Mike Curtis who is the Acting Chief from Epidemiology, Assessment, and Program Development at the MCH/Center for Family Health/Ca Dept of Public Health branch as well as Carina Saraiva, MPH who is a research scientist and she has been working with the breastfeeding side for about 3 years. Carina knows personally about policies and procedures in hospitals because her first was born and entered into a NICU, now has a new little boy that graced us with his presence earlier.
Mike explains how we get some of our breastfeeding data and the changes that have been made to the newborn screening form; these have been significant changes and why this is important. Some trend lines will disappear because of changes and after 2 years that trend line will re-appear.
Carina explains that the data comes from the NBS form, all newborns should get in hospital 24-48 hours of age. There have been recent revisions in 2007-2008. We have an example of the form that was used where there was not an area for NICU babies who got maybe TPN or fortifier; so there were many others as well as breastmilk. So changes were made and changes were made. Data on website is through 2007 and items such as the TPN has been taken out. There are county tables, state tables, ethnic categories, etc. See the cdph website for these details (short cut at calwic.org). However we needed to know whether a baby was given TPN. This was added back in as well as stating that a chart review should be done to ascertain the data; not just asking mother. Banked human milk is on there as well. This hit the field in late 2007 and 2008 which will be used for the data that is being done right now. Total number of records is lower in 2008 because some were not reported on the correct form; some reduction in combo feeding and increase in breast only as well as formula only. It is an understanding that there were trainings where hospitals were told to mark what baby was given up until test as opposed to the whole time baby was there; some may not know about feeding. 2008 data will be looked at the same, excluding TPN as well. If there was anything outside of the breast except for TPN and IV then they are other.
Concern is being raised about data being contaminated because of verbal instruction that most were not doing a chart review. Carina clarified that there will be many notes with the data to clarify. You will be able to compare past year but 2008 please do not compare to past years. We are hoping that 2010 will be a new data trend.
Can the NICU data be separated is raised by a panel member? There is an area to ask where heel stick occurred and they are looking at splitting data by where the information was gathered. Mike lets us know that we will have good data for a certain time but we are not able to know what hospitals got the information in June that only the prior feed was to be coded; not the chart review that is supposed to be done. Hospitals will need to look at their own data but 2008 will have to stand alone and cannot look at previous years. Overall the data tells us what has happened in a hospital but not comparing it to previous years. Especially now since the National Quality Forum is now looking at Maternity Care Measures and wants the NICU babies pulled out. This wants all babies pulled, not just ones who are still in NICU but even those who were in and are now out.
Another panel member said that they were told to change the timing of the heelstick which they were told to do as close to discharge as could. This is an issue because of maternal complications; also if some are doing at 24 hours as opposed to 36 hours.
Another asked what the minimum time is? Carina clarifies that it says 12 hours is minimal. 24-28 hours is most frequent.
Another panel member asked how new forms go out and how old ones are gone? for 2008 we know that 92% were done on one form and the others had begun with the newer one or even an older one. So they have to weed those out.
Another panel member explains that there are many areas within the state that operates to get this data collected and distributed. Lets remember why we do this screen however. It is not for the feeding data, and many feel that the disease screening is being complicated by the feeding data being asked. So how can we meet both? So for 18 months our data is not the best, but will be better.
Carina explains that the compromise: TPN must be there because it interferes with the screening, so there is simply a spot that asks yes or no if they receive.
Current we will look at on the new forms exclusive BF, any BF, and denominator for both which will exclude those that are marked TPN/Hyperali or other not known. She showed us our rates and gaps of exclusive and any, but we will not see changes on this with data issues. Carina also showed us the slide that looked at ethnic groups of any and exclusive as well as broken into maternal county of residence. Carina explains that the data has been used by many and many will need to be told not to use the data for awhile. Cal Compare and CWA both use this data. We want this to be used in the future as well.
Another panel member asks if a mother refuses the genetic test what can be done? They come to the state as blank and they are left that way. They then lump into unknown and missing.
Audience member says that Federal guidelines are asking for birth certificate data; where are we with this? Mike lets us know that needs a legislative approval to happen. We have not began work on this.
Audience member asks about getting data from childrens hospitals. They will show if they have more than 50 heelsticks their per month.
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