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					Fetal Infant Mortality Review
              (FIMR) Project

                   Overview




                      TM
  Infant Mortality


 Social                      Social Policy
 Conditions
                                     Quality
 Health                               of life
problems
              Health interventions
                                     Greene, L; 1981
The Nation‟s Goal:
                                        Healthy People 2010


 Reduction in Fetal and                             2010 Target
    Infant Deaths
        Fetal deaths                                       4.1
  (at 20 or more weeks of gestation)      (per 1,000 Live Births Plus Fetal Deaths)

     Neonatal deaths                                       2.9
   (within the first 28 days of life)              (per 1,000 Live Births)

  Postneonatal deaths                                      1.2
    (between 28 days and 1 year)                   (per 1,000 Live Births)

    All infant deaths                                      4.5
            (within 1 year)                        (per 1,000 Live Births)
Fetal Mortality Rates for Bergen County and NJ State
by Race and Hispanic Origin 1998-2001
(per 1,000 Live Births plus Fetal Deaths)


    14.0                                             13.7
                                          12.7


    12.0
                                                                                       BERGEN COUNTY

    10.0                                                                               NEW JERSEY STATE


     8.0
                   6.8                                            6.8
                                                            5.9
     6.0                         5.2
             4.5                                                                 4.4
                           4.0                                             4.3                   HP 2010
     4.0
                                                                                                 No more
                                                                                                 than 4.1
                                                                                                 per 1,000
     2.0



     0.0
           All Races     White Non-    Black Non-       Hispanic        Asian Non-
                          Hispanic      Hispanic                         Hispanic


                            Source: 1998-2001 Birth Certificate files for NJ resident mothers from Center for Health Statistics.
Infant Mortality Rates for Bergen County and NJ State
by Race and Hispanic Origin 1998-2001 (per 1,000 Live Births)



       14.0                              13.8           13.0
                                                                                      BERGEN COUNTY
       12.0
                                                                                      NEW JERSEY
                                                                                      STATE
       10.0



        8.0
                     5.9                                              5.9
        6.0
                                      3.9                       4.9                    4.0
               4.3                                                                                 HP 2010 Goal
                                                                                                   No more than 4.5
        4.0                     3.3                                              3.6               per 1,000



        2.0



        0.0
              All Races     White Non- Black Non-             Hispanic       Asian Non-
                             Hispanic   Hispanic                              Hispanic

                           Source: 1998-2001 Birth Certificate files for NJ resident mothers from Center for Health Statistics.
Infant Mortality Rates by Race/Ethnicity for New Jersey,
1990-2002




                                 Non-hispanic Black                 Non-hispanic White                           Hispanic


                    20.0


                    15.0
  Rates per 1,000




                    10.0


                     5.0


                     0.0
                           1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

                                                Source: 1990-2002 Birth Certificate files for NJ resident mothers from Center for Health Statistics.
Infant Mortality Rates for Bergen County by
Race/Ethnicity, 1990-2002




                                           Non-hispanic Black                   Non-hispanic White                    Hispanic
                  25.0



                  20.0
 Rates per 1000




                  15.0



                  10.0



                   5.0



                   0.0
                         19 9 0   19 9 1    19 9 2   19 9 3   19 9 4   19 9 5   19 9 6   19 9 7    19 9 8   19 9 9   2000     2001     2002

                                                                 Source: 1990-2002 Birth Certificate files for NJ resident mothers from Center for Health Statistics.
Fetal and Infant Mortality Review (FIMR)




 A Community Action-Oriented Process
FIMR in New Jersey

   In 1992, the NJDHSS received funding from ACOG to develop
    and implement a Community-Based FIMR project

   Northern NJ Maternal Child Health Consortium conducted two
    FIMR projects: The Essex County and Paterson FIMR Projects

   The NJDHSS has provided the MCH Consortia with funds to
    implement and/or expand FIMR within their regions

   Northern NJ Maternal Child Health Consortium was chosen as an
    agent of the State to conduct a FIMR project in Bergen County
NJ FIMR Goal


Establish a statewide system of fetal-infant
  mortality review by implementing FIMR
   projects within each of the Regional
   Maternal and Child Health Consortia
NJ FIMR Objectives


1. Utilize a community based multidisciplinary Case Review
   Team (CRT) to examine fetal and/or infant deaths in an
   ongoing process which includes information from
   medical and social service records and maternal
   interview.

2. Develop recommendations that address the significant
   social, economic, cultural, safety and health systems
   factors associated with the fetal-infant mortality case
   review process.
NJ FIMR Objectives (cont.)


