditions for change included: • keeping it simple, starting small with high quality results and building gradually • auditing and fine tuning the system • involving all stakeholders throughout the development process • strong leadership team and right skill mix

31. Future Directions • Implement & evaluate neonatal module • Enhanced user report options • Collaborate in the development of a provincial reporting format • Future variables to be added/adjusted using consultative regional/provincial approach • Linking to other health planning organizations • Enhanced utilization of data for research