The Central New York Fetal-Infant Mortality/Morbidity Review/Registry (FIMMRR)

Supported by a grant from the Community Health Foundation of Western and Central New York (www.chfwcny.org), The Central New York Fetal-Infant Mortality/Morbidity Review/Registry (FIMMRR) is a demonstration project. It combines aspects of traditional FIMR (Fetal Infant Mortality Review) programs with standardized case review to provide critical feedback to healthcare providers and community agencies which can be used for Continuous Quality Improvement.

Our overall project goal is to develop a model, clinically oriented, community based Fetal-Infant Mortality/Morbidity Review/Registry (FIMMRR) for Onondaga County and The Central New York Region.

The County and the Central New York region both have unacceptably high rates of poor pregnancy outcome, especially among the racial/ethnic/socio-economically disadvantaged minorities. To implement this standard process within the Quality Assurance system at affiliate birth hospitals, we have implemented a standardized case review process for all spontaneous late fetal deaths (≥ 300 Grams) and all neonatal deaths within these institutions.

Additionally, we have implemented a standardized case review process for all infant deaths (including post-discharge deaths, up to 1 year of age) and all Extremely Low Birth Weight babies (<1000 Grams) born to Onondaga county residents within the three county birth hospitals.

FIMMRR Flowchart

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Background

Infant Mortality

The Infant Mortality Rate (IMR) remains a critical problem in the United States as reflected by recent data showing an actual increase in the nationwide IMR.
Local statistics (2001-2003) are also striking with an IMR of 10.2 in Onondaga County, which is significantly higher than the New York State rate of 5.9.
Racial and ethnic disparity remains unresolved and in Onondaga County African American infants die over twice as often as white infants.
Syracuse (Onondaga County’s urban center) has the second-highest child poverty rate in the US for Hispanics and the worst rate in NY for Blacks.
The same disparity in birth outcome is found among the economically disadvantaged throughout Central New York.

Fetal Mortality

Fetal mortality is about as frequent and disparate as infant mortality but has been less adequately studied.
Examining fetal and infant mortality together is necessary to properly perceive the overlapping etiologies.

Morbidities

Infant morbidity, as reflected by the surviving ELBW babies (<1000 gm), is also the product of the same reproductive problems that exhibit racial/ethnic/ socioeconomic disparity.
In most cases of fetal/infant mortality/morbidity, there is inadequate detail regarding the cause of death/morbidity or the contributing factors on the part of the patient, provider, health systems and/or community supports.

Impact

Society cannot improve the current poor fetal and infant mortality and morbidity without being able to measure systems and evaluate the processes of care as well as the detailed causes and contributing factors.
In-depth review of individual and aggregate fetal/infant death and morbidity cases when studied as sentinel events will shed great light on the root causes of poor pregnancy outcomes and thus the means to improve them.
It will also improve the health of the children that survive.

Fetal-Infant Mortality Review

While Fetal and Infant Mortality Review (FIMR) programs have been implemented in 220 sites in 42 US states, the methodology that they have used has limited the extent to which they can provide evidence-based clinical feedback to health care providers and
Regional Prenatal Centers.

Innovative Aspects of the FIMMRR:

Includes Very Low Birth Weight survivors
Includes detailed medical root cause analysis of each fetal, infant and Very Low Birth Weight morbidity
Utilizes a Registry mechanism for analysis and evaluation
Embodies the potential for action plans that include the full spectrum of participants—consumers, providers, health and related agencies
It has great generalizability throughout the State of New York and even nationally.

The FIMMRR Team:

Richard H. Aubry, MD, MPH, FACOG, Principal Investigator
Professor of Obstetrics and Gynecology, SUNY Upstate Medical University
Division of Maternal-Fetal Medicine
Director, Academic and Community Obstetrics
Co-Director CNY Regional Perinatal Program
Medical Director, Center for Maternal & Child Health (C-MATCH)

Michelle Bode, MD, MPH,
Neonatal Associates, Crouse Hospital

Martha Wojtowycz, PhD,
SUNY Upstate Medical University,
Department of Obstetrics and Gynecology, C-MATCH

Pamela Parker, BA, SUNY Upstate Medical University, Department of Obstetrics and Gynecology, C-MATCH

Kristen Luke-Houseman, RN, BA, SUNY Upstate Medical University, Department of Obstetrics and Gynecology, C-MATCH

For more information or any questions or concerns, please contact:

Kristen Luke-Houseman
Perinatal Quality Assurance Coordinator of the Central New York FIMMRR
lukehouk@upstate.edu.

Supported by a grant from the Community Health Foundation of Western and Central New York. The Community Health Foundation is a non-profit private foundation with a mission to improve the health and health care of the people of Western and Central New York.