By Patricia W. Potrzebowski, PhD. Dr. Potrzebowski is the Executive Director of NAPHSIS—the National Association of Public Health Statistics and Information Systems
Vital statistics on important life events including births and deaths enable us to monitor prevalence of disease and overall health status, develop programs to improve public health, and evaluate the effectiveness of those interventions. Vital records from which these statistics are drawn serve critical administrative functions as well, proving someone is who they say they are when applying for official identification or benefits and stopping these benefit payments once individuals are deceased.
Given their value and importance to both public health and fraud prevention it's no wonder that for almost as long as we've collected vital statistics, myriad data users—health care providers, public health professionals, scientists, lawmakers and bureaucrats alike—have bemoaned their timeliness, or rather, lack thereof. Historically, vital statistics were often not made available for more than a year, or even longer, after the data year ended.
But in the timeless words of Bob Dylan, "The times, they are a changing…"
Five years ago, many would have scoffed at the idea that mortality statistics could be used in near real-time for public health surveillance. But this dream has become a reality. The National Center for Health Statistics (NCHS) recently posted this blog highlighting the vast improvements in mortality reporting by vital records jurisdictions and the use of the National Vital Statistics System (NVSS) to track pneumonia and influenza. With the success of this program, NCHS is currently developing surveillance partnerships to track deaths related to suicide, Creutzfeldt-Jakob disease, respiratory syncytial virus, and disasters. Other potential partnerships could focus on mortality surveillance data on firearm-related deaths, HIV/AIDS, stroke, Alzheimer's, diabetes, and many more. NCHS's Dr. Paul Sutton notes:
"As the quality and completeness of our data improves, it's just going to get better and better…In terms of potential, the improvements over the existing system are huge. We believe it's superior in every way."
So what brought about this transformation? It started in 2009 when a joint NAPHSIS-NCHS committee charged with negotiating the next five year vital statistics data contract between the states and NCHS began thinking about how to make improvements to the National Vital Statistics System. In 2013, with the support of the Annie E. Casey Foundation NAPHSIS convened data producers and users to document the challenges in the vital statistics supply chain—from the time of the event, to the release of the national data by NCHS—and identify short and long-term strategies for getting vital statistics in the hands of users more quickly.
As we documented in this infographic from our resulting "More Better Faster" report, the reasons for data delays are complex, and rooted in the complexities of the data collection process itself. We found the solutions wouldn't be straightforward, and more funding alone couldn't enhance timeliness. But together, NCHS, NAPHSIS, and the vital records jurisdictions have transformed vital statistics reporting. For example, federal and state funding has supported the expansion of electronic birth and death registration systems that enhance not only timeliness, but data accuracy and security. In addition…
NCHS and NAPHSIS worked together to revise the jurisdictions' contracts to shorten the deadlines for data submissions and to encourage more frequent data submissions using the State Territorial Exchange of Vital Events (STEVE) system.
Recognizing some—possibly many—jurisdictions would be challenged in meeting these new timeliness requirements, NCHS has a cooperative agreement with NAPHSIS for vital statistics improvement and to work with jurisdictions that are falling behind.
Through this agreement, NCHS and NAPHSIS are providing technical assistance, developing tutorials for data providers, and promoting improvements in vital statistics data that will make these data more useful for public health surveillance and research.
Beyond these formal agreements, there has been a dramatic culture shift across the jurisdictions and within NCHS to prioritize the end users' needs for data that are high quality, accessible, and timely. As we learned through our convening with the Annie E. Casey Foundation, vital statistics that are unresponsive to these needs are of little use. For example, data that are of the highest quality but three years old are not as useful, and data that are released quickly and are inaccurate are likewise of little value.
NCHS, NAPHSIS, and the jurisdictions are striving to find that delicate balance where "perfect isn't the enemy of the good," and "good is good enough." Opportunities for continuous quality improvement abound—be it continued implementation of electronic death registration systems in the remaining jurisdictions, increased utilization of these systems and more accurate reporting of cause of death data by providers, and widespread adoption of the Model State Vital Statistics Act. However, we should be proud of what we've already accomplished to make a good vital statistics system even better. Greatness is ours for the taking, and vital statistics data can only get better from here.