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Sedgwick County Fetal and Infant Mortality Review
(FIMR)
Project Imprint
Shalae Harris, RN, BSN, MPAFIMR Coordinator, Chart Abstractor
Ty Kane, MPH Carol Moyer, ASN, BS, MPHSCHD, Community Health Analyst KDHE, Office of BEPHI, Epidemiologist
Christy Schunn, LSCSW Linda Frazier, MD, MPHSIDS Network of KS, Executive Director KUMC-Wichita, Dept. of OB/GYNFIMR Maternal Interviewer
Infant health is a measure of community well-being.
(NFIMR website, 2001)
In 1984, National Fetal and Infant Mortality Review (NFIMR) was first developed by the federal Maternal Child Health (MCH) Bureau.
A continuous quality improvement model to help communities improve the services and resources available to women and families.
NFIMR began with 6 FIMR projects in the U.S.
In 1990, a public health collaboration began between the American College of Obstetricians and Gynecologists (ACOG) and the MCH Bureau to further expand FIMR projects.
There are 200 FIMR programs in 40 U.S. states.
The FIMR Project: Using the Public Health Model with Community Collaborations
History of Sedgwick County FIMR June 2007 ~ Joint research agreement with KDHE and Kansas City Healthy Start
February 2009 ~ Movement to develop a collaborative FIMR project based on the NFIMR model
September 2009 ~ FIMR Case Review Team (CRT) training
May 2010 ~ Part-time Chart Abstractor hired
July 2010 ~ Initial CRT Meeting
November 2010 ~ Initial Community Action Team meeting
April 2011 ~ KDHE IRB Approval
Project of the Child Health Advisory Committee
Formed in 2009 to review the IM problem in Kansas
Identifies potential solutions and recommendations for IM
Panel consists of 22 representatives from state, local, and private organizations who have a broad range of expertise in maternal child health.
Kansas Blue Ribbon Panel on Infant Mortality
Milestones
February 2010 Interim Recommendations
April 2010 Legislative Effort
February 2011 Actionable Framework
Kansas Blue Ribbon Panel on Infant Mortality
Sedgwick County FIMR: A Collaborative Process
Funding◦ Healthy Babies/Healthy Start◦ Central Plains Health Care Partnership
Support◦ SCHD - various departments◦ KDHE◦ KUMC-Wichita◦ SIDS Network of KS◦ Medical Society of Sedgwick County◦ Wesley Medical Center & Via Christi Health
Funding and Support for Sedgwick County FIMR
Why does Sedgwick County have a FIMR?
2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009
IMR for Sedgwick County (African American)
17.4621653084983
17.774343122102
17.3343605546996
19.1864927091327
19.5852534562212
21.5990905646078
17.9533213644524
18.7891440501043
IMR for Sedgwick County (all races)
9.02716914986853
8.60310421286033
7.95211255297767
7.84534697238958
8.19462227912933
8.69674290253795
7.69451152130313
8.06484132424695
IMR for Kan-sas (all races)
7.06986692015209
7.05393837801962
7.00246946990968
7.10750630232617
7.2742405326675
7.53174266409898
7.45215061526367
7.39888457420457
IMR for U.S. (all races)
6.91 6.89 6.87 6.84 6.78 6.77 6.65 6.53
2.5
7.5
12.5
17.5
22.5
Infa
nt M
orta
lity
Ra
te (p
er 1
,00
0 liv
e b
irth
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Infant Mortality Trends2000-2009
U.S. 2008, 2009 preliminary dataSource: Bureau of Epidemiology and Public Health Informatics, KDHE; National Center for Health Statistics
Infant Mortality Rates Worldwide(2009)
6.5
4.6
4.3
3.5
3.9
3.3
2.5
2.4
0 1 2 3 4 5 6 7
United States
United Kingdom
Australia
Germany
France
Spain
Sweden
Japan
Rate per 1,000 live birthsOECD Health Statistics
The Causes of Infant Mortality
Low birth weight
Prematurity
Birth Defects
SIDS
Disparities in health care access
Disparities in living conditions
Relational issues
Stress
Environmental conditions
Physical Social/Environmental
The FIMR Process
Notification of death
Case records abstraction
Maternal/Family interview
Case summary
The FIMR process: Data Gathering
Reviews case data from medical records and family interviews
Identifies trends and gaps in services
Makes recommendations to the CAT for systemic community change
The FIMR Process: Case Review Team (CRT)
21 members met July 2010-June 2011 Representing over 20 organizations 22 cases reviewed 25 Cases with attempted interviews 12 Cases with completed interviews
2010 recommendations surround 3 themes:◦ Education◦ Connection◦ Access
2010 FIMR CRT
Develops community interventions based on recommendations received
Utilizes existing community resources to implement intervention strategies
Addresses the need for resources and services not currently available
The FIMR Process: Community Action Team (CAT)
CAT core team is 15 members
Past year met 7 times
Representing 12 organizations
2 task forces focusing on FIMR CRT education recommendations:◦ Maternal Tobacco Cessation CAT Task Force◦ AHBBY CAT Task Force-PPE project
2010 FIMR CAT
A FIMR Community Collaboration:SIDS Network of Kansas, Inc.
