Project Imprint Shalae Harris, RN, BSN, MPA FIMR Coordinator, Chart Abstractor Ty Kane, MPH Carol Moyer, ASN, BS, MPH SCHD, Community Health Analyst KDHE, Office of BEPHI, Epidemiologist Christy Schunn, LSCSW Linda Frazier, MD, MPH SIDS Network of KS, Executive Director KUMC-Wichita, Dept. of OB/GYN FIMR Maternal Interviewer

Infant health is a measure of community well-being. (NFIMR website, 2001)

 In 1984, National Fetal and Infant Mortality Review (NFIMR) was first developed by the federal Maternal Child Health (MCH) Bureau.  A continuous quality improvement model to help communities improve the services and resources available to women and families.  NFIMR began with 6 FIMR projects in the U.S.  In 1990, a public health collaboration began between the American College of Obstetricians and Gynecologists (ACOG) and the MCH Bureau to further expand FIMR projects.  There are 200 FIMR programs in 40 U.S. states.

 June 2007 ~ Joint research agreement with KDHE and Kansas City Healthy Start  February 2009 ~ Movement to develop a collaborative FIMR project based on the NFIMR model  September 2009 ~ FIMR Case Review Team (CRT) training  May 2010 ~ Part-time Chart Abstractor hired  July 2010 ~ Initial CRT Meeting  November 2010 ~ Initial Community Action Team meeting  April 2011 ~ KDHE IRB Approval

 Project of the Child Health Advisory Committee  Formed in 2009 to review the IM problem in Kansas  Identifies potential solutions and recommendations for IM  Panel consists of 22 representatives from state, local, and private organizations who have a broad range of expertise in maternal child health.

 Milestones  February 2010 Interim Recommendations  April 2010 Legislative Effort  February 2011 Actionable Framework

 Funding ◦ Healthy Babies/Healthy Start ◦ Central Plains Health Care Partnership  Support ◦ SCHD - various departments ◦ KDHE ◦ KUMC-Wichita ◦ SIDS Network of KS ◦ Medical Society of Sedgwick County ◦ Wesley Medical Center & Via Christi Health

U.S. 2008, 2009 preliminary data Source: Bureau of Epidemiology and Public Health Informatics, KDHE; National Center for Health Statistics

OECD Health Statistics

The Causes of Infant Mortality  Low birth weight  Prematurity  Birth Defects  SIDS  Disparities in health care access  Disparities in living conditions  Relational issues  Stress  Environmental conditions Physical Social/Environmental

The FIMR Process

 Notification of death  Case records abstraction  Maternal/Family interview  Case summary

 Reviews case data from medical records and family interviews  Identifies trends and gaps in services  Makes recommendations to the CAT for systemic community change

 21 members met July 2010-June 2011  Representing over 20 organizations  22 cases reviewed  25 Cases with attempted interviews  12 Cases with completed interviews 2010 recommendations surround 3 themes: ◦ Education ◦ Connection ◦ Access

 Develops community interventions based on recommendations received  Utilizes existing community resources to implement intervention strategies  Addresses the need for resources and services not currently available

 CAT core team is 15 members  Past year met 7 times  Representing 12 organizations  2 task forces focusing on FIMR CRT education recommendations: ◦ Maternal Tobacco Cessation CAT Task Force ◦ AHBBY CAT Task Force-PPE project

If you don’t know where you’re going, how are you gonna’ know when you get there? –Yogi Berra Carol J. Moyer, RN, MPH, Epidemiologist, KDHE Linda M. Frazier, MD, MPH, Professor, KU School of Medicine-Wichita

Why Evaluate? Because funding agencies require it Determine if your program is making a difference Program improvement FIMR is about the cycle of improvement Best use of resources

Goals vs. Objectives Goals “Warm and fuzzy” Non-specific Non-measurable Ex: Improve birth outcomes for infants born in SG County EX: Improved services for pregnant moms in SG County Objectives Realistic targets for program/project Answers – Who – What – When – Why – EX: Increase number of cribs provided to high risk pregnant women

