ment support , maternal interview , records review , case review and community action . The process begins when the program is notified that a fetal or infant death has occurred . The FIMR Program receives referrals from hospitals , clinics , the Kentucky Office of Vital Statistics , case management programs and other perinatal providers . The five components are described below :
FAMILY SUPPORT
FIMR staff contacts parents through phone calls and home visits soon after the pregnancy loss or infant death . Staff provides emotional support , information and referrals to other services that assist parents and families .
MATERNAL INTERVIEW
After family support has been initiated , the mother may participate in an interview . The maternal interview is the heart of the FIMR Program and makes FIMR unique among other case review processes . The interview allows the mother ’ s voice to be heard and provides her with the opportunity to share her experiences before , during and after pregnancy .
RECORDS REVIEW
The FIMR Program reviews information from a variety of sources , including birth and death certificates , coroner ’ s reports , and records from health and social service agencies .
CASE REVIEW
A case summary is prepared using information from the maternal interview and records review . The summary is de-identified to assure the confidentiality of patients , providers and health care facilities . The case summary is then presented to the Case Review Team ( CRT ) for review . This team represents a range of professional organizations and public and private agencies that provide services and resources for women , infants and families . The CRT reviews the summaries , examines the circumstances related to each case and identifies social , economic , health , educational , environmental and safety factors associated with those deaths . The CRT then identifies problems with the health care system that require change and makes recommendations for how to improve policies and services that affect families .
COMMUNITY ACTION
The next step in the FIMR process is to turn CRT recommendations into action . Issue-specific task force groups are assembled to implement interventions designed to address the problems identified by the CRT . Task force members include those who are in a position to direct change at the community level .
Such interventions have included campaigns to educate and encourage parents and caregivers to put infants to sleep on their backs and to emphasize the importance of the infant having its own crib to sleep in as opposed to co-sleeping with parents .
Many organizations are a part of the Louisville FIMR Program . Participants include Baptist Health Louisville , Catholic Charities , the Crimes Against Children Unit of Louisville Metro Police , the Family and Children ’ s Place , Humana Caresource , the Jefferson County Coroner ’ s Office , the Kentucky Department for Public Health , the Kosair Office of Child Advocacy , the Louisville Metro Department of Public Health and Wellness , The March of Dimes , Norton Healthcare , Park DuValle Community Health Center , Passport Health Plan , University of Louisville Center for Women and Infants and the University of Louisville School of Medicine ’ s Department of Fetal-Infant Health .
The reinstituted Louisville FIMR Program is part of the newly formed Healthy Babies Louisville Coalition which brings together officials from 13 health and social service organizations to improve infant health throughout the city . Other initiatives include increasing referrals to prenatal and perinatal services through the Metro United Way 211 call center and increasing access to mental and behavioral health services for families and children .
Physicians can play an important role in the FIMR process . When the FIMR process is established in the community , physician participation ensures the program has the support and legitimacy of the medical community . Obstetricians , pediatricians , neonatologists , perinatologists , pathologists and others can play a vital role in case review team deliberations by interpreting medical information and identifying needed improvements and changes .
We are asking that physicians who have had a fetal loss of at least 24 weeks gestation or an infant loss of up to one year of age refer those women to the Louisville FIMR Program . The mother will be contacted by a case review nurse to begin the FIMR review process . Please contact program coordinator Mary Jolly at Mary . Jolly @ louisvilleky . gov . We also welcome physicians wishing to serve on the FIMR review team or who would like more information to contact us .
Larry Griffin , MD , is the director for Women ’ s Health Policy at Passport Health Plan .
Sarah Moyer , MD , MPH , is the medical director of the Louisville Metro Department of Public Health .
10 LOUISVILLE MEDICINE