Docstoc

Birth Certificates Wisconsin When a Baby Is Born

Document Sample
Birth Certificates Wisconsin When a Baby Is Born Powered By Docstoc
					Infant Mortality – Impact
on overall Child Mortality
       in Kansas


 Effective Strategies to reduce
         infant mortality
           July 17, 2009
        Presentation Goals:
1. Describe the impact of fetal and infant
   deaths on the overall child mortality rate
   for the US and Kansas
2. Identify the risk factors contributing to
   infant deaths due to conditions
   originating in the perinatal period.
3. Conduct effective reviews of infant
   deaths using lessons learned from FIMR
            Infant Mortality
• Definition: The        • “The most sensitive
  death of any live        index we possess of
  born infant prior to      social welfare . . . ”
                              Julia Lathrop, Children’s
  his/her first                  Bureau, 1913
  birthday.
           Definition of Live Birth
„„Live Birth‟‟ means the complete expulsion or
extraction from its mother of a product of human
conception, irrespective of the duration of pregnancy,
which, after such expulsion or extraction, breathes, or
shows any other evidence of life such as beating of the
heart, pulsation of the umbilical cord, or definite
movement of voluntary muscles, whether or not the
umbilical cord has been cut or the placenta is
attached.


Source: K.S.A. 1995 Supplement 65-2401, subsection (2), amended and effective July 1, 1995.
      Definition of Fetal Death
„„Stillbirth‟‟ means any complete expulsion
  or extraction from its mother of a product
  of human conception the weight of which
  is in excess of 350 grams, irrespective of
  the duration of the pregnancy, resulting in
  other than a live birth as defined in this act
  and which is not an induced termination of
  pregnancy.



Source: K.S.A. 1995 Supplement 65-2401, subsection (3), amended and effective July 1, 1995.
   Recommended Reporting
       of Fetal Deaths

 The 1992 Revision of the Model State Vital
 Statistics Act and Regulations recommends:


‘‘Each fetal death of 350 grams or more, or if
weight is unknown, of 20 completed weeks
gestation or more, calculated from the date last
normal menstrual period began to the date of
delivery, is reported to the office of Vital
Records.
    Variation in Fetal Death
    Reporting across States
– Eleven areas report all periods of gestation
– 25 areas report gestation periods of 20 weeks or
  more
– 13 areas specify birth weight of 350 grams or more or
  20 weeks of gestation or more;
– 1 area specifies 20 weeks or more or birth weight of
  400 grams
– 1 area specifies 20 weeks or more or birth weight of
  500 grams
– 1 area specifies 16 weeks of gestation or more
– 1 area specifies 5 months of gestation or more.
Additional Definitions

• Perinatal Death
  – Fetal deaths (stillbirths) plus infant
    deaths under 7 days
• Neonatal Death
  – Live birth dying within 28 days
• Post-Neonatal Death
  – Live birth dying between 28 days
    and 1 year

   Source: National Center for Health Statistics, CDC
                                                   US Infant Mortality Rate

                                25
Deaths per 1000 live births




                                20


                                15


                                10


                                   5


                                   0   1970 1980 1985 1990 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

                              HP 2010 4.5    4.5   4.5   4.5   4.5   4.5   4.5   4.5   4.5   4.5   4.5   4.5   4.5   4.5   4.5   4.5
                              US        20   12.6 10.6   9.2   7.6   7.3   7.2   7.2   7.1   6.9   6.8   7     6.9   6.8   6.8   6.7
       US Infant Death Rates
            1995 - 2006
   8

 7.5

   7

 6.5

   6

 5.5

   5

 4.5
      5   6   7   8   9   0   1   2   3   4   5   6
   199 199 199 199 199 200 200 200 200 200 200 200


2006 = 28, 527 infant deaths
       US Fetal Death Rates
           1995 - 2005
  7


 6.5


  6


 5.5


  5


 4.5
      5   6   7   8   9   0   1   2   3   4   5
   199 199 199 199 199 200 200 200 200 200 200


2005, 25,894 Fetal Deaths
            Maternal Mortality
•   569 Maternal Deaths in the US in 2006
•   Rate = 13.3/100,000 live births
•   White Rate = 9.5/100,000
•   Hispanic Rate = 10.5/100,000
•   Black Rate = 32.7/100,000
•   Disparity Ratio for Black to White of 3.5/1
   Total US Deaths of Children
        ages 0 – 19 years

