Fetal and Infant Mortality Review (FIMR) Marion County Health Department.
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Transcript of Fetal and Infant Mortality Review (FIMR) Marion County Health Department.
![Page 1: Fetal and Infant Mortality Review (FIMR) Marion County Health Department.](https://reader035.fdocuments.in/reader035/viewer/2022062221/56649d975503460f94a80b03/html5/thumbnails/1.jpg)
Fetal and InfantMortality Review
(FIMR)
Marion County Health Department
![Page 2: Fetal and Infant Mortality Review (FIMR) Marion County Health Department.](https://reader035.fdocuments.in/reader035/viewer/2022062221/56649d975503460f94a80b03/html5/thumbnails/2.jpg)
Perinatal Periods of Risk:The PPOR Map
• Developed over a decade ago to:– Monitor and investigate fetal-infant mortality.– Identify community gaps/challenges in perinatal health.
– Develop interventions to address these challenges.
• Operates in a cycle to:– Assess the problems.– Identify strategies.– Create and implement an action plan.– Monitor and evaluate progress.– Apply lessons learned and continue commitment in a
sustained fashion.
![Page 3: Fetal and Infant Mortality Review (FIMR) Marion County Health Department.](https://reader035.fdocuments.in/reader035/viewer/2022062221/56649d975503460f94a80b03/html5/thumbnails/3.jpg)
Why does the PPOR Map Work?• It is strategic.
– It’s a plan.
• It is consistent.– It sets a standard for terminology and formulas.– Can now compare statistics no matter where you are.
• It is data driven.– It uses real-time statistics.– We are no longer guessing.
• It is formal and provides:– Who– Where– Why– Now know who to target for future efforts
![Page 4: Fetal and Infant Mortality Review (FIMR) Marion County Health Department.](https://reader035.fdocuments.in/reader035/viewer/2022062221/56649d975503460f94a80b03/html5/thumbnails/4.jpg)
Understanding the PPOR Mapof Fetal-Infant Mortality
![Page 5: Fetal and Infant Mortality Review (FIMR) Marion County Health Department.](https://reader035.fdocuments.in/reader035/viewer/2022062221/56649d975503460f94a80b03/html5/thumbnails/5.jpg)
Connecting Results to Actions
PPOR Focus AreaPotential Action Areas for Community Interventions to Decrease Deaths in this
Category
Maternal Health/Prematurity
Preconceptual HealthHealth BehaviorsPerinatal Care
Maternal CarePrenatal CareReferral SystemHigh Risk OB Care
Newborn CarePerinatal ManagementPerinatal SystemPediatric Surgery
Infant HealthSleep PositionBreast-FeedingInjury Prevention
![Page 6: Fetal and Infant Mortality Review (FIMR) Marion County Health Department.](https://reader035.fdocuments.in/reader035/viewer/2022062221/56649d975503460f94a80b03/html5/thumbnails/6.jpg)
PPOR Map Examples: Example 1:•Age at death = Neonatal
•Birthweight = 1,600 grams
•This means = Newborn Care
PPOR Focus Area Potential Action Area
Newborn CarePerinatal ManagementPerinatal SystemPediatric Surgery
![Page 7: Fetal and Infant Mortality Review (FIMR) Marion County Health Department.](https://reader035.fdocuments.in/reader035/viewer/2022062221/56649d975503460f94a80b03/html5/thumbnails/7.jpg)
PPOR Map Examples: Example 2:•Age at death = Post-Neonatal
•Birthweight = 1,700 grams
•This means = Infant Health
PPOR Focus Area Potential Action Area
Infant HealthSleep PositionBreast-FeedingInjury Prevention
![Page 8: Fetal and Infant Mortality Review (FIMR) Marion County Health Department.](https://reader035.fdocuments.in/reader035/viewer/2022062221/56649d975503460f94a80b03/html5/thumbnails/8.jpg)
The Tale of Three Cities: The PPOR in Action.
• From 1995 to 1997 three cities had an IMR of:
• City 1- 12.5• City 2- 12.0• City 3- 12.8
Looking at these rates: • Do we know at what age in the perinatal period
that babies are dying the most?• Do we know where it is happening or who it is
happening to? • Do we know why it is happening?• Do we know what interventions can be done to
improve each cities infant mortality rate?
![Page 9: Fetal and Infant Mortality Review (FIMR) Marion County Health Department.](https://reader035.fdocuments.in/reader035/viewer/2022062221/56649d975503460f94a80b03/html5/thumbnails/9.jpg)
Plugging in the Numbers…
12.5 12.0 12.8
City 2 City 3
First we calculate the IMR for each of the four primary PPOR categories and plug it into the PPOR:•Maternal Health/Prematurity•Maternal Care•Newborn Care•Infant Health
City 1
4.7
3.4 1.7 2.7City 1
5.2
3.0 1.9 2.0City 1
5.0
2.2 2.2 3.5
City 1
The total score =
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Fetal-Infant MortalityNational Reference Group Rates* for 1998-2000
Compared to Marion County Reference groupRates per 1,000 pregnancies and (total deaths)
500-1499 g
1500+ g
Fetal Death Neonatal
Post- neonatal
2.2(8,671)
1.5(6,002)
1.1(4,437)
1.0(3,944)
*Total number of pregnancies=3,907,458, overall rate=5.9** PPOR reference group data at www.citymatch.org/ppor. National data uses cities with >250,000 population by state.
