Fetal and Infant Mortality Review

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Fetal and Infant Mortality Review
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National Fetal and Infant Mortality Review (NFIMR)
NFIMR is a collaborative effort between the

• American College of Obstetricians and
  Gynecologists (ACOG)

• Federal Maternal and Child Health Bureau,
  Health Resources and Services Administration
  (MCHB)

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FIMR 1988
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FIMR Today
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Rationale for FIMR Reviews

• Infant mortality is the most sensitive index we
  possess of social welfare.
• Julia Lathrop, MD
• 1913

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FIMR is CQI
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2001 Johns Hopkins University Study
Validates Components of FIMR.

• The FIMR program also creates a setting
  and a set of
• concrete activities wherein everyone has a
  contribution to
• make and everyone learns from the process. The
  case study
• findings indicate that because the FIMR
  process extends
• beyond problem identification to promote
  problem solutions,
• observable changes in practice and programs
  occur things
• get fixed and participants are inspired to
  take further action.
• Source Women's and Children's Health Policy
  Center, Johns Hopkins University. The evaluation
  of FIMR programs nationwide early findings.
  Online, 2002. Available from
  http//www.jhsph.edu/wchpc/pub/Brochure.pdf.

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Selected Components of FIMR

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1. Confidentiality Is Key!

• FIMR cases are de-identified so that the names of
  families, providers and institutions are
  confidential the FIMR focus is on improving
  systems assigning blame.

NOT
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2. FIMR Focuses on Systems

• Each FIMR case review provides an opportunity to
  improve communication among medical, public
  health and human service providers and develop
  strategies to improve services and resources for
  women, children and families.

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The process that brings together people to learn
from the story of a family that experienced a
fetal or infant loss helps awaken both commitment
and creativity. The stories illustrate community
needs that are concrete, local and significant.
The interaction among diverse community
participants generates ideas for action that
might lie beyond the imagination and power of an
individual provider or agency. Seth Foldy, MD
Former Commissioner of Health, Milwaukee WI
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3. FIMR Includes a Family Perspective

• The FIMR process includes a home interview with
  the mother who has suffered a loss and the
  mothers story is conveyed to the FIMR team
  members.
•  

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Maternal interviews give a voice to the
disenfranchised in my community, those without
clout or power. FIMR provides a rare opportunity
for the providers in a community to hear from
the consumers. Patt Young, FIMR Interviewer,
Alameda/Contra Costa Counties, CA
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4. FIMR Promotes Broad Community Participation

• FIMR is a community coalition that can represent
  all ethnic and cultural community views and
  becomes a model of respect and understanding.

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The Growing Into Life FIMR Task Forcehas built
respect and friendship among races, between
classes, around language, and among those of
differing political and economic
interests.Karen PapouchoadoFormer
MayorAiken, SC
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5. FIMR is Action-Oriented.

• FIMR leads to multiple creative community
  to improve resources and service systems for
  women, infants and families.

actions
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The mother and infant do not live in a vacuum.
If they do not have adequate housing education,
food, transportation or job opportunities, if
they live in isolation with no one to turn to for
the emotional nurturing we all need, then we as
their neighborhood must reach out to to enable
them not only to avoid infant death, but to
enable each mother and child to enjoy health in
its fullest meaning.Mary Hibbard, MDFormer
Commissioner of Health Suffolk County, NY
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National Fetal and Infant Mortality Review (NFIMR)

• Since 1990, NFIMR has been a resource center
  working with states and communities to develop
  fetal and infant mortality review programs.
• For more information about FIMR, call (202)
  863-2587, e-mail us at NFIMR_at_acog.org, or visit
  us at www.nfimr.org.

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FIMR/CFRWorking TogetherInclude a
representative from the SIDS community on both
teams. Bothcould benefit from training about
bereavement and SIDS risk reduction activities.
Work together to ensure that all families who
have lost a child as well as friends/peers of
older children who have died have access to
culturally appropriate bereavement services.
Identify one or two members who are common to
both teams to provide continuity and share
aggregate, de-identified recommendations back and
forth. Hold a joint FIMR and CFR meeting
annually to share aggregate findingsrelated to
fetal and infant mortality, identify any mutual
recommendations and discuss ways to collaborate
on moving from those recommendation to action.
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FIMR Does Not

• Manage cases
• Review infant abuse and neglect cases
• Review cases in litigation
• Assign blame to providers/institutions