title: Implications for Improving Fetal Death Vital Statistics: Connecting Reporters' Self-Identified Practices and Barriers to Third Trimester Fetal Death Data Quality in New York City.
abstract: OBJECTIVE
  Perinatal mortality prevention strategies that target fetal deaths often utilize vital records data sets shown to contain critical quality deficiencies. To understand the causes of deficient data, we linked survey responses of fetal death reporters with facility fetal death data quality indicators.
  
  
  METHODS
  In 2011, we surveyed the person most responsible for fetal death reporting at New York City healthcare facilities on their attitudes, barriers, and practices regarding reporting. We compared responses by 2 facility data quality indicators (data completeness and ill-defined cause of fetal death) for third trimester fetal death registrations using Chi squared tests.
  
  
  RESULTS
  Thirty-nine of 50 facilities completed full questionnaires (78 % response rate); responding facilities reported 84 % (n = 11,891) of all 2011 fetal deaths, including 329 third trimester fetal deaths. Facilities citing ≥1 reporting barrier were approximately five times more likely to have incomplete third trimester registrations than facilities citing no substantial barriers (37.5 vs 7.9 %; RR 4.7; 95 % CI [1.6-14.2]). Reported barriers included onerous reporting requirements (n = 10; 26 %) and competing physician priorities (n = 11; 28 %). Facilities citing difficulty involving physicians in reporting were more likely to report fetal deaths with nonspecific cause-of-death information (70.9 vs 56.6 %; RR 1.3; 95 % CI [1.1-1.5]).
  
  
  CONCLUSIONS
  Self-reported challenges correlate with completeness and accuracy of reported fetal death data, suggesting that such barriers are likely contributing to low quality data. We identified several improvement opportunities, including in-depth training and reducing the information collected, especially for early fetal deaths (<20 weeks' gestation), the majority of events reported.
authors.affiliation: Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, 125 Worth St., Room 219B, CN-7, New York, NY, 10013, USA. elee7@health.nyc.gov.
authors.forename: Erica
authors.initials: E
authors.lastname: Lee
authors.affiliation: Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, 125 Worth St., Room 219B, CN-7, New York, NY, 10013, USA.|Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Amita
authors.initials: A
authors.lastname: Toprani
authors.affiliation: Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, 125 Worth St., Room 219B, CN-7, New York, NY, 10013, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Begier
authors.affiliation: Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, 125 Worth St., Room 219B, CN-7, New York, NY, 10013, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Genovese
authors.affiliation: Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, 125 Worth St., Room 219B, CN-7, New York, NY, 10013, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Madsen
authors.affiliation: Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, 125 Worth St., Room 219B, CN-7, New York, NY, 10013, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Gambatese
mesh_terms: D002423:Cause of Death; D000068598:Data Accuracy; D003644:Death Certificates; D005260:Female; D005313:Fetal Death; D046689:Fetal Mortality; D006801:Humans; D009519:New York City / Q000453:epidemiology; D054238:Perinatal Mortality; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011795:Surveys and Questionnaires; D017749:Total Quality Management / Q000379:methods
keywords: Data collection; Fetal death; Perinatal mortality; Stillbirth; Vital statistics