The FIMR Project Shalae Harris, RN, BSN, MPA FIMR Coordinator/Chart Abstractor.
January 2005-December 2010 Laurie Lee, RN, BSN FIMR Coordinator Northeast Florida Healthy Start...
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Northeast Florida FIMR Findings January 2005-December 2010 Laurie Lee, RN, BSN FIMR Coordinator Northeast Florida Healthy Start Coalition
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Transcript of January 2005-December 2010 Laurie Lee, RN, BSN FIMR Coordinator Northeast Florida Healthy Start...
Northeast Florida FIMR Findings
January 2005-December 2010
Laurie Lee, RN, BSNFIMR CoordinatorNortheast Florida Healthy Start Coalition
Overview of the Fetal & Infant Mortality Review Process
The FIMR Case Review Team meets bimonthly Review process developed by the American
College of Obstetrics & Gynecology is used. Information abstracted from birth, death,
prenatal care, Healthy Start, WIC, hospital and autopsy records.
Efforts are also made to interview the family. All information is de-identified. Purpose is to determine specific medical,
social, financial and other issues that may have impacted the poor birth outcome.
Recommendations for community action drafted annually based on findings.
Overview of the Fetal & Infant Mortality Review Process
The purpose of FIMR is to examine cases with the worst outcomes to identify gaps in services that might be addressed through community action.
Cases selected for review based on specific criteria such as:Zip codes with high infant mortality ratesFetal losses over 36 weeks gestation or 2500
gramsDeaths in outlying counties, etc.
Resident Infant Mortality Rates-All RacesNortheast Florida and Florida2001-2010
2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
2
4
6
8
10
12
14
16
18
20
10.18.8
9.89.5
10.4
8.2 88.9
7.9 7.37.3 7.5 7.5 7 7.2 7.2 7.1 7.2 6.9 6.5
NE FL FL US
Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats
Resident White Infant Mortality RatesNortheast Florida and Florida 2001-2010
2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
2
4
6
8
10
12
14
16
18
20
7.2 7 6.7 6.67.6
6.2 5.9 6.3
4.95.6
5.5 5.9 5.85.5 5.3 5.6 5.2 5.5
5.8
4.8
NEFL FL
Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats
Resident Nonwhite Infant Mortality Rates Northeast Florida and Florida2001-2010
2001 2002 2003 2004 2005 2006 2007 2008 2009 20106
8
10
12
14
16
18
20
16
12.7
16.2
15.3
16.1
12
11.9
13.8
10.5 10.3
12.2 12.4 12.411.5
12.5 11.812.2
11.8 12.1 10.6
16.8
13.613.7
15.9
18.8
12.812.9
14.1
12.3
10.4
NEFL FL Black
Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats
Infant Birth weight Delivery Northeast Florida 2005-2010
22%
33%13%
28%
3%
< 500 grams (< 1.1 pounds)500-1499 grams (1.1-3.29 pounds)1500-2499 grams (3.3 - 5.49 pounds)2500+ grams (> 5.5 pounds)No info
Cause of Death0%
10%
20%
30%
40%
50%Prematurity
Sleep related
RDS/BPD/Pul-monary Hy-poplasia
Infection
Congenital Anomalies
NEC
Multiple Organ Failure
IVH
*records may have more than one cause of death listed N=938
NEFL Causes of Infant DeathNortheast Florida2005-2010
Infant Age at DeathNortheast Florida2005-2010
2005 n=189
2006 n=158
2007 n=154
2008 n=165
2009 n=155
2010 n=127
0%10%20%30%40%50%60%70%80%90%
100%
61.4 64.6 64.3 67.3 68.8 69.3
38.6 35.4 35.7 32.7 31.3 30.7
Neonates Postneonates
38 – 44% of neonates represented above died at < 24 hours of age
Northeast Florida
Sleep related deaths
2005-2010
Sleep Related DeathsNortheast Florida2005-2010
84%
16%
Infant deathsn=938
All other causesSleeping infant deaths
N=790
N=148
Total Number of Sleep Related DeathsNortheast Florida2005 – 2010
2005
2006
2007 2008 2009 2010
# 33 23 27 27 22 16
% of death
s
17.5%
14.6%
17.6%
16.4%
15.1%
12.6%
Prepared by Llee
NEFL FIMR
Healthy Start Coalition
Rate Comparison
