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An Overview of BORN Ontario Reporting
BORN Provincial Rounds
March 21, 2013
Objectives
1. To provide a summary and highlights from BORN Ontario
reports produced to-date
2. To provide an overview of new reporting features of the
BORN Information System
3. To highlight future BORN reporting plans
2
Background (I)
About BORN Ontario:
• Funded by Ministry of Health and Long-Term Care in 2009
• Integrate five founding partner organizations with different data
collection systems, but serving similar populations
Prenatal
Screening
3
Newborn
Screening
Midwifery
Program
Background (II)
The BORN Community:
• Labour & Birth
– ~140,000 births annually collected from 106 hospitals
– ~500 midwives in >80 practice groups with over ~16,500 Courses of Care
• Antenatal Specialty: women with women with high-risk pregnancies
requiring care at specialized centers
• Prenatal Screening: ~70% of pregnancies annually
• Newborn Screening: >99% of infants
• Screening Follow-up Centers
• Neonatal Care: 49 NICU/SCNs caring for ~7,200 babies
4
Background (III)
BORN Information System (BIS):
• https://my.bornontario.ca
• Registry of maternal-child data for Ontario
• Phased launch beginning January 23, 2012
• By April 1, 2012 BIS in 106 hospitals, >80 MPGs, screening labs
• Launched in provincial Fertility clinics January 1, 2013
• Future access to Public Health Units and other stakeholder groups
• Prior to April 1, 2012, data collected in the Niday Perinatal Database
• BIS Data Dictionary: www.BORNOntario.ca/data-dictionary
5
The Continuum
Prenatal
Screen
Antenatal
general
Labour
Antenatal
Specialty
P/P
Mother
Birth
P/P
Newborn
Screen
NICU
child
Fetus
Father
Mother-Continuum of Care
Child - Continuum of Care
Fertility
18-month
6
HBHC
NSO
IHP
LTFU
Well
Baby
Privacy
• BORN (as OPSS) was granted registry status under the
Personal Health Information & Privacy Act (PHIPA) in
November 2009
• Registry status affords BORN the authority to collect, use and
disclose personal health information without consent for the
purpose of “facilitating or improving the provision of health
care”
• This special authority requires BORN to develop and adhere to
rigorous privacy policies – and have them reviewed and
approved by the Ontario Information and Privacy
Commissioner
7
Objective 1: To provide a summary and
highlights from BORN Ontario reports
produced to-date
Objective 1: Pre-BORN Reporting
9
Objective 1: Perinatal Health Report for Public Health Regions
•
Data from 2008 calendar year on pregnancy, maternal
and newborn health and outcomes of interest to public
health
•
7 regional reports covering 36 Public Health Units
(PHUs), based on location of maternal residence
•
Consulted with: Child Health Network (CHN), Perinatal
Partnership Program of Eastern and Southeastern
Ontario (PPPESO), Public Health representatives
•
Objectives of this series of reports:
–
Illustrate the utility of the data in supporting indicators that are
relevant to reproductive and child health within the Ontario Public
Health Standards
–
Present a baseline for future examination of trends by Public Health
Region
http://www.bornontario.ca/reports
10
11
12
13
14
15
Objective 1: Perinatal Health Report for LHIN Regions
•
Data for the 2009–2010 fiscal year on maternal and
newborn health and outcomes of interest to care
providers, administrators, LHIN personnel, government
•
5 regional reports covering 14 LHINs, based on location
of birth
•
Consulted with: Child Health Network (CHN), Perinatal
Partnership Program of Eastern and Southeastern
Ontario (PPPESO), Scientific Working Group (BORN
Ontario)
•
Objectives:
–
Highlight maternal-newborn issues and trends arising from the
analysis
–
Present a baseline for future examination of trends by LHIN Region
16
17
*
*Nulliparous women with a singleton live birth in cephalic presentation at term gestation
18
*
19
*
20
Objective 1: H1N1 Reports
• As part of the response to the H1N1 pandemic, the
Public Health Agency of Canada requested that
BORN Ontario add three H1N1-related data
elements to the routine perinatal data collection for
one year
• Data collection began Nov 2, 2009 and continued
until Oct 31, 2010:
– influenza illness during pregnancy
– antiviral medication during pregnancy
– influenza vaccination during pregnancy
21
Objective 1: H1N1 Reports