1.93(27)
United States rates Marion County rates
1.00(14)
1.15(16)
.93(13)
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Marion County, Indiana Fetal-Infant Mortality1999-2003 Birth Cohort Data
Rates per 1,000 pregnancies and (total number of deaths)
500-1499 g
1500+ g
Fetal Death
NeonatalPost-
neonatal
3.88 (273)
2.09 (147)
1.42 (100)
2.31 (163)
Total number of pregnancies=70,431 Data compiled from birth certificate data from the Marion County Health Department, Indianapolis, IN
9.70
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Excess (Preventable) Infant Mortality Rates for Marion County, Indiana
9.70 5.01 4.69
All Races* Reference Excess/Preventable
Total number of pregnancies + 13.955 overall rate = 5.02
*Data compiled from birth certificate data from the Marion County Health Department, Indianapolis, In
City 1
3.88
2.09 1.42 2.31
City 1
1.93
1 1.15 .93
City 1
1.95
1.09 .27 1.38
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What to do with PPOR Map data:
• We can see that the highest IM rate falls into the Maternal Health/Prematurity Category.
• We can evaluate the demographics of the category to find out more about the mothers and their stories.
• We can target these women in the community and educate or assist them.
• We can focus our efforts on the areas listed in the corresponding potential action area to decrease future infant mortality.
City 1
3.88
2.09 1.42 2.31
Marion CountyPotential
Action Area
Preconceptual Health
Health Behaviors
Perinatal Care
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PPOR Map Results for Excess Deaths in Marion County, Indiana
Maternal Health/Prematurity Category
This category had the largest number of excess deaths in Marion County
(Fetal, Neonatal, Post neonatal deaths of infants 500-1,499 g)
Category Demographics Part 1:
• Mothers with the highest rate of excess deaths in category:
African American women and women age 20 to 34 years old.
• Top zip code areas with the highest rates for VLBW in category:
46202, 46205, 46208, 46214, 46218, 46226, 46228
• Mothers with >40% chance of mortality due to birth-weight:
Black women and women age 20 to 34 years old.
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PPOR Map Results for Excess Deaths in Marion County, Indiana
Maternal Health/Prematurity Category
This category had the largest number of excess deaths in Marion County
(Fetal, Neonatal, Post neonatal deaths of infants 500-1,499 g)
Category Demographics Continued:
• Mothers with the highest probability of having a VLBW infant:
Single women with an education of 12 years or less, women who smoked during pregnancy, Black women and women age 24 or younger.
• Risk Factors for this category of having a VLBW birth:
Black women were 1.9 times more likely to have an intermediate-level/amount of prenatal care than the reference group. Women age 20 to 34 years were 1.7 times more likely than the reference group.
Potential Action Area
Preconceptual HealthHealth BehaviorsPerinatal Care
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•Category Demographics:
•Suffocation Related Deaths and Racial Differences:
• Blacks were mentioned as having been found on an adult bed 2.5 times more than Whites. Whites were mentioned as sleeping with multiple family members (bed sharing) 3 times more than Blacks.
•Causes of Infant Deaths For Category:• Highest category is injury (39%), with most being suffocation deaths.
Largest number of deaths occurred while co-sleeping on an adult bed or sofa.
PPOR Map Results for Excess Deaths in Marion County, Indiana
Infant Health Category(Post neonatal deaths of infants weighing 1,500 g or more at birth)
This category had the second largest number of excess deaths in Marion County
Potential Action Area
Sleep PositionBreast FeedingInjury Prevention
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Category Demographics:
Causes of Fetal Death:• Perinatal Conditions contributed largely (74%) with the top
contributor “fetal death of unspecified cause” (35%).
Potential Action Area
Prenatal CareHigh Risk ReferralObstetric Care
PPOR Map Results for Excess Deaths in Marion County, Indiana
Maternal Care Category(Fetal deaths of infants weighing 1,500 g or more at birth)
This category had the third largest number of excess deaths in Marion County
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To date, the data for this category has not been examined.
PPOR Map Results for Excess Deaths in Marion County, Indiana
Newborn Care Category(Neonatal deaths of infants weighing 1,500 g or more at birth)
This category had the least number of excess deaths in Marion County
Potential Action Area
Perinatal ManagementNeonatal CarePediatric Surgery
![Page 19: Fetal and Infant Mortality Review (FIMR) Marion County Health Department.](https://reader035.fdocuments.in/reader035/viewer/2022062221/56649d975503460f94a80b03/html5/thumbnails/19.jpg)
PPOR Will Allow FIMR to:
• Focus FIMR activities on the group contributing to the gap.
• Describe in greater depth the risk factors, events or services that may contribute to the gap.
• Validate the quality of vital records and other information.
• Paint the faces behind the numbers.