            26%



                                            0 - 1 yr
                                            1 yr - 4 yr
                                    53%
                                            5 yr - 9 yr
                                            10 yr - 14 yr
       7%
                                            15 yr - 19 yr


            5%

                  9%


53,501 Child deaths in 2005, 0 – 19 years
28,440 or 53% are infant under 1
Kansas: Percent of Child Deaths
        by age at Death
             0-1   1 -19-




                            In 2005, 547 Child Deaths
                            0 – 19. 294, or 54% were
                            Infants under one
   Infant mortality rates by maternal
   US, 1996-2005 race/ethnicity




All race categories exclude Hispanics. An infant death occurs within the first year of life.
Source: National Center for Health Statistics, period linked birth/infant death data. Retrieved April 8, 2009, from
www.marchofdimes.com/peristats.
      Infant mortality rates by maternal
   US, 2005    race/ethnicity




All race categories exclude Hispanics. An infant death occurs within the first year of life.
Source: National Center for Health Statistics, period linked birth/infant death data. Retrieved April 8, 2009, from
www.marchofdimes.com/peristats.
 Neonatal and postneonatal mortality rates
   US, 1960-2005




A neonatal death occurs in the first 28 days of life. A postneonatal death occurs between 28 days and one year of life.
Source: National Center for Health Statistics, period linked birth/infant death data. Retrieved April 8, 2009, from
www.marchofdimes.com/peristats.
       Preterm births among singleton
  US, 2006        deliveries




Preterm is less than 37 completed weeks gestation.
Source: National Center for Health Statistics, final natality data. Retrieved April 8, 2009, from
www.marchofdimes.com/peristats.
     State Rankings for Overall Infant Mortality



•   Mississippi (11.3)                  •   Georgia (8.2)
•   Louisiana (10.1)                    •   Oklahoma (8.1)
•   South Carolina (9.4)                •   West Virginia (8.1)
•   Alabama (9.4)                       •   Indiana (8.0)
•   Delaware (9.0)                      •   Arkansas (7.9)
•   Tennessee (8.9)                     •   Michigan (7.9)
•   North Carolina (8.8)                •   Missouri (7.5)
•   Ohio (8.3)                          •   Virginia (7.5)

                        Kansas (7.4)
                Source: National Kids Count Database
                                         Kansas Infant Mortality:
                                            Black and White
                                                                    Black       White

                              25

                              20
Deaths per 1000 live births




                              15

                              10

                              5

                              0
                                  1      3        5           7           9          1           3           5      7
                               199    199      199         199         199        200         200         200    200


                                             Source: 1995-2007 The Kansas Department of Health and Environment
                                                                       Vital Records
          Kansas‟ Disparity Ratio

25

20

15                                                                                     B/W ratio
                                                                                          2.8
10

 5

 0      95-97    96-98    97-99   98-00    99-01    00-02   01-03-   02-04-   03-05-    04-06-   05-07-
Black   19.2      16.5    13.8     12.1     15.4    15.6     16.6     15.6     16        17       18
White    6.6      6.8      6.8      6.8     6.6      6.3     6.2      6.3      6.3       6.4      6.4


                Source: 1995-2007 The Kansas Department of Health and Environment
                                          Vital Records
              Kansas Ranks 47th among States for Black
                       Infant Mortality Rate

                        States:       Black IMR 05   Rank:
                       Delaware           18.9        50
                       Michigan           18.3        49
                      Wisconsin           17.7        48
                        Kansas            17.6        47
                      Mississippi         17.2        46
                          DC*             17
                        Indiana           17          45
                         Ohio             16.9        44
                     North Carolina       16.4        43
                        Illinois          16.4        43
Source: National
Center for VS, CDC     Colorado           16.3        41
                         USA              13.7
      Percent of all Kansas
      Births by Race, 2007

•   Total births: 41,951
•   White births: 30,170 (72%)
•   Black births: 2,856 (6.8%)
•   Hispanic Moms, all races: 6,676 (15.9%)
•   Other/Multiple races, non-hispanic: 5.3%

