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

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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

cmoyer@kdheks.gov

KDHE Contact Information

Shalae Harris, RN, BSN, MPAFIMR Coordinator/Chart AbstractorSedgwick County Health DepartmentHealthy Babies434 N. Oliver, Suite 110Wichita, KS 67208316-660-0984sharris@sedgwick.gov

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