2005 2006 2007 2008 2009 2010
# NEFL SIDS cases
10 10 6 6 3 1
NEFL SIDS rate/1,000 live births
.55 .53 .31 .32 .16 .06
FL SIDS rate .38 .39 .34 .35 .32
# NEFL Undetermined or other sleep related cases
23 13 21 21 19 15
NEFL sleeping infant death rate/1,000 live births
1.83 1.21 1.40 1.45 1.20 .91
Prepared by LleeNEFL FIMR
Healthy Start Coalition
Distribution of Sleep Related Deaths in 2010
Baker Clay Duval Nassau
St Johns
# deaths
1 3 8 3 1
• Baker-1 in Glen St. Mary• Clay-2 in Keystone Heights and 1 in Middleburg• Nassau-2 in Bryceville and 1 in Callahan • St. Johns- 1 in Saint Johns
Maternal DemographicsSleep Related Deaths
• 79% in their 20’s• 71% single• 63% white• about ½ had inadequate prenatal care• 42% with no high school diploma• about 1/3 are overweight or obese
Risk Factor Comparison
Risk Factor 2005 – 2009n=132
2010n=16
Unsafe sleep surface 79% 80%
Not on back to sleep 66% 63%
Not in an infant bed 67% 63%
Never breast fed 67% 63%
Unsafe items in bed 61% 56%
Second/third hand smoke
46% 44%
Sharing sleep surface 58% 31%
Resident Infant Mortality Rates by CountyAll Races2005-2010
Baker Clay Duval Nassau St. John's0
2
4
6
8
10
12
14 12.07
5.43
9.37
7.54
4.93
Chart Title
State rate
Baker County-6 year summary
40 total fetal and infant deaths; 28 infants/12 fetals
78% white; 12% black 65% single moms (highest) > half moms w/ unhealthy BMI 30% with no HS diploma; 15% w/ college ¼ with poor birth spacing
Zip City Total Fetal and Infant Deaths
32063 MacClenny 21
32040 Glen St. Mary 14
Clay County-6 year summary
Maternal demographics: 51% single 18% teens (highest-was Nassau) 10% Hispanic (highest) 71% white 52% w/ unhealthy BMI—1/3 of those underweight
(highest)
Zip City Deaths
32068
Middleburg 45
32065
Orange Park
26
32073
Orange Park
37
143 fetal and infant deaths; 75 infants/68 fetals
Nassau County-6 year summary
Maternal Demographics86% white, 11%
black, 48% single¼ w/out HS diplomaMore smokers1/2 w/ unhealthy BMI
Zip City Deaths
32011 Callahan 12
32034 Fernandina 16
32097 Yulee 21
57 total deaths: 32 infant and 25 fetal
St. John’s County-6 year summary
Maternal Demographics: 80% white (highest) 60% married (highest) 43.2% w/ some college (highest) Best pnc, birth spacing and
healthy BMI’s More variety in substance abuse
Zip City Deaths
32082 Ponte Vedra 11
32084 DowntownSt Aug
34
32086 St Aug Shores
18
32092 Palmo 23
32145 Hastings 9
109 total deaths:• 45 infants• 64 fetals (all other
counties had fewer fetals than infants)
Resident Infant Mortality Rates by RaceDuval County2001-2010
2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
5
10
15
20
25
16.2
13
15.815.7
16.8
12.812.1
13.4 12.410.9
7.8 7.5
6.9
7.5 7.9
7.2 6.7 7.15.5 5.8
11.29.6 10.5
10.9 11.6
9.59
9.78.4
8
22.1
12.1
16.816.4
20.1
14.615.4
15.3 15.9
8.83
17.514.3
15.515.3
16.9
12.9
12.9 14 13.0611.3
Nonwhite
White
Total County
Florida
Target Area
Black
Prepared by L.Lee Source: Birth and Death Certificates/Vital stats
Birth versus Death Cohorts: Demographics
Birth Cohort Death Cohort
Race W=58%; B=35% W=40%; B=50%
Age Teens @ 11%; 20’s –high 50%
Teens trending down since 2007 approaching birth cohort; 20 year olds represent 50-60%; slight upward trend in 40 year olds
Single Marital Status
47% last 3 years Decreased from 65% to 57% last 3 years
Education-HS or higher
82% Increase over last 3 years from 60 to 70%
Birth versus Death Cohorts:Behavior
Birth Cohort Death Cohort
Smoking 8% 12-17%
Unhealthy BMI 46% 52%
Inadequate prenatal care 24% Trending down over last 3 years but still
@ 34% in 2010
Pregnancy Interval < 12 mos
15% 17%
Contributing Factors in FIMR CasesJuly 2006- June 2011N=142
Maternal Medical and OB History0%
10%
20%
30%
40%
50%
60%
70% 63%
32%
16%15%12%
Pre-existing condi-tions such as hy-pertension, dia-betes, asthma, etc.