       Source: 1995-2007 The Kansas Department of Health and Environment
                                 Vital Records
   Percent of Births by Race and Ethnicity
         US Compared to Kansas
                                           7.00%
          4.10%



          15.30%
                                         23.8%
7.10%
                                                   55.1%


                      73.40%



                                       14.1%




  White     Black   Hispanic   Other
            Kansas Infant Mortality trend
             Rates by Race & Ancestry
    20


    15


    10


        5


        0
             98-00     99-01      00-02      01-03-     02-04-     03-05-         04-06-   05-07-
Black         12.1      15.4       15.6       16.6        15.6        16           17       18
Hispanic      5.6        5.9        7.3        7.9        7.1        7.3           6.6      7.7
White         6.8        6.6        6.3        6.2        6.3        6.3           6.4      6.4


              Source: 1995-2007 The Kansas Department of Health and Environment
                                        Vital Records
   Leading Causes of Infant Death (2007)
          from Death Certificates

 Perinatal
                                                                                 62%
Conditions

Congenital
                                  20%
Anomalies


     SIDS                   15%



     Other   3%


             Source: 1995-2007 The Kansas Department of Health and Environment
                                       Vital Records
Preterm and Low Birth Weight in Kansas
       Percent of all Live Births


                 1995                    2005                     2010 US
                                                                  Objective

 Preterm         9.9%                    12.2%                    7.6%


 Low Birth       6.4%                    7.2%                     5.0%
 Weight

           Source: March of Dimes, Peristats http://www.marchofdimes.com/peristats/
                                         Infant Mortality




          Racism     Bad Housing            Weathering
                                            Unemployment
   Fatherless           Bad Neighborhoods                Hopelessness
   households
                        Premature Birth                       Stress
                                      Low Birth Weight
Limited    Poverty
                           Smoking         Substance Use
Access
to Care                        Family Support
            Under-
            Education   Poor Working Conditions
                           Genetics      Nutrition
                                                               With permission from
                                                               Arthur James, MD
              When Vital
              Statistics alone
              cannot tell us
              the story . . . .




. . . Communities
turn to FIMR to tell
us how and why
babies are dying
  Addison and Aiden were the most
       popular names given to
newborns by Kansas parents in 2008.


     Source: 1996-2009 The Kansas Department of
               Health and Environment
      Fetal Infant Mortality Review
               1988 - 2009


                            Data Gathering                      Changes in
                                                                Community

• A process that tells us
                                                                  Systems




  How and Why babies                          The Cycle of

  die in a community                         Improvement




                            Case Review                      Community
                                                               Action
      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, HRSA)
FIMR 1988
                        FIMR Today




Over 240 projects in 42 states
      Characteristics of State
         FIMR Programs

• Over 240 Local FIMR projects in 42 States
• 25 States have a State Coordinator with
  training and technical assistance available
• Most FIMR‟s are administered through
  local public health
        The FIMR Process
• FIMR brings a       Review Team
  multidisciplinary
  community team
  together to
  examine
  confidential, de-
  identified cases
  of infant deaths.
FIMR: Two Tiered Process

     CRT                 CAT




                   Community Action
Case Review Team   Team
 Selected
Components
  of FIMR
               Confidentiality
• FIMR cases are de-
  identified so that the
  names of families,
  providers and
  institutions are
  confidential – the
  FIMR focus is on
  improving systems,
  NOT assigning
  blame.
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.
    “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
      FIMR Includes a Family
             Perspective
   Home Interview
• Gives insight into
  the mother‟s
  experience before
  and during
  pregnancy
• Conveys the
  mother‟s story of her
  encounters with
  local service
  systems
 “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
      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.
 “The Growing Into Life FIMR
Task Force…has built respect
 and friendship among races,
   between classes, around
language, and among those of
    differing political and
     economic interests.”

    Karen Papouchoado, Former Mayor
               Aiken, SC
FIMR is Action-Oriented.

