Fetal & Infant Mortality Review (FIMR)
The Healthy Start Coalition of Sarasota County has been conducting Fetal and Infant Mortality Reviews (FIMR) since 1992. The FIMR process is based on a model developed by the American College of Obstetricians and Gynecologists. There are currently 200 FIMR projects in the nation.
Florida is considered a leader among the states. Fully funded FIMR Projects positively impact infant mortality statistics. Additionally, the FIMR process fits well with the State Surgeon General’s Strategic Priority on Public Health Wellness, Access, Prevention & Protection and the focus on Improvements to Women’s Health across the Lifespan.
The FIMR Process
Data for fetal and infant deaths are gathered from sources including birth and death certificates and records from hospitals, physicians, Healthy Start, WIC, social service and law enforcement agencies, interviews with the mother, and other family members.
All information is de-identified and access to records is given to Healthy Start Coalitions through public health research statutes. The de-identified cases are reviewed by the Case Review Team, an interdisciplinary team of professionals, who examine the medical record case abstractions and family interviews to answer the question, “Where did the system fail this family?”
The review team prioritizes and documents all contributing factors for each case. Annually, the year’s cases and priority contributing factors are examined by the FIMR Community Action and Education Group. After determining the major issues and trends, the group makes formal recommendations for community interventions to prevent further deaths. Strict confidentiality is maintained at all steps in the process, and the cases the team reviews have no identifying information.
How is Sarasota County doing?
Although vital statistic information coupled with current research provides a wealth of information, it is still unclear why some babies die. Many disturbing trends and issues continue to beleaguer Florida.
For example, the racial disparity in fetal and infant mortality statistics is staggering. The infant mortality rate for non-white babies in Florida is almost two and a half times that of white babies and the fetal mortality rate is three to four times higher.
An example of how the FIMR process and Coalition activities address these needs is the implementation of the “Save My Life” educational awareness campaign and program for African-American residents. It focuses on prevention and early treatment of risk factors for poor birth outcomes.
FIMR Case Review Team
The FIMR Case Review Team (CRT) examines fetal and infant deaths in order to achieve a better future for all children and families. Each case reviewed provides us with an opportunity to look more broadly at community and system circumstances. The CRT process includes:
- Data abstraction from hospital, medical and vital records by a nurse/medical records abstractor.
- Maternal interview.
- De-identified fetal and infant death case review.
Sources of data may include vital records data, prenatal, delivery, neonatal and pediatric records, autopsy medical records, physician and hospital records along with those from home visits, Healthy Start, WIC and, additional social service records when available.
The role of the Case Review Team is to determine whether:
- The family received the services they needed?
- Are there gaps in the system?
- What can this case tell us about how families can best utilize existing local resources?
CRT members include a broad range of medical and health professionals, organizations and public and private agencies (health, welfare, education and social services), consumers and maternal child health advocates.
The Case Review Team:
- reviews the case summaries to identify barriers to care, gaps in services, trends in service delivery and availability of community resources for families.
- documents what opportunities for improvement exist.
- reports their findings to the community action team.
Video: Dr. Washington Hill discusses the FIMR Program
FIMR Community Action and Education Group (CAEG)
Based on FIMR priorities and other activities of the Service Delivery Plan, this committee advises and assists in the preparation and implementation of educational programs and activities for the community, clients, and service providers.
Agencies, organizations, and individuals interested in working for the advancement of maternal and infant health in the community through action and education are invited to join.