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Data to Action:

Examples of how data at the State Center for Health Statistics is used to improve health!

The Perinatal Quality Collaborative of North Carolina (PQCNC): The Vital Statistics Team in the Statistical Services Unit provided data regarding the rising rates of Cesarean sections and preterm deliveries in North Carolina to the PQCNC). As a result, perinatal leaders at PQCNC concluded that some scheduled early term births (either induction of labor or planned Cesarean delivery) occurring in the state might be due to non-medical or non-obstetrical indications (early-term elective delivery or EED). EEDs carry a significantly increased risk to the baby and may place infants at greater risk of Neonatal Intensive Care Unit admissions for increased transient tachypnea of the newborn, respiratory distress syndrome, ventilator support, suspected and proven sepsis and/or newborn feeding problems. As a result, in 2009, the PQCNC partnered with the March of Dimes to launch the "39 Weeks" project. The goal of the initiative was to eliminate elective delivery less than 39 weeks without documented fetal lung maturity in participating hospitals. Forty-one N.C. hospitals participated in the first year of the project, and the program reported that EEDs were reduced by 43 percent in these hospitals.

World Trade Center (WTC) Exposure and Cancer Outcomes: N.C. Central Cancer Registry data along with 10 other state registries data were linked with the World Trade Center Health Registry (WTCHR) to determine an association between World Trade Center Exposure and Excess Cancer Risk. This study was designed to monitor the health effects of the Sept. 11, 2001, attacks among rescue/recovery workers and persons who worked, lived or attended school in lower Manhattan. The study concluded that among persons enrolled in the WTCHR, there was an excess risk for prostate cancer, thyroid cancer and myeloma in 2007–2008 compared with that for New York State residents. These findings were based on a small number of events and multiple comparisons and no significant associations were observed with intensity of WTC exposures. Cite:

E. coli Outbreak Investigations: The Health and Spatial Analysis Unit worked closely with the Epidemiology Section in October 2012 on an outbreak of E. coli. Preliminary investigations and interviews determined that the outbreak involved the Cleveland County Fair. A geographic information system (GIS) was used to map the fairgrounds to determine the best locations to collect samples from the environment. Results of the samples were added to the map and the source of the outbreak was easily determined to be near the petting zoo. The map was also used to communicate to the press and public the actions taken by N.C. DPH during the investigations.

Women Infants and Children (WIC): Several years ago, a WIC Vendor was found to be committing fraudulent actions and was removed from the WIC vendor program. That vendor sued WIC to be reinstated to the program. The reason given for the vendor to be reinstated was that WIC would not be able to serve the clients in that area of town. Through
the use of GIS, it was easily demonstrated in court that there were vendors as close or sometimes located even closer to the clients than the fraudulent vendor. WIC successfully defended the decision to remove the vendor.

Monitoring prevalence of neural tube defects to help focus folic acid education programs in areas with the highest prevalence: Western North Carolina had one of the highest rates of neural tube defects in the United States, but since the mid-1990s the rate of birth defects like spina bifida has dropped almost 80 percent in that region following fortification and other folic acid promotion initiatives. Prevalence information from the Birth Defects Monitoring Program (BDMP) helped target and evaluate folic acid education efforts.

Research collaboration to identify risk factors and preventions to reduce the occurrence of birth defects: Since 2002 the BDMP has been a collaborator on the National Birth Defects Prevention Study (NBDPS), which is a multistate project aimed at identifying the causes of major birth defects. The NBDPS has studied dietary and nutritional factors, medications, occupational and environmental exposures and various lifestyle factors as they relate to preventable causes of birth defects.

Promoting Preconception Health in North Carolina: The North Carolina Strategic Preconception Plan was developed as part of a statewide collaborative effort among over 80 different leaders and organizations. The plan took over a year to develop and focused on two health issues in particular; healthy weight and pregnancy intendedness. The North Carolina Preconception Health Coalition strives to be data driven both in development of its strategic plans and in monitoring the impact of preconception health activities throughout the state. The Coalition utilized the Pregnancy Risk Assessment Monitoring System (PRAMS), the Behavioral Risk Factor Surveillance System (BRFSS) and vital statistics data on women of childbearing age to develop their initial Preconception Health Strategic Plan for the state. According to the Coalition: "The use of PRAMS, BRFSS, vital statistics, and census data was vitally important to the process of creating the initial 2008–2013 Preconception Health Strategic Plan and is critical to the work currently being done to prepare the 2014–2019 Preconception Health Strategic Plan. Systematically reviewing the data during stakeholder meetings helps inform the decisions that the Preconception Health Leadership Team makes concerning funding opportunities, educational materials, social marketing, and program development.… Having access to data sources that help guide strategic planning and prioritize funding decisions is essential to implementing effective interventions that can improve the health of women and their infants." Each year the Statistical Services Unit staff provides updated data from PRAMS, BRFSS and other data indicators that the Coalition uses to help track the state’s progress on these indicators and determine the effectiveness of maternal health initiatives throughout the state.