             FIMR leads to multiple
             creative community
             actions to improve
             resources and service
             systems for women,
             infants and families.
FIMR‟s Strength
• Access to medical records
• Home Interviews (Qualitative Data)
• Community specific determinants of Infant
  Mortality
Use of Data
• Death certificates provide an overview of
  all infant deaths
• When matched with birth certificates, we
  know maternal characteristics, prenatal
  care, and labor complications
• FIMR provides information on more
  specific psychosocial issues, gaps in care,
  factors which contribute to infant death in
  specific communities
 Evaluation of FIMR
Programs Nationwide
                 Methods
• 193 participating communities
• Cross-sectional observational study
 (Telephone interview, written survey & site visits)
  – Communities with FIMR
  – Communities with Perinatal Initiative
  – Communities with both (FIMR & PI)
  – Communities with neither
           Results

   FIMR Programs contribute
significantly to improvements in
    systems of health care for
  pregnant women and infants
through enhanced public health
    activities in Communities.
     FIMR-Specific Influences
•   Data assessment and analysis
•   Client services and access
•   Quality improvement for systems of care
•   Partnerships and collaboration
•   Population advocacy and policy
    development
                                             Results
    “[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.
           FIMR as part of other
              MCH Initiatives
– Vital Statistics
– PRAMS (Pregnancy Risk Assessment
  Monitoring)
– PPOR (Perinatal Periods of Risk)
– CDR (Child Death Review)
– MMMS (Maternal Mortality Surviellance)
– BRFSS (Behavioral Risk Factor survey
  System)
  Interaction of State Public
Health and Local FIMR Projects
• Technical Assistance
• Grant of Authority/Legislation
• Data Management
          Technical Assistance
• Hands on Training:
  –   Team development
  –   Recruiting members for review and action teams
  –   Case Abstraction
  –   Access to Medical records
  –   Home Interviews/Bereavement
• On site consultation for CRT and CAT
  – Connect sites with “best practices” and solutions from
    other communities
  – Assist teams with developing recommendations
  – Fidelity to Program: confidentiality, forms, etc.
        Technical Assistance
• Monthly Network Meeting
  – Dialog and common understanding of issues
    related to infant mortality and the FIMR
    process
  – in-services on factors associated with infant
    morbidity/mortality and maternal health
  – Create and maintain a base of support for
    FIMR personnel
• Annual Training
       Grant of Authority/FIMR
             Legislation
• The laws and regulations relevant to the process
  of fetal and infant mortality review are found
  primarily in state rather than local or federal
  laws. All states have laws that afford immunity to
  those participating in certain types of reviews.
• Many states have other regulations that permit
  access to medical and vital statistics records for
  “investigations for the benefit of the health of the
  public”.
   Michigan‟s Grant of Authority
• Michigan‟s Public Health Code provides authorization for
  local FIMR project staff to collect protected health
  information from covered entities on MDCH‟s behalf for
  the purpose of “public health investigation” (Surveillance)
  of fetal and infant deaths.
• 45 CFR 164.512 (b) 45 164.501 of the Privacy Rule
  permits disclosure to “a public health authority that is
  authorized by law to collect or receive such information
  for the purpose of preventing or controlling disease,
  injury, or disability . . . .vital events such as births or
  deaths, and the conduct of public health surveillance”.
  New York State Public Health Law

§ 206.1(j) Commissioner; general powers and duties
      » 1. The commissioner shall:
      » (j) cause to be made such scientific studies and research,
        which have for their purpose the reduction of morbidity and
        mortality and the improvement of the quality of medical care
        through the conduction of medical audits within the state. In
        conducting such studies and research, the commissioner is
        authorized to receive reports on forms prepared by him and the
        furnishing of such information to the commissioner, or his
        authorized representatives, shall not subject any person,
        hospital, sanitarium, rest home, nursing home, or other person
        or agency furnishing such information to any action for
        damages or other relief.
New York State Public Health Law