INPUTS: Resources dedicated to or consumed by the program ACTIVITIES: The actions used to bring about the intended program changes or results. OUTPUTS: The direct products of program activities OUTCOMES / IMPACTS: Benefits for participants during and after program activities Source: Measuring Program Outcomes: A Practical Approach © Copyright 1996 United Way of America Logic Models

ResourcesActivitiesOutputs (Process evaluation) Short & Intermediate Long Term / Impact In order to accomplish our set of activities we will need the following: In order to address our problem or asset we will accomplish the following activities: We expect that once accomplished these activities will produce the following evidence of service delivery: We expect that if accomplished these activities will lead to the following changes in 1-3 years (short term time interval) or 4-6 years ( intermediate time intervals) We expect that if accomplished these activities will lead to the following changes in 7-10 years W.K. Kellogg Foundation Logic Model Development Guide downloaded 11/27/07 from Logic Model Development

ResourcesActivitiesOutputs (Process) Short Intermediate Long Term /Impact FIMR, collaborating partners (Kansas Quit Line, KDHE) Educational needs research Healthy Babies Program, SG County Peer reviewed research on causes of LBW Establish program to educate nurses working in prenatal care clinics Gather baseline data Protocol for 5 A smoking cessation and motivational interviewing for pregnant women Baseline data Increase % of pregnant women who follow through with the Quit Line. Increase number of warm handoffs Increase % of pregnant women who reported they quit smoking Reduce % of low birth weight babies (<2500 grams) Goal: All infants born in Sedgwick County will be healthy. Logic Model Development

Live births:n=36 Stillbirths:n=28

Summary of findings Top causes of death are birth defects, prematurity and unsafe sleep/SIDS 3/4 of liveborn infant deaths are in 1 st 28 days Medical risk factors: smoking, drug/alcohol, obesity, twins, older maternal age

1 Project Imprint, KDHE annual summary, Sedgwick County, Wesley Medical Center inpatient data, all births * At any time during pregnancy

1 Project Imprint, KDHE annual summary, Sedgwick County, Wesley Medical Center inpatient data, all births

Communities with FIMR Data assessment and analysis Client services and assess Quality assurance and improvement Community partnerships and mobilization Policy development Enhance workforce capacity The National Evaluation of Fetal and Infant Mortality Review (FIMR)

FIMR Case Review Team (CRT) issues that lead to community action (Percent of FIMR Programs) Prenatal care % Substance abuse % Sudden infant death syndrome risk reduction - 86% Smoking cessation - 72% Domestic violence % The National Evaluation of Fetal and Infant Mortality Review (FIMR)

Carol Moyer, RN MPH Data Quality Epidemiologist Bureau of Epidemiology and Public Health Informatics Division of Health Kansas Department of Health and Environment Curtis State Office Building 1000 SW Jackson Street, Suite 130 Topeka, Kansas (W) (F)

Shalae Harris, RN, BSN, MPA FIMR Coordinator/Chart Abstractor Sedgwick County Health Department Healthy Babies 434 N. Oliver, Suite 110 Wichita, KS

 Dr. Dennis Cooley, Chairperson, Kansas Blue Ribbon Panel on Infant Mortality “Kansas Infant Mortality” PowerPoint, September 2,  Kansas Department of Health and Environment, Bureau of Family Health, Bureau of Public Health Informatics.  Kansas Department of Health and Environment, Center for Health Disparities  Kansas Blue Ribbon Panel on Infant Mortality,Infant Mortality Factsheet and FIMR concept paper.  KU School of Medicine- Wichita, Dr. Linda Frazier and evaluation team  SIDS Network of KS, Christy Schunn, LSCSW  TFIMR, Tulsa Fetal & Infant Mortality Review Project, “An Introduction for Prospective Members of the Case Review Team (CRT), PowerPoint,  NFIMR, National Fetal Infant Mortality Review, ACOG website