Birth Certificate and Hospital Discharge - Word version

Form Approved

OMB No. 0920-0879

Exp. Date 03/31/2014

Birth Certificate and Hospital Discharge Linkage—State Survey

Thank you for your agreement to participate in this survey.

Please note that due to software requirements, the survey must be completed and submitted online in one session. If you are not ready to complete the entire survey, please wait until you have all your responses prepared before you begin.

If you have any questions, please contact [NAME] at [Email].

As was noted in the email you received, the purpose of this survey is to understand the status of birth certificate and hospital discharge linkages in the United States and to improve surveillance, research policy, and programs around maternal, infant, and child health.

The data collected from this survey will be used to understand whether a state has a birth certificate and hospital discharge linkage, the process and quality of the linkage, the resources related to linking, and barriers and limitations to linkages.

Your feedback will also be used for improvements in data linkages that inform public health surveillance, research, policy, and programs around pregnancy conditions, risk behaviors, and neonatal outcomes.

The survey is being conducted through collaboration with AMCHP, NAPHSIS, and the Centers for Disease Control and Prevention.

Has any organization, including your state health department, or another organization or university, linked your state’s birth records and hospital discharge records (maternal and/or infant discharges) in the last 4 years?	___ Yes ___ No __Don’t know	If no or don’t know, go to question 22
Which inpatient hospital discharge records are linked to the birth record, in the last 4 years?	__Maternal __Infant __Both
Does your state health department currently have access to this linked file for analysis?	___ Yes ___ No __Don’t know
How often is the linked file updated?	__Less than once every two years __Every other year __Annually __More frequently than annually __ __Have only done the linkage once __Other (specify) __Don’t know
Is your linkage automated (i.e. when data are received, there is already code developed to clean and merge into full dataset)?	__Yes __No __Don’t know	If no, go to question 7 If don’t know, go to question 9
If yes, what percentage of records can be linked electronically without manual judgment or intervention?	About____%	Go to question 8
If no, why not?	__Lack of experience __Lack of software __Data not provided in an electronic format __Data files are sent in different format __Other (specify) __Don’t know
What data software is used to automate the linkage?	--By Hand --SAS --Stata --SPSS --Microsoft Access --SQL Server --Oracle --Fril --LinkPlus --Link Pro --Link King --Other (specify)
Would you be interested in collaborating with other states in sharing linkage processes, including lessons learned, challenges encountered, and codes?	__Yes __No Not Sure	If yes, go to question 12 (if no, proceed to Q10) If not sure, go to question 11
If no, why not? (check all that apply)	__Lack of staff time __Confidentiality of data __Other (specify)	Go to question 12
If not sure, what are your concerns? (check all that apply)	__Time commitment __Cost __Confidentiality of data __Other (specify)	Go to question 12
You stated that an organization conducts a linkage in your state, more specifically, has your state health department conducted this linkage, either maternal or infant, in the last 4 years?	___ Yes ___ No __Don’t know	If no or don’t know, go to question 14
Which organizational unit or program in the state health department was responsible for doing the linkage? (Check all that apply)	__Vital Records/Health Statistics Office __Epidemiology Office __MCH Program Office __Office responsible for collecting hospital discharge abstracts __Other (specify)
What data elements are used to link the data sources? (Check all that apply)	__Maternal social security number __Child’s Date of birth __Child’s name __Race __Gender of child __Mother’s first name __Mother’s last name __Mother’s surname prior to first marriage __Hospital medical record __Birth Facility/Hospital Name __Discharge Date __Patient Address (City, state, house number, zip code) __Other patient identifier (specify) __Other (specify) __Don’t know
What is the methodology used for linking the records? (Check all that apply)	__Deterministic (specify %) __Probabalistic (specify %) __Other (specify and %)
Has the quality of the birth-hospital record linkage been evaluated?	___ Yes ___ No __Don’t know	If no or don’t know, go to question 18
How has the quality of the linkage been evaluated? (Check all that apply)	__Review sample of records __Chart review __Other (specify)
Does your state utilize the linked birth and hospital record dataset for research, policy, surveillance or programs?	__Yes __No __Don’t know	If no or don’t know, go to question 20
If yes, how does your state currently use your birth-hospital record linked dataset? (Check all that apply)	__Statistical reports (regular published or unpublished written reports) __ Surveillance (understand trends and prevalence estimates) __ Special studies __ Policy evaluation (pass legislation, provide legal support) __Program or quality improvement __Other (specify)
