1. Jackson County Fetal and Infant Mortality Review Report 2017
Prepared by
Aimee Fors, FIMR Health Educator
Mary Kops, BSN FIMR Abstractor

2. What Is Fetal Infant Mortality Review (FIMR)?
The Jackson County FIMR case review team consists of a diverse group of health professionals, social service professionals and community members.
This team reviews the life and death circumstances of infants who died in Jackson County.
The team identifies factors contributing directly or indirectly to the infants death.
The goal is to identify ways to improve our community’s service systems for pregnant women, infants and families with young children.

3. Why is FIMR important
Infant Mortality is often used as an indicator to measure the health and well-being of a community, because factors affecting the health of entire populations can also impact the mortality rate of infants.
FIMR is a surveillance methodology used nationally to monitor and understand infant death.
Evaluating these deaths is a window into the communities health, which allows us to identify gaps and improve birth outcomes in Jackson County.

4. Two Tiered Process FIMR Case Review Team Community Action Team Or
Maternal Child Health Action Team
Identifies social,
economic, cultural, health,
and safety system issues
Takes recommendations to action
to improve community resources
and service delivery systems
FIMR is a 2 tiered process involving a Case Review Team (FIMR Team) and a Community Action Team (Jackson County Prenatal Task Force).
Data is gathered from record abstraction and home interview. It is summarized and de-identified and presented to the CRT. CRT identifies social, cultural, economic, health, safety and system factors that contribute to infant death and makes recommendations to the Community Action Team. CAT takes recommendations to action in order to improve community resources and service delivery systems.

5. The FIMR Process Cycle of Improvement Changes in Community Systems
Data Gathering
Cycle of Improvement
FIMR is a comprehensive community approach to decreasing infant mortality. It is a continuous cycle of improvement involving data gathering, case review, community action, and changes in community service systems.
While the long term goal is a reduction in infant mortality; it is the intermediate (steps) of making improvements in community resources and service systems for women, infants and families that drive the reduction in infant mortality.
Community Action
Case Review

6. Number of Infant Deaths 1999-2015
* FIMR began in 2003

7. Jackson County Infant Mortality Rate 2005-2015
Rates are per 1,000 life births
* 2015 rate is Provisional

8. Jackson County; 3 year average IMR Compared to Michigan and US, 2004-2015

9. Percent of Jackson Co. Infant Deaths by Cause, 2013-2015 (n=30)
Other =2014, undertermined (possibly sleep), 2013 (Broncho-pneumonia), 2012 (respiratory Failure/Sepsis) .

10. JC Infant Death by Leading Causes 2002-2015
Prematurity
Congenital
Positional

11. Jackson County: Black/White IMR (3 year moving average) 2003-2015
Deaths per 1,000 live births
African American or black rate is both Mother and Father are listed as African American on birth certificate

12. Jackson County compared to Michigan risk ratio for Black/White IMR disparities 3 year moving average ( )
In African American babies were 3.1 times more likely to die before their 1st birthday than Caucasian babies

13. Jackson County IMR by race 3 year moving average (2004-2015)

14. % Deaths by Race and Cause of Death, 2013-2015 n=32
*Multi racial infants are considered ‘other’
* Other includes Bronchopneumonia, Undetermined, and Accidental (fire)

15. Sleep Related Deaths (Jackson County)
For Sleep related deaths between
In 80% of the sleep related deaths babies were co-sleeping
40% of the babies were in an adult bed
80% of babies were put to bed with blankets
In 60% of the cases parent used drugs or alcohol just prior to the death
60% of babies were put to bed with a pillow

16. Natality and Pregnancy Data
The following slides look at prenatal care trends and live births in Jackson County compared to Michigan

17. 2000-2015 Teen Pregnancy Rates Rates per 1000 females, aged 15-19)

18. 2014/2015 Teen Birth Rates (Rates per 1000 females, aged 15-19)

19. Jackson County Compared to MI Percent of Preterm Live Births and LBW 2000-2015
11.1
9.8
9.5 %
8.5
Mi PT
Jxn PT
MI LBW
Jxn LBW

20. Adequate(*Kessner index) & Entry into care(1st trimester)
Prenatal Care
Adequate(*Kessner index) & Entry into care(1st trimester) %
The dotted line looks at Michigan compared to Jackson on “The percent of women that received prenatal care during the first trimester”
* The Kessner Index is a classification of prenatal care based on the month of pregnancy in which prenatal care began, the number of prenatal visits and the length of pregnancy (i.e. for shorter pregnancies, fewer prenatal visits constitute adequate care).
Adequacy of prenatal care (Kessner index)
Jackson
Michigan
Entry to care
Jackson MI
*The Kessner index classifies care based on entry into care, the number of prenatal visits and the length of pregnancy

