Maternity Framework
Antenatal Access Target and
Outcome Measures
Data Theme Work Stream
Women and Children’s Health Information
Programme
Etta Shanks
Senior Information Analyst
Lindsay Mathie
Project & Information Manager
Proposed Target –
Current Situation
Antenatal Access Target • Data from Scottish Morbidity Record 02 (SMR02)
• Key components
– The record is submitted by 6 weeks following the
end of
the month of discharge
– ‘Date of Booking’ field (will be Mandatory from 1st
April 2012)
– ‘Gestation at Time of Delivery’ field (Mandatory)
– Using both these fields ‘Gestation at Time of
Booking’ can be calculated
SMR02 Submissions
• In October 2010 ISD notified all Health
Boards of the definitional enhancement to
‘Date of Booking’
– the ‘Date of history taking appointment’ as
recorded on the ‘Demographic information
and EDD’ page in SWHMR Pregnancy
Record page 2
Why we need to pursue these
actions with SG support?
Submission backlogs across Scotland (for the
last 3 months of data available)
Aug 2011
3,349
Sep 2011
3,782
Oct 2011
4,479
All Health Boards
Number of SMR02 records submitted by
the target date of 6 weeks following the
end of the month of discharge
Submitted within 6 week target
Submitted after 6 week target
Estimated current backlog
10,000
8,000
6,000
Number of records
4,000
2,000
0
2,000
4,000
6,000
8,000
Nov09
Dec09
Jan10
Feb10
Mar10
Apr10
May10
Jun10
Jul10
Aug10
Sep10
Oct10
Nov10
Dec10
Month of discharge
Jan11
Feb11
Mar11
Apr11
May11
Jun11
Jul11
Aug11
Sep11
Oct11
Quality
• Of the SMR02 forms submitted in 2010, and where all necessary
fields were completed, we could derive a figure for 82% completion of
‘Date of Booking’
• A large number of records have been with ‘not known’
• An example: Gestation at booking calculated in NHS Fife (9%), NHS
Forth Valley (30%) and NHS Shetland (38%)
• SMR02 Data Quality Project in 2009 identified:
– In some sites date of booking be recorded in SWHMR but not
transferred to SMR02
– Findings and recommendation fed back to hospitals (a web report
is available)
• ISD can provide reports and analysis to help support you in
managing your local performance – what information would be useful
for you?
Proportion of patients booking <= 12
weeks gestation, 2010, by Health Board
of Residence
NHS Western Isles
NHS Tayside
NHS Shetland
NHS Orkney
NHS Lothian
NHS Lanarkshire
NHS Highland
NHS GG&C
NHS Grampian
NHS Forth Valley
NHS FIfe
NHS Dumfries & Galloway
NHS Borders
NHS Ayrshire & Arran
0
10
20
30
40
50
60
70
80
90
Proportion of patients booking <= 12
weeks gestation, Scotland, 2010, by
SIMD Quintile
60
50
40
30
20
10
0
1 - Most
Deprived
2
3
4
5 - Least
Deprived
Provisional Figures
Please contact ISD for copy of figures
nss.isdmaternity@nhs.net
Developing a Set of
Quality Measures for
Maternity Care in
Scotland
Policy Aims
• Improve early access to antenatal
services to support mothers-to-be to
breastfeed, improving maternal and
infant nutrition, reduce harm from
smoking, alcohol and drugs, and
improve healthy birth weight.
Proposed measures
• Access, HEAT Target
At least 80% of pregnant women in each SIMD
quintile will have booked for antenatal care by the
12th week of gestation by March 2015
– Data currently recorded on SMR02
• Check that all units are recording properly
• Encourage prompt completion of SMR02
• Monitor data and set up routine analysis
and reporting (quarterly)
Proposed Outcome Measures
Examples…
• Breast feeding
• Maternal and Infant nutrition
• Smoking
• Alcohol & drugs
• Improvement in birth weight
• Continuity of Carer
Institute for Healthcare
Improvement Framework
(adapted)
•
•
•
•
•
•
Measure title and Source (rationale)
Type of measure (outcome/process etc)
Why do we need it?
Definition
Exclusions (e.g. where it would be inappropriate)
Stratifiers (e.g. age, deprivation, ethnicity,
disability etc)
• Data collection method
• Analysis and presentation
Other Initiatives
•
•
•
•
Implementation of Patient Management Systems
National Screening Initiatives
– Pregnancy
– Newborn
– Universal Hearing Screening
– Congenital Anomalies
Child Health Screening
– Childhood Immunisations
– Breastfeeding
– Child Healthy Weight
Other targets, indicators and initiatives
– Alcohol & Drugs
– Sexual Health
– Patient Safety
– Smoking Cessation
– Stillbirth & Caesarean section groups
– Scottish Woman Held Maternity Record
– Scottish Birth Record and Neonatal systems
– Older Peoples Agenda
– Mental Health incl. Child and Adolescent Mental Health
The way through the
complexity
• Find the right balance:
– What we want to measure
– What is measurable
• Are we already measuring it?
– What makes sense in analysis
• e.g. sufficient numbers
– What the service will tolerate
ISD’s role
• Engage data providers and other stakeholders
• Assure the measure makes sense
• Tease out all the relevant definitions
• Work out how to get the data
• Collate the data
• Analyse and help to interpret resulting information
How will we get there…..
• Agree scope, plan and timescales by end of March
2012
• Project to run until March 2016
• Governance - including principles, deliverables &
outputs, plans for communication & engagement
• Agree development and phased implementation
approach with stakeholders
• Define and agree the Measures with stakeholders