Successful Implementation of Pregnancy Risk Assessment Monitoring System Studies

Kentucky Department for Public Health, Division of Maternal and Child Health

What Is PRAMS?

In 1987, the Pregnancy Risk Assessment Monitoring System (PRAMS) was developed to find out why some babies are born healthy and others are not. By collecting data and monitoring mothers’ behaviors and experiences before, during, and immediately after pregnancy, PRAMS is designed to:

  • Identify groups of women and infants at high risk for health problems;
  • Examine changes in health status; and
  • Measure progress towards goals in improving the health of mothers and infants.

PRAMS, administered by the Centers for Disease Control and Prevention (CDC), is an ongoing, population-based data-collection effort. It supplements vital records by providing state-specific data on maternal behaviors and experiences for planning and assessing health programs for before, during, and immediately after pregnancy. One of the key features of PRAMS is that it uses standardized data collection methods, allowing data to be compared among states.

Our Experience with PRAMS

Since 2013, we have been conducting monthly PRAMS telephone surveys for the Massachusetts Department of Public Health, Bureau of Family Health and Nutrition. In 2018, we began conducting monthly PRAMS telephone surveys for the Rhode Island Department of Public Health, Center for Health Data and Analysis. We have also conducted many other heath surveillance assignments that use mail and telephone data collection.

PRAMS in Kentucky

In 2016, the CDC funded the Kentucky Cabinet for Health and Family Services, Department for Public Health, Division of Maternal and Child Health, to participate in PRAMS. In recent years, Kentucky has seen an increase in both maternal and sudden unexplained infant deaths, and the Division wanted to implement PRAMS to learn more about these increases, as well as how to help mothers with perinatal health, such as breastfeeding, prenatal dental care, and sleep safety. We responded to an RFP and were selected to implement PRAMS in Kentucky from the ground up.

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Experience Is Key to Smooth Implementation

Our PRAMS experience made many implementation processes go well. We anticipated the Division’s needs and already knew how to handle many of the problems that could arise.

  • PIDS

    One of the operational aspects of PRAMS data collection requires the use of the PRAMS Integrated Data Collection System (PIDS). We were among the first firms to test and then adopt PIDS. Implementation of PRAMS in Kentucky went smoothly, because we are thoroughly familiar with PIDS and experienced in its use.

  • Interviewers

    Because some of the questions posed by PRAMS interviewers are personal, only female interviewers are used. All are carefully screened; subject to background checks; and trained in both the use of PIDS and interviewing techniques. This ensured that interviewing was handled appropriately from the beginning.

  • Multi-mode Data Collection

    We specialize in large-scale custom healthcare studies and have conducted many other heath surveillance assignments that, like PRAMS, use mail and telephone data collection. This experience lends itself to the strict requirements and logistical complexities of PRAMS, such as PRAMS’s successive 90-day cycles with multiple steps with mailings and telephone surveying in each cycle.

  • Ongoing Communication and Support

    We developed special materials and tools to support all operational aspects of PRAMS. We also provided the Division with support in applying for supplemental funding from the CDC for additional survey questions related to opioid use. Like many other states, Kentucky is struggling with substance use challenges, such as increased emergency room visits and death rates due to overdoses. With a turnaround for submissions of only a month, we gave insights and helped the Division prepare a well-designed application for submission in a timely manner.

One particularly challenging aspect of the application was requesting funding for a callback survey on opioid use to be administered to mothers who completed PRAMS. The Division succeeded in getting funding for the callback survey which will be administered when babies turn nine months old.

  • Innovative Experimentation

    We are particularly adept at data collection strategies for hard to reach respondents. For example, one challenge facing Kentucky was collecting enough data from African American mothers, a population of special interest because of particularly high infant mortality rates. The Division had been oversampling African American mothers but response rates from this group were significantly lower than from other groups. In addition, this oversampling was disproportionately effecting the overall response rates.

We worked collaboratively with the Division and the CDC to increase those response rates, using a configuration in PIDS that allows for conducting an “experiment.” When the opportunity to provide an additional incentives was presented, we configured an experiment in PIDS to test whether this would increase response rates. Half of African American mothers are offered an additional incentive, while the other half are offered only the standard incentive. Preliminary results look promising; we will fully analyze and report the results at the conclusion of the experiment.

“We appreciate how closely MDR’s staff worked with us,” said Tracey D. Jewell, MPH, BS, Epidemiologist, Division of Maternal and Child Health, Kentucky Department for Public Health. “They were very responsive and timely.”

Jennifer Oliver - Practice Leader