22
Objective 1: Perinatal Health Indicators for Ontario
23
•
In May 2012, Canadian Perinatal Surveillance System
(CPSS) within the Public Health Agency of Canada
released a national report updating data for 14 perinatal
indicators
•
Ontario was excluded from all indicators based on vital
statistics data (9 of the 14 indicators)
•
Objective: to act as a companion to the CPSS report,
providing estimates for the province of Ontario that can
be interpreted alongside those from the rest of Canada
•
Data for 2006–2010 calendar years
24
25
26
27
28
Objective 1: 2011–2012 Perinatal Indicators by LHIN Region
29
Objective 1: 2011–2012 Perinatal Indicators by LHIN Region
30
Objective 1: Summary
31
Objective 2: To provide an overview of
new reporting features of the BORN
Information System
Objective 2: BORN Information System Reporting Features
1. Standard reports: standard administrative and clinical reports
2. Dashboard: audit and feedback tool
3. Cubes: for creating customized queries (coming soon)
33
Objective 2: Standard Reports
Administrative reports
•
Reconciliation: reconcile admissions, births, transfers, discharges
•
Incomplete Records: determine if any incomplete encounters
•
Missing Data Elements: determine if any missing data
Acknowledge data submission for a given month
Available for hospital and Midwifery Practice Group users
34
Clinical reports: for hospital users
• Encounter List: Antenatal Specialty, Birth Mother, Labour, NICU/SCN
• Patient Experience List: Infant and Maternal
• Key Indicator: counts and frequencies of hospital data
• Infant Summary
• Maternal Summary
• Profile of Birth: hospital and comparator data
• Demographics, Pregnancy, Forward Sortation Area (FSA)
• coming soon – Birth/Mother and Birth/Newborn
• Baby-Friendly Initiative (BFI) Statistics: breastfeeding statistics
• Robson Cesarean Section Monitoring
35
Objective 2: Key Indicator – Maternal Summary Report
Available in BIS
Month end acknowledgment summary
First trimester visit
Prenatal classes
Pre-existing maternal health conditions
Maternal mental health concerns
Complication of pregnancy
Diabetes and pregnancy
Hypertension disorder in pregnancy
Infection and pregnancy
GBS screening
Alcohol exposure
Drug and substance exposure
Medication exposure in pregnancy
Maternal smoking at time of newborn's birth
Fetal surveillance
36
Type of labour
Pain management during labour
Labour and birth complications
Type of birth
Type of Cesarean Section
Previous Cesarean Section
Attending HCP
Forceps/Vacuum
Anesthesia for Cesarean Section
Multiple gestation
Postpartum complications
Maternal age (years)
Intention to breastfeed
HBHC screening
Maternal outcome
Maternal primary language
Objective 2: Key Indicator – Infant Summary Report
Available in BIS
Type of gestation
Gestational age at birth
Birth weight
Apgar1
Apgar5
Newborn resuscitation
Newborn conditions and complications
Early attachment / infant feeding
Infant feeding on discharge
Arterial status
Arterial cord pH
Arterial base excess/deficit
Hearing screening
37
Confirmed congenital anomalies
Transfers to NICU/SCN
Final neonatal disposition
Length of stay (no transfer NICU)
Length of stay (NICU no transfer
MBU)
Length of stay (NICU transfer MBU)
Length of stay
(NICU transfer Paediatric Unit)
Objective 2: Profile of Birth – Hospital Reports
Available in BIS
Profile of Birth – Demographics
Number of women who gave birth
Number of total births
Location of birth
Live births and stillbirths
Maternal age
Parity
Maternal Primary Language
Profile of Birth – FSA
Maternal residence, by forward sortation area
(FSA)
38
Profile of Birth – Pregnancy
Pre-pregnancy body mass index (BMI)
Maternal pre-existing health conditions
Obstetrical complications during pregnancy
Gestational Diabetes
Maternal Hypertension disorder during
pregnancy
Mental health concerns in pregnancy
Alcohol exposure in pregnancy (coming soon)
Drug and substance exposure in pregnancy
Group B Streptococcus (GBS) Screening
**All data shown in Objective 2 of this presentation is MOCK data**
Profile of Birth – Pregnancy
39
Objective 2: Profile of Birth – Hospital Reports
Coming soon
Profile of Birth – Birth/Mother
Type of admitting health care provider
Type of attending health care provider
Type of birth: type of birth (vaginal vs. CS)
type of vaginal birth (assisted vs. spont.)