21. Live Births using Medicaid Payment, Jackson County, 2000-2015 (MDHHS, Vital statistics)

22. Pregnancy Intention of infant deaths 2013-2015 (n=30)

23. Jackson County infant deaths/live births Maternal Characteristics
(3 year average)
% Infant Deaths (n=30)
2015
% infant Deaths (n=9)
% live births
Jackson
% live births
Michigan
13%
Teen Mom 0%
7.3%
5.7%
53%
1st pregnancy as teen
11%
33%
< 12th grade education
12.7%
12.1%
73%
Mother Unmarried
67%
50.1%
42.7%

24. Maternal/Prenatal Characteristics
3 year average
% Infant Deaths (n=30)
2015
% infant Deaths (n=9)
% live births
Jackson
% live births
Michigan
63%
Adequate Prenatal Care
78%
66.7
67.2
73%
Entered Prenatal care 1st trimester
89%
72.3%
77%
Low Birth weight baby (<2500grams)
9.5%
8.5%
70%
Kept 6 Week postpartum visit
56%
53%
Obese (BMI > 29)
44%

25. Social/Economic Characteristics
3 year average
% Infant Deaths (n=30)
2015
% infant Deaths (n=9)
% live births
Jackson
% live births
MICHIGAN
60%
Multiple Stressors /
Social Chaos
44%
20%
Drug Use 0%
40%
Smoking
11%
28%
17%
43%
Mental Health /
Depression Issues
56%
67%
Medicaid
47.5%

26. Systems Issues and Recommendations
The following slides look at recurring systems issues and team recommendations from the reviewed infant death cases

27. Identified System Issues
( cases n=30)
Lack of PNV/folic acid prior to conception (15)
Lack of preconception and interconception care/education (14)
Lack of dental care assessment. Referral and follow-up (14)
Smoked during pregnancy (12)
Did not keep postpartum visit (8)

28. Top Recommendations 2013
Improve assessment, referral process and follow up on high Edinburgh score, to include pediatricians, hospital, OB office and postpartum
Improve communication and increase referrals between available resources (i.e. hospital, high risk clinic, OB office, ultrasound, mental health/depression, smoking cessation and substance abuse)
Provide Inter-conception care including folic acid, obesity and dental care
Improved assessment and referral for substance use / alcohol and the effects on the pregnancy

29. Top Recommendations 2014 Gather accurate birth abstract information
Improve post-partum care follow up in the areas of depression, immunizations & contraception education.
Conduct follow up on referrals during pregnancy for smoking cessation, mental health and substance abuse

30. Top Recommendations 2015
Provide drug screen testing on all preterm deliveries
Institute standard safe sleep training module for hospital and community staff
Provide complete communication between tertiary care and local OB’s, and ensure local bereavement services know when a baby from Jackson area has passed
Provide prenatal vitamin for all women of childbearing age

31. Recommendations to Action
Possible strategies to turn recommendations to action
Example:
Meet with birth abstract person at HFAH by 12/2017 to determine potential roadblocks in gathering accurate birth certificate information.
Gather accurate birth abstract information

32. Maternal Child Health Action Team

33. Maternal Child Health Action (MCHAT) Team Accomplishments
Community Navigation Specialist (pathways program/MHEF) promoting community linkages
37 referrals, 116 pathways completed
Most commonly used pathways have been: housing, financial, transportation, clothing, and childcare
43% of referrals were currently pregnant
Worked to update the local PRAMS survey to include more social determinates of health / equity questions
Continued safe sleep presentations to colleges, non-profits, DHHS, adoption services, rehabilitation organizations etc.

34. Emerging concepts
Opioid use in pregnancy and the burden of Neonatal Abstinence Syndrome
Using an equity lens to addressing racial disparities
Impact of trauma experiences on birth outcomes
The impact of changes in health care coverage

35. Summary
As the leading causes of infant mortality in Michigan our primary goal is reduce the number of preterm births, congenital anomalies and positional asphyxia deaths of our infants.
Infant mortality remains a complex, multi-factorial issue that must be challenged on multiple fronts with emphasis on addressing the top causes of infant death through some of the following:
Interconception Care
Folic acid, chronic disease management, depression screening, pregnancy planning, dental care and weight management
Inter-agency referrals
Substance abuse assessment and treatment
Focus on social determinates of health and the impact on birth outcomes

36. Summary (cont.)
Our community action team (MCHAT) must address these issues in a collaborative way looking at root causes and implementing system changes for long term effects.
Improved maternal and infant outcomes require strategies that focus on specific factors across the life course.
In order to support better health status of women and girls, communities must ensure access to health care, health information, and health education, in ways that empower individuals and families to become active participants in healthy lifestyles and behavioral choices.

37. Questions? Aimee Fors & Mary Kops Jackson County Health Department
(517) / /