Adapting Fetal and Infant Mortality Review (FIMR) to Congenital - - PowerPoint PPT Presentation

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Adapting Fetal and Infant Mortality Review (FIMR) to Congenital - - PowerPoint PPT Presentation

Oct 07, 2022 102 likes •273 views

Adapting Fetal and Infant Mortality Review (FIMR) to Congenital Syphilis (CS) National Coalition of STD Directors (NCSD) 2017 Annual Meeting Alexandria, Virginia November 15, 2017 Craig Wilson STD and Viral Hepatitis Administrator Florida

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Adapting Fetal and Infant Mortality Review (FIMR) to Congenital Syphilis (CS)

National Coalition of STD Directors (NCSD) 2017 Annual Meeting Alexandria, Virginia November 15, 2017

Craig Wilson STD and Viral Hepatitis Administrator Florida Department of Health

Division of Disease Control and Health Protection 1

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Learning Objectives

  • Understanding the need for additional is CS data
  • History and construct of FIMR
  • Healthy Start Program in Florida
  • Supplemental grant activities

Division of Disease Control and Health Protection 2

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Currently Collected – Maternal

  • Contact and demographic data
  • Pregnancy history, last menstrual period, estimated date
  • f delivery, prenatal visit data
  • Syphilis and HIV testing history and diagnoses
  • Treatment and serologic response

Division of Disease Control and Health Protection 3

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Currently Collected - Baby

  • Delivery – date, weight, vital status, gestational age
  • Testing data – type(s), source, date, results
  • Symptoms – long bone, cerebrospinal fluid, venereal

disease research laboratory test or white blood cell, other

  • Treatment
  • Congenital record created whether or not morbidity

claimed

Division of Disease Control and Health Protection 4

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Data Collection Gaps

  • Barriers to prenatal care
  • Social services agencies’ involvement
  • Cultural beliefs
  • Many current data fields are not required
  • Missing pregnancy status

Division of Disease Control and Health Protection 5

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FIMR Roots

  • Infant mortality considered proxy for health of

communities

  • US infant mortality rate in 1989 was 9.7/1,000 live births
  • Ranked 19 of 25 industrialized countries (range 4.4–14.4)
  • Racial and ethnic disparities: 1989–91 African American

babies 2.4 times more likely than Caucasian babies to die in first year

  • Early discussions around social determinants of health

Division of Disease Control and Health Protection 6

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FIMR and Healthy Start in Florida

  • National American Congress of Obstetricians and Gynecologists

initiative begun around 1990 to address infant mortality rates

  • Broward County, Florida among first 12 projects funded nationally
  • Florida established Healthy Start in 1991 to improve birth and

developmental outcomes; included local coalitions to assess community needs, system of care

  • Healthy Start funded with state general revenue and Maternal and

Child Health Federal Block grant

  • 12 FIMR projects currently (11 funded)

Division of Disease Control and Health Protection 7

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Elements of FIMR

  • Selection process: all, randomized, conditional
  • Data extraction: family interviews, birth/death certificates,

autopsy reports, hospital records, outpatient records,

  • ther service providers
  • Case review team: consumers, array of professionals
  • Community action team: politically savvy, gatekeepers
  • Evaluation

Division of Disease Control and Health Protection 8

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FIMR Process for Improvement

Death Occurs  Cases Selected  Data Abstracted  Case Review Team Reviews and Recommends  Community Action Team Proposes Community Action  Improved Health

Division of Disease Control and Health Protection 9

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Syphilis in Women versus Congenital Syphilis

Division of Disease Control and Health Protection 10

39 35 48 38 60 10 20 30 40 50 60 70 200 400 600 800 1000 1200 1400 1600 2012 2013 2014 2015 2016

Number of Congenital Cases Number of Female Cases Females with Syphilis Congenital Syphilis

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FIMR Process for Congenital Syphilis

  • Contract with Florida Association of Healthy Start Coalitions
  • Directly funding five counties with largest number of CS cases

in 2016 (44/60 cases)

  • Review process to be replicated statewide
  • Review ≥90% of reported cases
  • Case Review Team: consumers, professionals including

Healthy Start representative, social worker, Sexually Transmitted Diseases Program member, medical professionals

Division of Disease Control and Health Protection 11

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FIMR Process for Congenital Syphilis, continued

  • Confidentiality statements required
  • Data sources:

– Mothers’ medical records – Baby’s medical records – Delivery facility records – Records from all involved social service agencies – Interview with mother – Surveillance records

Division of Disease Control and Health Protection 12

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FIMR Process for Congenital Syphilis, continued

  • Missed opportunities
  • Service gaps
  • Barriers/contributing factors:

– Transportation – Insurance – Cultural beliefs – Prenatal testing

Division of Disease Control and Health Protection 13

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Anticipated Outcomes

  • More complete epidemiologic profile of CS cases
  • Improved coordination of case prevention effort
  • More targeted education campaign for providers
  • Identified needs addressed via local community planning

processes

Division of Disease Control and Health Protection 14

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Questions and Discussion Craig Wilson STD and Viral Hepatitis Administrator Florida Department of Health Craig.Wilson@flhealth.gov 850-245-4602

Division of Disease Control and Health Protection 15