§ 206.1(j) Commissioner; general powers and duties
  (cont.)
» Such information when received by the commissioner,
  or his authorized representatives, shall be kept
  confidential and shall be used solely for the purposes of
  medical or scientific research or the improvement of the
  quality of medical care through the conduction of
  medical audits. Such information shall not be admissible
  as evidence in any action of any kind in any court or
  before any other tribunal, board, agency or person.
     Texas FIMR Legislation
• Enacted in September of 2007, amends
  chapter 674 of Health and Safety Code.
• Creates a FIMR as a unit of local
  government
• States who may establish a FIMR team
• Prescriptive of membership
• Authorizes disclosure of information to
  review teams (includes medical, social,
  mental health)
• Gives teams immunity from subpoena and
             FIMR and HIPAA
• The National Fetal and Infant Mortality Review, in
  collaboration with the American College of
  Obstetricians and Gynecologists and Hogan and
  Hartson, LLP, developed "The Fetal and Infant
  Mortality Review Process: The HIPAA Privacy
  Regulations." This detailed monograph on FIMR
  and HIPAA is designed to help local and state
  FIMR programs understand the regulations. A
  PDF document is available at the NFIMR website:
                   www.acog.org
          Data Management
• Administers and manages Statewide database
  for local FIMR‟s
  – TA
  – Data analysis on request
  – Aggregate Annual Report


• Examples of Database
  – Web Based: BASINET (created by Florida HS)
  – NFIMR: ACCESS database, free to states
FIMR and CDR common goal:




  Local, multidisciplinary review aids
    in better understanding how to
  prevent future deaths and improve
     lives of babies, children, and
                families.
                                             Review preventable deaths

                                             Review mostly child abuse deaths


                                             Transitioning to prevention

                                             No review team(s)




• CDR is now mandated or enabled by law in 39 states.
• 22 are housed out of their State Health Department.
• 37 states now have local review teams.
• 48 states review deaths through age 17.
• Half review deaths to all causes.
• Median state funding level is $150,000, with limited local
  funding
    Case Inclusion Criteria

          FIMR                           CDR
                          •   Age of child < 18
• Reviews deaths of
                          •   All unexplained deaths
  infants born live
                          •   All fatal abuse and
  who do not reach            neglect deaths
  their first birthday    •   All homicides and
• Select cases of fetal       suicides
  death (<400 grams or    •   All accidents/injuries
  20 weeks gestation)
        Effective Reviews of
      Perinatal/Neonatal Deaths
• Get the right People to the table . . .
• Gather enough data to give a clear picture
  of maternal health history
• Identify the risks, gaps in care and
  services
• Put findings into action to improve care
  and resources for women, infants, and
  families
         Team Composition

       FIMR                     CDR
• Medical Expertise
  –   OB                • Law enforcement
  –   Peds              • Prosecutors
  –   Pathology
                        • Social Services/FIA
  –   ED
  –   Family Practice
      Team Composition

       FIMR                  CDR
• Other Health Care
     Providers        • Emergency Medical
  – Nurses                Personnel
  – Social Workers    • Medical Examiners
  – Dietitian
  – Discharge
    Planning
  – Home Care
   Team Composition

     FIMR                  CDR

• Human Service     • Department of
  Providers           Corrections
  – Child Welfare   • Housing Authority
    Agencies
                    • Transportation
  – Mental Health
                      Authority
  – Substance
    Abuse
      Team Composition

        FIMR                    CDR

• Public Health         • Schools District
  –   Medicaid          • Juvenile Court
  –   WIC               • Child Care
  –   Family Planning     Licensing
  –   MSS/ISS
  –   Outreach
      Workers
       Team Composition
                FIMR/CDR

• Community Leaders
  – Mayor, City Council, County Executive
  – Business Leaders, Chamber of Commerce
  – Clergy
  – Civic Groups (Kiwanis, Junior League)
    Team Composition
       FIMR                   CDR

• SIDS/OID Programs
                      • State and Local
• Advocacy Groups
                        Safe Kids Coalitions
  – March of Dimes
  – Healthy
    Mothers/Healthy
    Babies
  – Family Support
    Groups
        Effective Reviews of
      Perinatal/Neonatal Deaths
• Get the right People to the table . . .
• Gather enough data to give a clear
  picture of maternal health history
• Identify the risks, gaps in care and
  services
• Put findings into action to improve care
  and resources for women, infants, and
  families
      Sources of information for
       Maternal Health History
• Birth and Death certificates
• Prenatal records
  – OB/GYN history, past pregnancies
• Hospital records
  – Antepartum
  – Delivery
  – Newborn/NICU
  – ED admissions
        Sources of information for
         Maternal Health History
• Public Health Records
  –   MSS/ISS (Maternal Infant Health Program: MIHP)
  –   WIC
  –   Family Planning
  –   Other support services (CSHC, Healthy Start)
• Human Service Records (including Child
  Protective Service histories)
• Police reports (domestic violence, other
  stressors)
    Risk Factors in Infant Deaths
        Maternal Characteristics
•   Living in poverty
•   Unmarried
•   Low education level
•   Unintended, unwanted pregnancy
•   Less than adequate prenatal care
•   Smoking during pregnancy
       Risk Factors cont.

