LOUISVILLE REINSTITUTES FETAL
MORTALITY REVIEW
Larry Griffin, MD and Sarah Moyer, MD, MPH
I
n March, Louisville
reinstituted its Fetal Infant Mortality
Review (FIMR) Program after the process
had lapsed for several
years. FIMR strives to
reduce fetal and infant
death in the community by examining the psychosocial causes of those deaths and
undertaking systemic change to prevent future deaths.
specific individual cases.
FIMR is a community-based, action-oriented initiative that enhances the health and well-being of women, infants and families
through the review of fetal and infant death. With the FIMR, we
attempt to understand how a wide array of social, economic, health,
educational, environmental and safety issues relate to infant loss
on a local level. In turn, we hope to utilize that information to
improve community resources and systems of care to reduce fetal
and infant mortality.
The FIMR case review team never sees the actual medical record. Instead, FIMR staff abstract a standard set of information of
each case. An interview with the mother is conducted to discover
psychosocial and economic issues and barriers to care affecting the
family during pregnancy and the first year of the child’s life. The
purpose of the FIMR review is to look for ways to improve service
systems and resources for women and families and to address gaps
in care and to understand how psychosocial and economic issues
affect outcomes.
The FIMR process has entirely different goals and methods from
hospital or physician peer reviews. FIMR is aimed at improving
broad community social health conditions for mothers and babies,
not at determining who is responsible for negative outcomes in
Whereas hospital peer review committees are composed of personnel from the facility that provides health care and examine actual
medical records with identifiers in place to determine the adequacy
of the management of the case or individual physicians who have
privileges at the hospital, FIMR case reviews are confidential and
materials are de-identified before they are reviewed. The names of
physicians, hospitals and other institutions are removed from the
case. Much of the FIMR case review involves examining family
circumstances or psychosocial issues impacting the health of the
baby and mother.
THE FIMR PROCESS
The FIMR process consists of five components: grief and bereaveJUNE 2016
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