3. Implement community-based interventions based on CRT
   recommendations and findings.

4. Monitor the progress and impact of the FIMR process and
   community-based interventions.

5. Incorporate NJ FIMR into regional continuous quality
   improvement activities.
NJ FIMR Model


          Infant Death/Fetal Death

   Data Gathering (Chart Review & Maternal
                   Interview)

           Case Review Team (CRT)

        Community Action Team (CAT)

                Interventions

 Improved Maternal and Child Health Outcomes
NJ FIMR Process

 CASE REVIEW TEAM (CRT)
Reviews cases,identifies issues and reports to
the community action team.

 COMMUNITY ACTION TEAM (CAT)
Assesses broader issues and translates issues
into action.

 THE COMMUNITY
Benefits through the development of new
solutions and takes actions.
NJ FIMR Findings and Actions

   Service Delivery Issues
     – Gaps in Care
     – Access to Services
     – Barriers to Care
   Psychosocial Issues
     – Social Support of Family Members
     – Domestic Violence
   Economic Issues
     – Income at or below Poverty Level
     – Basic Family Needs
   Environmental Issues
     – Community Safety
Clear FIMR Goals




    not to assign blame

    not to conduct research
FIMR offers:


 A warning system that can describe effects of
  health care systems change
 A method for implementing continuous quality
  improvement (CQI)
 A means to implement:
    needs assessment
    quality assurance and
    policy development
Essential public health functions
Valuable FIMR Outcomes



   For Families
   For Public/Private Agencies
   For Institutions and Providers
   For Communities
FIMR Issues Identified by CRT & Actions
Planned by CAT in Our Region


   Issue 1: Lack of bereavement education in the
    community
   Actions:
     – Perinatal Bereavement Conference: “Post-traumatic
       Stress/Perinatal Loss and Grief”
     – “Perinatal Loss and Bereavement” Seminar for Clergy
     – Bereavement Workshop: “The Parenting Experience
       of Grief and Loss and the Impact on the Subsequent
       Pregnancy”
FIMR Actions

         Perinatal Bereavement Conference:
    “After 9/11: Post-traumatic Stress/Perinatal
                     Loss & Grief”

   Conference purpose: train professionals on
    techniques for dealing with post-traumatic stress,
    perinatal loss and grief.

   Target audience: nurses, social workers, clergy,
    family care workers, psychologists and parents.
FIMR Actions

     “Perinatal Loss and Bereavement” Seminar

   Seminar purpose: discuss with clergy the issue of
    fetal/infant mortality in their community, and the
    guidelines for providing pastoral care to the family
    experiencing perinatal loss, neonatal, or infant
    death

   Target audience: clergy members from the Paterson
    community
FIMR Actions

    Bereavement Workshop: “The Parenting
     Experience of Grief and Loss and the Impact
     on the Subsequent Pregnancy”

•   Workshop purpose: train professionals to provide
    counseling to the family experiencing a subsequent
    pregnancy after perinatal loss, neonatal, or infant death

•   Target audience: nurses and social workers from
    member hospitals
FIMR Issues Identified by CRT & Actions
Planned by CAT in Our Region


   Issue 2: Lack of fetal activity awareness and it‟s
    relation to positive pregnancy outcomes among
    pregnant women
   Actions:
     – „Kick Count‟ Bookmark designed to convey
       information regarding fetal movement counting
     – Distribute the bookmark to pregnant women or
       women planning pregnancy
     – Survey a pilot group of high-risk pregnant women
FIMR Actions

                  „Kick Count‟ Bookmark
•   Contains information regarding fetal movement
    counting, often called kick counting
•   Pregnant women can monitor the movements of the
    unborn baby by counting the number of kicks in a
    certain time period
•   The information provided through the bookmark is
    expected to increase fetal activity awareness and
    encourage women to consult their physicians anytime
    they have doubts about their baby‟s well-being
FIMR Actions


           „Kick Count‟ Bookmark Evaluation

•   For evaluation purposes, after presenting the kick count
    bookmark, the pregnant women are asked to answer a
    few questions enclosed in a survey

•   A pilot group of high-risk pregnant women enrolled into
    NNJM/CHC - Reduce Stress for Baby‟s Best Program are
    being evaluated by using a pre/post-test survey
FIMR Actions

            „Kick Count‟ Bookmark Evaluation
•   The survey analysis showed the following results:
    •   62.5% of the women never heard about kick count or fetal
        movement before
    •   100% of the women reported that they clearly understood the
        information enclosed in the bookmark
    •   All the women surveyed reported that they felt comfortable doing
        „kick counts‟ and reporting the results to their health provider
    •   Some of the women commented: “It‟s different, I never thought
        of kick counts as movements”; “My baby is always moving, so
        now I have something to do besides telling her to go to sleep.
        I‟m very excited about counting baby‟s movement”
Thank

you!

				
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