History of fetal or infant loss
History of previous preterm or low birth weight baby
History of STD or other GU infection
History of elective termination
Contributing Factors in FIMR CasesJuly 2006- June 2011N=142
Pre-existing Nutritional Issues-5%0%5%
10%15%20%25%30%35%
Obesity
Inadequate Nutri-tion (underweight BMI or anemia at 1st trimester pnc
visit)
Prepared by L.Lee Source: FIMR/CRT case reviews
Contributing Factors in FIMR CasesJuly 2006 – June 2011N=142
Socioeconomic0%
5%
10%
15%
20%
25%
30%
35%
40%38%
30%
17% 18%
Life Course Perspective Issues
Maternal Age < 21 or > 35
Poverty
Other emotional stres-sors during pregnancy such as loss of job, loss of loved one, incarcer-ation, divorce, natural disaster, etc.)
Prepared by L.Lee Source: FIMR/CRT case reviews
Prepared by L.Lee Source: FIMR/CRT case reviews
Contributing Factors in FIMR CasesJuly 2006-June 2011N=142
Prepared by L.Lee Source: FIMR/CRT case reviews
Prepared by L.Lee Source: FIMR/CRT case reviews
Parental Knowledge/Compliance I...-10%
0%
10%
20%
30%
40%
50%
60%
51%
8%14%
58%
34%
Inadequate pnc
Signs and symptoms of labor or rupture of membranes and when to call MD
Kick counts; signs of decreased fetal movement and when to call MD
Family Planning
Substance abuse
Contributing Factors in FIMR CasesJuly 2006-June 2011N=142
Prepared by L.Lee Source: FIMR/CRT case reviews
Prepared by L.Lee Source: FIMR/CRT case reviews
Service Issues0%2%4%6%8%
10%12%14%16%18%20%
2%
10%9%
Medical and social services/community resources unavailable in area
Medical and social services/community resources available, but not used
Patient fear of/dissat-isfaction with system
Contributing Factors in FIMR CasesJuly 2006-June 2011N=142
Prepared by L.Lee Source: FIMR/CRT case reviews
Prepared by L.Lee Source: FIMR/CRT case reviews
Fetal/Infant Medical Issues0%
5%
10%
15%
20%
25%
30%
35%
40%
45%44%
33%
11%
Prematurity
Infection
Cord Problem
Contributing Factors by RaceMom’s Medical/OB History2008-2010
BlackN=49
Contributing Factor WhiteN=31
36.7% Obesity 25.8%
35.7% Previous fetal or infant loss 22.6%
26.5% Previous preterm and/or low birth weight baby (< 5.5 pounds)
6.5%
18.4% Previous STD or other genitourinary infection
6.5%
Contributing Factors by RaceFamily Planning2008-2010
BlackN=49
Contributing Factor
WhiteN=31
65.3% Unplanned pregnancy
32.3%
14.29% Inadequate birth spacing
0%
Contributing Factors by RaceMedical Conditions During Pregnancy2008-2010
BlackN=49
Contributing Factor WhiteN=31
55.1% Infections other than STD’s
45.2%
59.2% Preterm Labor 51.6%
34.7% Anemia 19.4%
24.5% PPROM/PROM 0%
26.5% Placental Abruption 9.7%
26.5% STD’s 3.2%
Contributing Factors by Race
Patient knowledge/compliance
BlackN=49
Contributing Factor WhiteN=31
38.8% Late Entry after 13th week
16.1%
26.53% No prenatal care 12.9%
16.33% Noncompliance 0%
Contributing Factors by RaceStressors2008-2010
BlackN=49
Contributing Factors Whiten=31
51.1% Life Course Perspective Issues 22.6%
36.7% Poverty 12.9%
10.2% Lack of support systems during pregnancy or infant’s life
0%
32.7% Other emotional stressors during pregnancy or infant’s life such as loss of loved one, loss of job, incarceration, natural disaster, etc.
12.9%
24.49% Maternal age < 21 12.9%
Other comparisons
No significant differences between races with provider issues
White mom’s had more pre-existing conditions, placenta previa, substance abuse and noncompliance/lack of understanding w/ kick counts
Black mom’s had more contributing factors in each category
Black babies had more infections and prematurity
0 to 5 6 to 10 11 to 15 16 to 200
5
10
15
20
25Black n=49White n=31
Frequency of Contributing Factors by RaceFIMR Cases 2008-2010
# of contributing factors per case
# of
cas
es
2011 FIMR Recommendations
(based on 2010 data)
1. Continue to focus on preventing sleep related deaths▪ 80% unsafe sleep surface▪ 63% not on backs or in infant beds▪ 50% exposure to second/third hand smoke
2011 FIMR Recommendations (based on 2010 data)
2. Focus on Family Planning with prenatal and interconceptional care
▪ Contraception in the immediate postpartum period▪ Birth spacing▪ Smoking▪ Timely Medicaid
3. “Did you know?” campaign to educate consumers and providers re: key facts
▪ Reinforce importance of prenatal care
▪ Expand Baker County’s prenatal fan project into all counties.
▪ Improve dissemination of FIMR findings to all providers.
