Leveraging pregnant people-infant linkages from electronic health records in the largest integrated Midwestern healthcare system to improve long-term surveillance of public health threats - The association between prenatal exposures and early childhood outcomes are well established. However, challenges persist in understanding the mechanistic pathways over time, especially during the first six years of life. This gap is largely due to the lack of robust longitudinal data linking pregnant people and infants consistently through early childhood. Challenges in pregnant people-infant linkages include errors in patient identifiers, data quality, and missing data. Most importantly, pregnant people-infant linkage errors disproportionately affect racial minorities. Differences in linkage errors by race/ethnicity can produce biased results, limit the generalizability of the findings, and contribute to the widening health gaps between White people and people of color. Given the limited data available to assess emerging exposures and outcomes from perinatal care, infancy, and early childhood, the applicant organization Advocate Aurora Research Institute (AARI) – part of Advocate Aurora Health (AAH) – is proposing to improve national surveillance efforts by the CDC based on CDC, statewide, and healthcare system priorities, to improve critical health outcomes in response to Component A. AAH is the largest integrated healthcare system in the Midwest including - Chicago, IL and Milwaukee, WI. These diverse centers result in robust electronic health record (EHR) data from priority and underrepresented populations to include administrative, medication, laboratory, ultrasound, emergency room, delivery hospitalization, referrals, well-visits, postpartum, and other health data from pregnant person and infants through 6 years of age. AAH is a non-profit healthcare entity that directly maintains and enters information into the largest single instance of Epic in the world and able to demonstrate existing linkages between pregnant person and infant records on over 4,500 pregnant people-infant dyads from birth through at least six years of age. The objective of this proposal: Leveraging pregnant people-infant linkages from electronic health records in the largest integrated Midwestern healthcare system to improve long-term surveillance of public health threats is to: 1) Evaluate current surveillance data extracted from EHR on existing pregnant people-infant linkages, 2) Improve people-infant linkage data quality and dissemination by expanding coordination with external partners and organizations, and 3) Improve patient-community linkages through enhanced data quality and external partnerships. To carry out the study objectives, investigators will use AARIs current research data analytics infrastructure to extract clinical data on priority exposures, outcomes, and supplementary data on existing dyads (Objective 1), disseminate results internally and externally with partners in the CDC collaborative (Objective 2), and establish community partnerships to improve initiation and closing of patient referral loops (Objective 3). The overall goal of this project is to provide robust and meaningful data to improve the CDC’s surveillance of national pregnant people-infant morbidity and mortality measures to enable better health outcomes for pregnant people, infants, and children. AARI’s unique placement within the largest integrated healthcare system in the Midwest allows the capture of a robust and diverse cohort while capitalizing on an existing data infrastructure. A cohort, specifically of underrepresented pregnant people-infant dyads with data through early childhood is vital for equitable surveillance of current and emerging public health crises.