What other ways would you like to use your birth-hospital record linked dataset? (Check all that apply)	__Statistical reports (regular published or unpublished written reports) __ Surveillance (understand trends and prevalence estimates) __ Special studies __ Policy evaluation (pass legislation, provide legal support) __Program or quality improvement __Other (specify)
What prevents your states from using the birth-hospital record linked dataset the way you would like to use it?	__ Cost __ Lack of staff time available ___Lack of interest in utilizing the linkage __Most people are not aware of the availability of linkage __Access to linkage too difficult to obtain __ Other (specify) __Don’t know	Skip to Q25
In your organization or state, what prevents birth-hospital discharge linkages from occuring? (check all that apply)	__ Cost __ Lack of staff time available for linkage __Data linkage is not a priority __Cannot access raw hospital discharge data __Cannot access raw birth certificate data __No statewide hospital discharge data collected ___Linkage fields (e.g. name, SSN, or other identifiers) not collected or not available ___Lack of effective matching/linkage software ___Lack of interest in obtaining/using these data __ Other (specify) __Don’t know
Does your organization or state want to have a linkage of birth and hospital discharge records?	__Yes, definitely __Yes, no rush __Undetermined __No, not right now __No, never __Don’t know
Would you be interested in collaborating with other states to learn about the linkage process?	__Yes __No __Don’t know
The following questions are to get an understanding of the quality of each individual data source. Please answer to the best of your ability.
Has the quality of the data items from the birth record only been evaluated?	___ Yes ___ No __Don’t know	If no or don’t know, go to question 27
How has the quality of the data items from the birth record been evaluated? (Check all that apply)	__ Medical chart validation __Linkage with other data sets __Other (specify) __Don’t know
Has the quality of the data items from the hospital discharge abstract only been evaluated?	___ Yes ___ No __Don’t know	If no or don’t know, go to question 29
How has the quality of the data items from the hospital discharge abstract been evaluated? (Check all that apply)	__ Medical chart validation __Linkage with other data sets __Other (specify) __Don’t know
Is there a state developed instruction manual for completing the birth record for the birth clerk?	__Yes __No __Don’t know
Are there training programs available for hospital and birthing center staff on how to fill out the birth record?	__Yes __No __Don’t know	If no or don’t know, go to question 32
If yes, who provides the trainings on procedures for completing the birth record?	__Online (if online, offered by whom?) __Someone in the health department (specify) __Someone from a hospital (specify __Other (specify) __Don’t know
Are personnel completing the birth record provided any guidance (written, training, consultation) on how to prioritize different sources of information and make decisions when there are conflicting values?	__Yes __No __Don’t know	If no or don’t know, go to question 34
How often is training to complete the birth record offered?	__Monthly __Quarterly __Annually __Less frequently than once a year __As needed or on demand __Available online at anytime __Other (specify) __Don’t know
Is there an instruction manual for abstracting hospital discharge data?	__Yes __No __Don’t know
Are there training programs available for hospital and birthing center staff on how to abstract data from hospital discharge data records?	__Yes __No __Don’t know	If no or don’t know, go to question 37
If yes, who provides the trainings on procedures for abstracting the hospital discharge data?	__Online (if online, who is offering the training) __Hospital Association __Someone in the health department (specify) __Someone from a hospital (specify __Other (specify) __Don’t know
Are personnel abstracting data from discharge records given guidance on how to prioritize different sources of information and make decisions when there are conflicting values?	__Yes __No __Don’t know	If no or don’t know, go to 39
How often is training to abstract hospital discharge records offered?	__Monthly __Quarterly __Annually __Less frequently than once a year __As needed or on demand __Available online at anytime __Other (specify)	Go to 39
What other data do you link to the birth record? (Check all that apply)	__No other linkages __WIC __Medicaid __Infant deaths __Death certificate of women of reproductive age __PRAMS __Birth defects registry __Newborn blood spot screening __Newborn hearing screening __Immunizations __Family planning (Title X) __Health department client data __Public health program data (Healthy Start, home visiting, etc.) __Education data __Child maltreatment data __Children’s special healthcare program __Health insurance other than Medicaid __Outpatient Records __ER/Ambulatory Data __EMS Registry __Other (specify)
Is there any other information you think we should know regarding hospital discharge and birth record linkages?
Please state your jurisdiction and any additional comments on this survey?

Public reporting burden of this collection of information is estimated to average 25 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0879).