Increasing Maternal and Child Health (MCH) Epidemiology and Surveillance Capacity through Operational Efficiencies: An Examination of Louisiana PRAMS Process Improvement Efforts

BACKGROUND: The Centers for Disease Control and Prevention (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) has been an integral part of Louisiana MCH surveillance activities since 1997. Louisiana utilizes PRAMS data to inform program development, policy and resource allocation.  Per CDC protocol, a threshold response rate of 65% is required for findings to be generalizable at the population level.  Louisiana’s annual response rate has not exceeded 60% since 2004. Barriers to achieving the 65% rate included inability to reach mothers due to inaccurate or missing contact information and unappealing materials not clearly communicating the benefit of participation.   Staff spent excessive time searching for contact information and preparing mail materials. Solutions were sought to allow for improved visibility of the PRAMS brand and to gain more time for staff to focus on phone interviews and data entry.

METHODS: Improvement projects included:

Operations

• Redesigned all materials for aesthetic appeal and efficiency to increase PRAMS brand recognition, eliminate folding and reduce packet components
• Replaced individually addressed letters with generic, colorful cards prepared ahead of time
• Employed MCH-wide staff and student events to prepare mail materials
• Created program to electronically match WIC, newborn screening and PRAMS participant data to eliminate manual search for phone numbers/alternative addresses
• Prioritized/dedicated days and staff to search for missing/incorrect phone numbers 

Outreach

• Capitalized on partner relationships (WIC) for survey promotion and hand delivery
• Developed outreach materials (brochure and poster) for clinics and birthing hospitals
• Attended events targeting pregnant and new moms to promote PRAMS
• Increased reward from $10 to $20 gift card

RESULTS: Louisiana’s unweighted response rates increased 10 percentage points from 57% in 2014 to 67% in 2015.  

CONCLUSIONS: Louisiana’s comprehensive improvement efforts contributed to increased response rates, more timely availability of surveillance data and increased engagement from partners.  An initial effort to improve response rates through an increased reward did not have an effect on overall rates.  Only after a broader effort to target operational inefficiencies, materials design, and outreach were response rates effected as seen in the 10 percentage point increase in unweighted response rates from 2014 to 2015. The use of Kellogg funding to implement operational improvements and forge partnerships to promote PRAMS has affected the visibility of and interest in PRAMS.  While too early to tell the impact of partner outreach, activities initiated with WIC and Healthy Start should continue to elevate PRAMS recognition.