FIMR Maternal/Family Interview
FIMR Maternal/Family Interview Process
Interview Challenges Encountered
Interview Benefits
If you don’t know where you’re going, how are you gonna’ know when you get there?–Yogi Berra
Evaluation
Carol J. Moyer, RN, MPH, Epidemiologist, KDHELinda M. Frazier, MD, MPH, Professor, KU School of Medicine-Wichita
Why Evaluate?
•Because funding agencies require it•Determine if your program is making a difference•Program improvement
• FIMR is about the cycle of improvement•Best use of resources
Goals vs. ObjectivesGoals
• “Warm and fuzzy”• Non-specific• Non-measurable
• Ex: Improve birth outcomes for infants born in SG County
• EX: Improved services for pregnant moms in SG County
Objectives• Realistic targets for
program/project• Answers
– Who– What– When– Why– EX: Increase number of
cribs provided to high risk pregnant women
INPUTS: Resources dedicated to or consumed by the program ACTIVITIES: The actions used to bring about the intended program changes or results.OUTPUTS: The direct products of program activities OUTCOMES / IMPACTS: Benefits for participants during and after program activities
Source: Measuring Program Outcomes: A Practical Approach © Copyright 1996 United Way of America
Logic Models
Resources Activities Outputs(Process
evaluation)
Short & Intermediate
Long Term / Impact
In order to accomplish our set of activities we will need the following:
In order to address our problem or asset we will accomplish the following activities:
We expect that once accomplished these activities will produce the following evidence of service delivery:
We expect that if accomplished these activities will lead to the following changes in 1-3 years (short term time interval) or 4-6 years ( intermediate time intervals)
We expect that if accomplished these activities will lead to the following changes in 7-10 years
W.K. Kellogg Foundation Logic Model Development Guide downloaded 11/27/07 from http://www.cdc.gov/eval/resources.htm
Logic Model Development
Resources Activities Outputs(Process)
Short Intermediate Long Term
/Impact
FIMR, collaborating partners (Kansas Quit Line, KDHE)
Educational needs research
Healthy Babies Program, SG County
Peer reviewed research on causes of LBW
Establish program to educate nurses working in prenatal care clinics
Gather baseline data
Protocol for 5 A smoking cessation and motivational interviewing for pregnant women
Baseline data
Increase % of pregnant women who follow through with the Quit Line.
Increase number of warm handoffs
Increase % of pregnant women who reported they quit smoking
Reduce % of low birth weight babies (<2500 grams)
Goal: All infants born in Sedgwick County will be healthy.Logic Model Development
Deaths with birthweight >350 g
2010
• Live births: n=36• Stillbirths: n=28
Summary of findings
• Top causes of death are birth defects, prematurity and unsafe sleep/SIDS
• 3/4 of liveborn infant deaths are in 1st 28 days
• Medical risk factors: smoking, drug/alcohol, obesity, twins, older maternal age
Live births
1 Project Imprint, 20102 KDHE annual summary, Sedgwick County, 20093 Wesley Medical Center inpatient data, all births
*At any time during pregnancy
Live births and stillbirths
*At any time during pregnancy 1 Project Imprint, 20102 KDHE annual summary, Sedgwick County, 20093 Wesley Medical Center inpatient data, all births
Communities with FIMR• Data assessment and analysis• Client services and assess• Quality assurance and improvement• Community partnerships and mobilization• Policy development• Enhance workforce capacity
The National Evaluation of Fetal and Infant Mortality Review (FIMR)
http://www.nfimr.org/site/assets/docs/ClinicalReviewArticle.pdf
FIMR Case Review Team (CRT) issues that lead to community action (Percent of FIMR Programs)•Prenatal care - 82.5%•Substance abuse - 81.5%•Sudden infant death syndrome risk reduction - 86%•Smoking cessation - 72%•Domestic violence - 75.5%
The National Evaluation of Fetal and Infant Mortality Review (FIMR)
http://www.nfimr.org/site/assets/docs/ClinicalReviewArticle.pdf
Carol Moyer, RN MPHData Quality Epidemiologist
Bureau of Epidemiology and Public Health InformaticsDivision of Health
Kansas Department of Health and Environment Curtis State Office Building
1000 SW Jackson Street, Suite 130Topeka, Kansas 66612
(W) 785-296-8627(F) 785-368-7118
KDHE Contact Information
Shalae Harris, RN, BSN, MPAFIMR Coordinator/Chart AbstractorSedgwick County Health DepartmentHealthy Babies434 N. Oliver, Suite 110Wichita, KS [email protected]
Sedgwick County Contact Information
Dr. Dennis Cooley, Chairperson, Kansas Blue Ribbon Panel on Infant Mortality “Kansas Infant Mortality” PowerPoint, September 2, 2010.
Kansas Department of Health and Environment, Bureau of Family Health, Bureau of Public Health Informatics.
Kansas Department of Health and Environment, Center for Health Disparities
Kansas Blue Ribbon Panel on Infant Mortality ,Infant Mortality Factsheet and FIMR concept paper. KU School of Medicine- Wichita, Dr. Linda Frazier and evaluation team
SIDS Network of KS, Christy Schunn, LSCSW
TFIMR, Tulsa Fetal & Infant Mortality Review Project, “An Introduction for Prospective Members of the Case Review Team (CRT), PowerPoint, 1998.
NFIMR, National Fetal Infant Mortality Review, ACOG website
Acknowledgments