•   Young maternal age (under 20)
•   First birth as teen
•   Victim of domestic violence
•   Substance abuse during pregnancy
•   Presence of life stresses
    – homelessness
    – lack of transportation
    – mental illness
    – poor nutrition
        Effective Reviews of
      Perinatal/Neonatal Deaths
• Get the right People to the table . . .
• Gather enough data to give a clear picture
  of maternal health history
• Put findings into action to improve care
  and resources for women, infants, and
  families
• Identify the risks, gaps in care and
  services
Snapshots of Michigan FIMR‟s . . .
 Translation of Findings into Action
             Oakland County

• Started FIMR in 2000
• One of the highest disparity ratio‟s for
  Black/White Infant Mortality in the state:
  Black Rate = 25.2, White Rate = 4.3
  Ratio 5.9/1
• Team focused on reviewing deaths of all
  live born infants for residents of Pontiac
  and Southfield
FIMR in Oakland County, Michigan

• population 1,214,255
• GM & Chrysler are top 2
  employers
• ranks 20th nationally in
  total disposable income
• City of Pontiac has
  66,337 residents, 5% of
  the county total
• 48% of Pontiac residents    Oakland
  are Black                   County
                FIMR Findings:
            Factors most frequently
          contributing to Infant Mortality
•   Low Birth weight
•   Prematurity
•   Sexually transmitted & other infections
•   Frequent and closely spaced pregnancies
•   Previous fetal or infant loss, termination
•   Use of alcohol, tobacco, & other drugs
•   Through home interview, women did not
    understand or recognize preterm labor signs
        FIMR CAT Activities
• Partnered with Faith           Material
  Based Organizations
• “Save our Babies,       – Church Bulletin Inserts
  Save our Heritage”      – Posters
• A public awareness      – Presentations to
  campaign to reduce        Parish Nurse Groups
  heath disparities and   – Presentations to area
  infant deaths in          churches in Pontiac
                            and Southfield
  Oakland County
     Save Our Babies
Save Our Heritage Brochure
          Oakland County Infant Mortality
                Rates 1990 - 2005

                                            23.3        23.3
25                                                 25
                                                                    21     21.3
          18                     19.7
20                                                 20
                                                                                     16.8        16.8
                          16.5
15                                                 15
                                                                                                       15.4
10                                                 10

5                                                  5

0                                                  0
          2           5          8           0




                                                                                   -

                                                                                            -

                                                                                                     -
                                                        00

                                                               01

                                                                         02
        -9          -9         -9          -0




                                                                                03

                                                                                         04

                                                                                                  05
     90          93         96          98
                                                      -

                                                                -

                                                                       -

                                                                                 -

                                                                                          -

                                                                                                   -
                                                   98

                                                             99

                                                                    00

                                                                              01

                                                                                       02

                                                                                                03
               Black       Overall       White                  Black          Overall           White
                Saginaw County
• Population 210,000
• City: 70,000
• 28% Of County
  population is Minority
• 58% of Saginaw City is         Saginaw
  Minority
• Urban
• Major Industries:
   – GM, Health Care,
     Education, Agriculture
      Saginaw FIMR Findings:
   Domestic Violence and Pregnancy
• 20% of infant deaths reviewed have
  documented abuse
• 31% of women report lifetime abuse
• 5% of pregnant women are beaten while
  pregnant
• Few prenatal care providers routinely
  asked women about abuse
         Pregnancy and Abuse:
         Window of Opportunity
• May be the only time
  a woman routinely
  seeks health care
• Desire to protect
  baby
• Opportunity to think
  about the future
• Develops trust in
  provider
                              DV and Infant Loss
                                       Non-Abused   Abused

