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Northeast Florida FIMR Findings

January 2005-December 2010. Northeast Florida FIMR Findings. Laurie Lee, RN, BSN FIMR Coordinator Northeast Florida Healthy Start Coalition. Overview of the Fetal & Infant Mortality Review Process. The FIMR Case Review Team meets bimonthly

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Northeast Florida FIMR Findings

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  1. January 2005-December 2010 Northeast Florida FIMR Findings Laurie Lee, RN, BSN FIMR Coordinator Northeast Florida Healthy Start Coalition

  2. 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.

  3. 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 rates • Fetal losses over 36 weeks gestation or 2500 grams • Deaths in outlying counties, etc.

  4. Resident Infant Mortality Rates-All RacesNortheast Florida and Florida2001-2010 Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats

  5. Resident White Infant Mortality RatesNortheast Florida and Florida 2001-2010 Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats

  6. Resident Nonwhite Infant Mortality Rates Northeast Florida and Florida2001-2010 Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats

  7. Infant Birth weight Delivery Northeast Florida 2005-2010

  8. NEFL Causes of Infant DeathNortheast Florida2005-2010 *records may have more than one cause of death listed N=938

  9. Infant Age at DeathNortheast Florida2005-2010 38 – 44% of neonates represented above died at < 24 hours of age

  10. Northeast Florida Sleep related deaths 2005-2010

  11. Sleep Related DeathsNortheast Florida2005-2010

  12. Total Number of Sleep Related DeathsNortheast Florida2005 – 2010 Prepared by Llee NEFL FIMR Healthy Start Coalition

  13. Rate Comparison Prepared by Llee NEFL FIMR Healthy Start Coalition

  14. Distribution of Sleep Related Deaths in 2010 • 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

  15. 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

  16. Risk Factor Comparison

  17. Resident Infant Mortality Rates by CountyAll Races2005-2010 State rate

  18. 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

  19. 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) 143 fetal and infant deaths; 75 infants/68 fetals

  20. Nassau County-6 year summary Maternal Demographics • 86% white, 11% black, • 48% single • ¼ w/out HS diploma • More smokers • 1/2 w/ unhealthy BMI 57 total deaths: 32 infant and 25 fetal

  21. 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 • 109 total deaths: • 45 infants • 64 fetals (all other counties had fewer fetals than infants)

  22. Resident Infant Mortality Rates by RaceDuval County2001-2010 Prepared by L.Lee Source: Birth and Death Certificates/Vital stats

  23. Birth versus Death Cohorts: Demographics

  24. Birth versus Death Cohorts:Behavior

  25. Contributing Factors in FIMR CasesJuly 2006- June 2011N=142

  26. Contributing Factors in FIMR CasesJuly 2006- June 2011N=142 Prepared by L.Lee Source: FIMR/CRT case reviews

  27. 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

  28. 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

  29. 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

  30. 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

  31. Contributing Factors by RaceMom’s Medical/OB History2008-2010

  32. Contributing Factors by RaceFamily Planning2008-2010

  33. Contributing Factors by RaceMedical Conditions During Pregnancy2008-2010

  34. Contributing Factors by RacePatient knowledge/compliance

  35. Contributing Factors by RaceStressors2008-2010

  36. 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

  37. Frequency of Contributing Factors by RaceFIMR Cases 2008-2010 # of cases # of contributing factors per case

  38. 2011 FIMR Recommendations (based on 2010 data) • 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

  39. 2011 FIMR Recommendations (based on 2010 data) • Focus on Family Planning with prenatal and interconceptional care • Contraception in the immediate postpartum period • Birth spacing • Smoking • Timely Medicaid • “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.

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