Transcript Sedgwick County Fetal and Infant Mortality Review Project

Project Imprint
Shalae Harris, RN, BSN, MPA
FIMR Coordinator, Chart Abstractor
Ty Kane, MPH
SCHD, Community Health Analyst
Carol Moyer, ASN, BS, MPH
KDHE, Office of BEPHI, Epidemiologist
Christy Schunn, LSCSW
SIDS Network of KS, Executive Director
FIMR Maternal Interviewer
Linda Frazier, MD, MPH
KUMC-Wichita, Dept. of OB/GYN
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.
 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.

Milestones
 February 2010 Interim Recommendations
 April 2010 Legislative Effort
 February 2011 Actionable Framework
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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
Infant Mortality Rate (per 1,000 live births)
25.0
20.0
15.0
10.0
5.0
0.0
IMR for Sedgwick County (African
American)
IMR for Sedgwick County (all races)
IMR for Kansas (all races)
IMR for U.S. (all races)
2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009
17.5
17.8
17.3
19.2
19.6
21.6
18.0
18.8
9.0
7.1
6.9
8.6
7.1
6.9
8.0
7.0
6.9
7.8
7.1
6.8
8.2
7.3
6.8
8.7
7.5
6.8
7.7
7.5
6.7
8.1
7.4
6.5
U.S. 2008, 2009 preliminary data
Source: Bureau of Epidemiology and Public Health Informatics, KDHE; National Center for Health
Statistics
Japan
2.4
Sweden
2.5
Spain
3.3
France
3.9
Germany
3.5
Australia
4.3
United Kingdom
4.6
United States
6.5
0
OECD Health Statistics
1
2
3
4
5
6
Rate per 1,000 live births
7
The Causes of Infant Mortality
Physical
Social/Environmental
 Low birth weight
 Disparities in health care
access
 Prematurity
 Birth Defects
 Disparities in living
conditions
 SIDS
 Relational issues
 Stress
 Environmental conditions
The FIMR Process

Notification of death

Case records abstraction

Maternal/Family interview

Case summary

Reviews case data from medical records and family
interviews

Identifies trends and gaps in services
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Makes recommendations to the CAT for systemic
community change
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



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

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
If you don’t know where you’re going,
how are you gonna’ know when you get
there?
–Yogi Berra
Carol J. Moyer, RN, MPH, Epidemiologist, KDHE
Linda 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. Objectives
Goals
• “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
Logic Models
Source: Measuring Program Outcomes:
A Practical Approach © Copyright 1996 United Way of Americ
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
Logic Model Development
Resources
In order to
accomplish our
set of activities
we will need the
following:
Activities
In order to
address our
problem or
asset we will
accomplish
the following
activities:
Outputs
(Process
evaluation)
We expect
that once
accomplished
these
activities will
produce the
following
evidence of
service
delivery:
Short &
Intermediate
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)
Long Term /
Impact
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
Goal: All infants born in Sedgwick County will be healthy.
Resources
FIMR,
collaborating
partners (Kansas
Quit Line, KDHE)
Educational
needs research
Activities
Establish
program to
educate
nurses
working in
prenatal care
clinics
Protocol for
5 A smoking
cessation
and
motivational
interviewing
for pregnant
women
Gather
baseline data
Baseline
data
Healthy Babies
Program, SG
County
Peer reviewed
research on
causes of LBW
Outputs
(Process)
Short
Intermediate
Increase %
of pregnant
women
who follow
Increase %
through
of pregnant
with the
women who
Quit Line.
reported
they quit
Increase
smoking
number of
warm
handoffs
Long Term
/Impact
Reduce %
of low birth
weight
babies
(<2500
grams)
•
•
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
*At any time during pregnancy
1
Project Imprint, 2010
annual summary, Sedgwick County, 2009
3 Wesley Medical Center inpatient data, all births
2 KDHE
*At any time during pregnancy
1
Project Imprint, 2010
annual summary, Sedgwick County, 2009
3 Wesley Medical Center inpatient data, all births
2 KDHE
The National Evaluation of Fetal and
Infant Mortality Review (FIMR)
Communities with FIMR
•Data assessment and analysis
•Client services and assess
•Quality assurance and improvement
•Community partnerships and mobilization
•Policy development
•Enhance workforce capacity
http://www.nfimr.org/site/assets/docs/ClinicalReviewArticle.pdf
The National Evaluation of Fetal and
Infant Mortality Review (FIMR)
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%
http://www.nfimr.org/site/assets/docs/ClinicalReviewArticle.pdf
Carol Moyer, RN MPH
Data Quality Epidemiologist
Bureau of Epidemiology and Public Health Informatics
Division of Health
Kansas Department of Health and Environment
Curtis State Office Building
1000 SW Jackson Street, Suite 130
Topeka, Kansas 66612
(W) 785-296-8627
(F) 785-368-7118
[email protected]
Shalae Harris, RN, BSN, MPA
FIMR Coordinator/Chart Abstractor
Sedgwick County Health Department
Healthy Babies
434 N. Oliver, Suite 110
Wichita, KS 67208
316-660-0984
[email protected]

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.
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KU School of Medicine- Wichita, Dr. Linda Frazier and evaluation team

SIDS Network of KS, Christy Schunn, LSCSW
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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