                         35              30.1       P<0.048
Deaths per 1000 births




                         30
                         25                                         18.6
                         20
                         15      8.9                          9.0
                         10
                         5
                         0
                                 Stillborn             Infant Mortality
    Domestic Violence and
        Pregnancy
• Developed Screening and
  Assessment Tool
  – 5 questions
  – Every woman, every visit
• Standard DV screening in all
  Prenatal Provider sites
   Effects of DV Programs on Low
          Birth Weight Rate
                          Non-Abused               Abused           County Average

                    25                      22.7
                              20.9
                    20
Percent of Births




                                                        16.5
                                                               15
                    15
                                       12
                         11
                    10
                                                                         6.9 6.3
                     5


                     0
                         1996          1997                 1998          1999
Selected Risk Factors for 2004 FIMR
         Cases Reviewed
  Maternal Risk               Number      Percent
First Pregnancy < 18     77            33.5
< 12th grade education   60            26.1
Unplanned pregnancy      91            39.6
Entry to care < 12       134           60.9
weeks
Entry to care > 12       52            22.6
weeks
Unknown ETC              44            19.1
     Total               230           100
                Plan First!
• Through this waiver, MDCH offers
  family planning services to women:
  – 19 through 44 years of age.
  – Who are not currently Medicaid eligible.
  – Who do not have full family planning benefits
    through private insurance, including Medicare.
  – Who have family income at or below 185% of
    the federal poverty level (FPL).
    SIDS or Something Else?
• 12 - 15% of Infant Deaths in Michigan due to
  SIDS

• Through FIMR and CDR, multiple
  communities began to identify that many of
  these deaths lacked one of the three criteria
  for SIDS diagnosis:
  – Negative Autopsy
  – Negative Death Scene Investigation
  – Negative Medical Health Hx
Large numbers of deaths were
  actually related to un- safe
   sleep environments . . .
      Where Should Infant‟s Sleep? A Comparison of Risk for
              Suffocation . . . Cribs vs. Adult Beds
          Scheers, Rutherford, & Kemp, Pediatrics, 2003



                  35
                                              25.5
                  30
RATE OF DEATH




                  25
  (per 100,000)




                  20
                  15
                  10
                        0.63
                  5
                  0
                       CRIB              ADULT BED
                       PLACE INFANT WAS SLEEPING
            Translation to Action:
               SIDS/Asphyxia
• Mandatory Death Scene Investigation
  using State of Michigan Protocol
  – State Police
  – Medical Examiners
  – Prosecutors
• Enhanced education /public awareness
  on safe sleep environment
Michigan Legistation related to Safe
      Sleep and Suffocation:
• House bill 5225 – became Public Act
  179 on July 1, 2004
• Mandates investigation by county
  medical examiner for cases of child
  death (under 2) under circumstances of
  sudden death, cause unknown.
• Promotes consistency and accuracy
  among county medical examiners in
  determining the cause of death
State Wide Prevention Efforts
• Multidisciplinary State level task force
  convened: MDCH‟s Division of Family
  and Community Health
• Uniform message and
  recommendations issued for:
  – Child Care providers
  – Health care professionals
  – General public
State Wide Prevention Efforts
• On-line training for providers, clinics,
  MIHP staff     MIHealth.org

• Developed web site through DHS




• http://michigan.gov/safesleep
     Postneonatal Death Rate Trends
          Michigan 1990 - 2007
                         SIDS       ASSB         Undetermined

18
16
14
12
10
 8
 6
 4
 2
 0
    90


            95


                    00


                            01


                                    02


                                            03


                                                    04


                                                            05


                                                                    06


                                                                            07
 19


         19


                 20


                         20


                                 20


                                         20


                                                 20


                                                         20


                                                                 20


                                                                         20
    There is much to be learned about the
delivery of services even if the death was not
          thought to be preventable.
 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@acog.com, or
 visit us at http://www.acog.org/goto/nfimr.
      The FIMR State Support Program is funded by
    the Michigan Department of Community Health,
Administered by the Michigan Public Health Institute



              Rosemary Fournier, RN, BSN
             State FIMR Program Coordinator

           MDCH: Washington Square Building
                 109 W. Michigan
                 Lansing, MI 48913

                  Phone: (517) 335-8416
            e-mail: Fournierr1@michigan.gov

				
DOCUMENT INFO
Description: Birth Certificates Wisconsin When a Baby Is Born document sample