The FIMR Process includes the following:
- Selection of cases based on the infant mortality issues of the community.
- Collection of appropriate records from medical, social service and other providers.
- Maternal interview.
- Abstraction of available records to produce a de-identified case summary.
- Presentation of de-identified case summary to review team.
- Development of data-driven recommendations.
- Implementation of recommendations to prevent future deaths.
The classic FIMR includes two components: a case review team (CRT) and a community action team (CAT).
- CRT — reviews case summaries and develops recommendations
- Diversity and community involvement in the CRT is key.
- CRT members should have influence and commitment to improve services.
- Members should be those who provide services for families as well as community advocates. Recommended professionals include: representatives from local health department, OB/GYN, social services, SIDS agencies, Medicaid, WIC, minority advocacy, child care providers, drug treatment centers, and hospital administrators.
- CAT — reviews the recommendations presented by the CRT and develops a plan to implement these interventions
- It is recommended that an existing community group serve as the CAT, rather than creating a new team.
- Examples of possible CAT teams: Healthy Mothers/Healthy Babies program, Prenatal/Perinatal Regional Consortium, Community Advisory Board, mayor’s or county commissioner’s blue ribbon panel on infant mortality.
- The CAT coordinates their plan with the CRT and shares their interventions.
Key roles for local FIMR programs include coordinator, abstractor, and interviewer. These positions can be all one person, or three different, coordinated staff members. Most of the FIMR budget is spent on salaries for these positions.
- Oversees the FIMR process including: selection of cases to review, monitoring case preparation, coordination of CRT and CAT teams, meetings and activities, preparation and summarization of data for local teams and the Ohio Department of Health.
- Requests medical/social services records, enters appropriate information (including maternal interview) into the database system, and prepares case summary.
- Tracks, contacts, and engages the mother/family of the infant who died, conducts interview, and provides information to abstractor.
For full job descriptions and other tools for FIMR teams, please see the National Center for Fatality Review and Prevention website.
FIMR and CFR
There are several similarities between Fetal Infant Mortality Review and Child Fatality Review (CFR). In some cases, FIMR is a subset of a county’s CFR team, and both work together to complete case reviews.
Similarities between FIMR and CFR:
- Both are local systems, with local control and determination.
- Both are public health focused.
- Both are prevention focused.
- Neither is a medical peer review system.
- Neither is investigative or prosecutorial.
- Neither is research.
Differences between FIMR and CFR:
- CFR is mandated by the Ohio Revised Code, FIMR is not.
- FIMR has two teams; a CRT and a CAT.
- Number and type of cases reviewed – FIMRs usually review a relevant sample of cases, which includes fetal deaths and infant deaths up to a year of age. CFR in Ohio reviews all child deaths from birth through age 17.
- Anonymity – FIMR is de-identified whereas CFR is confidential.
- Family Participation – FIMR includes a maternal/family interview.
- Community Participation – FIMR includes community members on the Case Review Team.
- Membership – FIMR teams usually include more OB/GYN, maternal-fetal medicine and neonatology representatives than CFR.