assisted vaginal birth (forceps, vacuum)
vaginal birth after CS
planned vs. unplanned CS
type of labour (induced vs. spontaneous)
primary CS vs. repeat CS
Rate of episiotomy or 3rd/4th degree perineal
laceration
Pain management in vaginal live birth
CS anesthesia
Intrapartum complications
40
Profile of Birth – Birth/Newborn
Gestational age at birth
Type of gestation (singleton, multiples)
Birth weight
Infant size for gestational age (SGA, LGA)
Resuscitation methods used in live births
Apgar 5
Newborn complications: hypoglycemia &
jaundice
Neonatal death
Newborn and hearing screening
Parkyn screening
41
Rate of cesarean section, by Robson classification groups
Hospital 1, 01-Apr-2012 to 30-Apr-2012
Robson classification group
1 Nulliparous, singleton, cephalic,
≥37 weeks, spontaneous labour
(1a) Augmentation
(1b) No Augmentation
2 Nulliparous, singleton, cephalic,
≥37 weeks, induced labour or
cesarean before labour
(2a) Induced labour
(2b) Cesarean before labour
3 Multiparous, singleton, cephalic,
≥37 weeks, no previous cesarean,
spontaneous labour
(3a) Augmentation
(3b) No Augmentation
≥37 weeks, no previous cesarean,
with induced labour or no labour
(4a) Induced labour
(4b) Cesarean before labour
(Continued)
42
Number of
cesarean
sections
(A)
n
Relative size of
Contribution to
Total number of
Rate of cesarean
group
overall rate
deliveries
(A/B) x 100
(B/Total obstetrical (A/Total obstetrical
(B)
population) x 100
population) x 100
n
%
%
%
6
31
19.4
32.3
6.3
4
2
26
5
15.4
40.0
27.1
5.2
4.2
2.1
7
10
70.0
10.4
7.3
4
3
7
3
57.1
100.0
7.3
3.1
4.2
3.1
1
22
4.5
22.9
1.0
0
1
9
13
0.0
7.7
9.4
13.5
0.0
1.0
0
2
0.0
2.1
0.0
0
0
2
0
0.0
0.0
2.1
0.0
0.0
0.0
Rate of cesarean section, by Robson classification groups (continued)
Hospital 1, 01-Apr-2012 to 30-Apr-2012
Number of
cesarean
sections
(A)
Total number
of deliveries
(B)
Rate of
cesarean (A/B)
x 100
Relative size of
group
(B/Total
obstetrical
population) x 100
Contribution to
overall rate
(A/Total
obstetrical
population) x 100
Robson classification group
n
n
%
%
%
≥37 weeks, previous cesarean
4
7
57.1
7.3
4.2
(5a) Spontaneous labour
3
6
50.0
6.3
3.1
(5b) Induced labour
0
0
0.0
0.0
0.0
(5c) Cesarean before labour
1
1
100.0
1.0
1.0
6 Nulliparous, singleton, breech
1
1
100.0
1.0
1.0
7 Multiparous, singleton, breech
3
3
100.0
3.1
3.1
8 Multifetal pregnancy
7
10
70.0
10.4
7.3
9 Singleton, transverse or oblique
lie
1
1
100.0
1.0
1.0
10 Singleton, cephalic, <37 weeks
2
6
33.3
6.3
2.1
All others with missing information
on presentation, parity,
gestational age, number of
fetuses, type of labour or previous
cesarean
2
3
66.7
3.1
2.1
N/A
0
N/A
N/A
N/A
34
96
35.4
100.0
35.4
Type of birth not indicated
43
TOTAL POPULATION
Clinical reports: for Midwifery Practice Users
• Active Practice Reports – available in the BIS
• Profile of Midwifery Births, Midwifery Care Profile – coming soon
Other reports that will be available in the future
• NICU/SCN Profile
• Healthy Babies Healthy Children (HBHC)
• Newborn Screening Ontario (NSO) & NSO Follow-up
• Prenatal Screening Ontario (PSO) & PSO Follow-up
• Public Health Unit (PHU)
• Assisted Reproductive Technology (ART)
44
Objective 2: Dashboards
A dashboard is a performance measurement system that
provides data on structure, process and outcome variables and
incorporates the following functions:
•
•
•
Reports on a selected key performance indicators (feedback)
Compares performance to established ideal levels (benchmark)
Provides alerts to trigger action when performance is sub-optimal
(signal)
Target
Alert
Warning
Dashboards are primarily implemented to drive quality
improvement.
Key Performance Indicators: selected using rigorous
process. Evidence summaries developed for each KPI.
http://www.bornontario.ca/reports/dashboard
45
Objective 2: Maternal Newborn Dashboard
46
Objective 2: Maternal Newborn Dashboard Report
47
Objective 2: Maternal Newborn Dashboard Sub-Report
You can’t manage
What you don’t measure.
48
Objective 2: Cubes
Tool to create customized queries.
COMING IN THE FUTURE
Types of Cubes
•
•
•
•
•
•
49
Pregnancy & Birth: maternal-newborn hospital users
Midwifery Practice Groups: BIS and Legacy data
NICU/SCN
Public Health Units
Newborn Screening
Prenatal Screening
Objective 2: BIS Reports
Roadmap & FAQ
Navigating further down webpage
Training materials
http://bornontario.ca/data/born-information-system/hospital-deployment
50
Objective 3: To highlight future BORN
reporting plans
Objective 3: Future BORN Reporting Plans
• BORN currently developing a strategic plan for future BORN reports
• Considerations:
– BIS Reports now provide comprehensive reporting options for authorized users
– How often?
– Regional (LHIN, PHU) versus provincial?
– Specialty topics versus routine surveillance report updates?
• Consultation with:
– Clinical, academic and public health experts who sit on BORN Committees
– Canadian Perinatal Surveillance System
– Other stakeholders: MOHLTC, PCMCH, OHA, CMO, LHINs, PHO/PHUs, etc.
52
Objective 3: Future BORN Reporting Plans
 2011-2012 BORN Annual Report (April 2013)
• Data Quality
• Infant Mortality
• Congenital Anomalies
• Normal Healthy Birth
• NICU/SCN
Additional Feedback?
[email protected]
53
Deshayne Fell, Epidemiologist
[email protected]
Sherrie Kelly, Epidemiologist
[email protected]
54

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