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Data Collection Overview

National Maternal Mortality Data Collection (NMMDC)

Data Collection Sources

The data for the National Maternal Mortality Data Collection are collated from state and territory maternal mortality review committee sources. The Australian Institute of Health and Welfare (AIHW) obtained jurisdictional approval for release of these data to the AIHW.

Institutional environments

The AIHW is Australia’s national agency for health and welfare statistics and information. The role of the AIHW is to provide information on Australia’s health and welfare, through statistics and data development which inform discussion and decisions on policy and services. The AIHW works closely with all state, territory and Australian Government health authorities in collecting, analysing and disseminating data. The AIHW is an independent statutory authority within the Health and Ageing portfolio, and is responsible to the Minister for Health and Ageing. The AIHW is governed by a Board, which is accountable to the Parliament of Australia through the Minister.

Relevance and Scope

The National Maternal Mortality Data Collection is a specification for data compiled primarily from state and territory maternal mortality data collections, or where not available, other data sources. For the 2006–12 Data Set, data was requested on the death of all women reported to have died while pregnant or within 42 days of termination of pregnancy in Australia in hospitals, birth centres and the community between these years. Information was collected from each state and territory health department through the completion of a standardised data collection form: the National Maternal Death Reporting (NMDR) form 2006–2012, as well as any additional case summaries. Specifications for the NMDR form 2006–2012 used nationally standardised data items where available from the National health data dictionary which has a repository, METeOR - AIHW online metadata repository. It includes data items relating to the mother, including demographic characteristics and factors relating to the pregnancy, labour and birth; details of death; classification of death and data items relating to the baby, including birth status.
A National Maternal and Perinatal Mortality Advisory Group (NMPMAG) has been convened to oversee the establishment of an ongoing national maternal mortality data collection.

Timeliness

Historically, data collection and reporting from the Maternal Death Reporting Data Set has been on an ad hoc basis. The AIHW has since created an electronic data collection system for an established national collection. Jurisdictional processes for review of maternal deaths and the time-frames for collation and review of national data introduce a lag period of 2 to 3 years between the end of the reference period and the release of the report. Data are published in the Maternal deaths in Australia series. The most recent published report for the reference years 2008 to 2012 was published in 2015 by the AIHW in conjunction with the National Epidemiology and Statistics Unit (NPESU).

Accuracy

Inaccurate responses may occur in all data provided to the AIHW. The AIHW does not have direct access to Maternal mortality committee records to determine the accuracy of the data provided. However, the AIHW undertakes validation on receipt of data. Data received from states and territories are checked for completeness, validity and logical errors. Potential errors are queried with jurisdictions, and corrections and resubmissions are made in response to these edit queries. The AIHW does not adjust data to account for possible data errors.
Errors may occur during the processing of data by the states and territories or at the AIHW. Processing errors prior to data supply may be found through the validation checks applied by the AIHW. The data are corrected when verification of an error was supplied.
The AIHW does not adjust the data to correct for missing values.
Prior to publication, data are referred back to jurisdictions for checking and review. Note that because of data editing and subsequent updates of state/territory information, numbers reported may differ from those in reports published by the states and territories.
While definitions and some individual data elements have changed over time in response to expert review, changes in international definitions and coding relating to maternal deaths, in many cases it is possible to map these changes and make meaningful comparisons over time.

Accessibility

The latest published product is Maternal deaths in Australia 2008–2012.
Data are also used in a number of other AIHW products including Australia’s health and the Australia’s mothers and babies series. Data are subject to strict confidentiality restrictions due to the small number of deaths and potential for identification and are not available on request. In accordance with the Human Research Ethics Committee (HREC) approvals these data will be kept for seven years from the date of report publication and will then be destroyed.

Interpretability

The organisational structure including relevant legislation, policy and process for maternal death data collection varies by state and territory. The National Maternal Death Report Data Set reflects these variations. In all cases the best available information is used to form the National Maternal Death Report Data Set.
An overview of each state’s maternal death data collection process as it applied to the 2008–12 Data Set is outlined below (data at this times was supplied to NPESU):
The New South Wales Ministry of Health is notified of maternal deaths through a variety of organisations and methods including: hospitals, the Department of Forensic Medicine at Glebe, Ministry of Health systematic searches of New South Wales population health data sets (e.g. Admitted Patient Data Collection and the New South Wales Perinatal Data Collection) and through the National Coronial Information system. The number of maternal deaths for each year is assessed against Australian Bureau of Statistics (ABS) mortality data, where available (deaths with an ICD-10 cause of death code commencing with an ‘O’) to maximise ascertainment. During the development of the 2008–12 report, the New South Wales Maternal and Perinatal Committee were out of term and a number of cases were provided to NPESU as not yet reviewed by the New South Wales Maternal and Perinatal Committee. For some cases, only very limited information was available.
In Victoria, maternal deaths are identified through direct notification by health services, Victorian Perinatal Data Collection Unit (birth forms), the Coroner’s Office, the Registrar of Births, Deaths and Marriages and through media reports. In 2010, automatic electronic notification through the coronial e-Medical Deposition Form was introduced.
Queensland Health conducts dedicated searches of hospital administrative data sets intended for the sole purpose of identifying maternal deaths. In 2012, the Minister of Health approved consideration of changes to the Public Health Act to mandate reporting of maternal deaths to the Department (working with the Queensland Maternal and Perinatal Quality Council).
South Australia Health has no formal process of maternal death notification in place. The Maternal Mortality Committee accesses multiple notifications, including review of media articles, word of mouth, clinicians, pathologists and sentinel event reporting from hospitals. Although there is a tick box on death certificates to indicate if a woman has been pregnant in the last 3 months, this has never been a source of notification to the Maternal Mortality Committee of a maternal death. Hospital separation discharge codes are also reviewed as a quality check to identify maternal deaths. However, to date, this process has never informed the Maternal Mortality Committee of a maternal death the Committee was not already aware of. Similarly, sentinel event reporting has not identified a new maternal death to this Committee.
Data provided by Western Australia has been subject to legislative privacy restrictions, and limited information was initially provided to the NPESU. Data as collected by the Western Australian Perinatal and Infant Mortality Committee were not provided and data were sourced from the Department of Health, Western Australia perinatal and hospital administrative data collections. Classification of death, as decided by the Maternal Mortality Committee, was subsequently supplied at a later date for some cases.
The Department of Health and Human Services Tasmania is notified of maternal deaths through the following sources: health statistics, the Register of Births, Deaths and Marriages and local clinicians who are members of the Tasmanian Council of Obstetric and Paediatric Mortality & Morbidity (COPMM) (state-wide) and local hospital Morbidity and Mortality Committees.
Information on the process of notification and data collection for 2006–10 was not provided by the Australian Capital Territory Department of Health.
Northern Territory undertook a process of maternal death ascertainment and review specifically to supply data to the National Maternal Death Report Data Set 2008–12.

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