ABSTRACT
OBJECTIVE: An evaluation of fetal and infant mortality review (FIMR) programs nationwide was conducted to characterize their unique role in improving the system of perinatal health care. The aim of this paper is to examine intermediate outcomes of the FIMR, in particular the development and implementation of recommendations produced by the FIMRs and the conduct of essential MCH services by the FIMRs. METHODS: We report on 74 FIMRs whose communities were selected for the nationwide evaluation and for whom we had data from the FIMR director or comparable respondent. We focus on the recommendations of the FIMRs and the essential maternal and child health (MCH) services conducted by the FIMRs as intermediate outcomes (or outputs) and then examine how selected characteristics of the FIMR may influence these. RESULTS: FIMRs developed recommendations on a broad range of topics but there were some areas for which nearly all programs had developed recommendations. The FIMRs relied primarily on strategies related to programs and practices, with few FIMRs reporting attention to policy-oriented approaches. Implementation of recommendations was high. Factors that influenced likelihood of implementing recommendations and conduct of essential MCH services included structure of the FIMR and training received by FIMR directors and staff. CONCLUSIONS: The focus of FIMR recommendations and the likelihood of implementation vary across FIMRs as does the conduct of essential MCH services. FIMR team structure and training of the director and staff are important areas to consider in efforts to maximize the impact of FIMR.
Subject(s)
Child Health Services/organization & administration , Fetal Death , Infant Mortality/trends , Maternal Health Services/organization & administration , Female , Forecasting , Health Planning/organization & administration , Health Planning Guidelines , Humans , Infant, Newborn , Male , Organizational Innovation , Outcome Assessment, Health Care , Pregnancy , Prenatal Care/organization & administration , Program Development , Program Evaluation , Public Health , United States/epidemiologyABSTRACT
OBJECTIVES: To evaluate the association of the presence of a fetal and infant mortality review (FIMR) program, other perinatal systems initiative (PSI), or both in a community with the performance of essential maternal and child health (MCH) services by local health departments (LHDs). METHODS: Data were obtained from telephone interviews with professionals from LHDs across the United States. Logistic regression was used to estimate the odds of a LHD conducting each essential MCH service in communities with and without FIMR programs or with and without PSIs, adjusted for geographic area. RESULTS: Of the 193 communities in the sample, 41 had only a FIMR program, 36 had only a PSI, 47 had both programs, and 69 had neither. The presence of a FIMR was related to greater performance of essential MCH services in LHDs in six areas: data assessment and analysis; client services and access; quality assurance and improvement; community partnerships and mobilization; policy development; and enhancement of capacity of the health care work force. Similar findings were noted for the same broad essential services for PSIs. The comparisons of LHDs in FIMR and non-FIMR communities, however, showed greater involvement of communities with a FIMR program in essential MCH services related to data collection and quality assurance than were found for comparisons of LHDs in communities with and without a PSI. The presence of a PSI was uniquely associated with conducting needs assessments for pregnant women and infants, participation in coalitions for infants, promoting access for uninsured women to private providers and involving local officials and agencies in health plans for both populations. When both programs were present, LHDs had a greater odds of engaging in essential MCH services related to assessment and monitoring of the health of the population, reporting on progress in meeting the health needs of pregnant women and infants, and presenting data to local political officials than when either program alone was in the community. CONCLUSIONS: Local health departments in communities with FIMR programs or PSIs appear to be more likely to conduct essential MCH services in the community. Some of these relations are unique to FIMR, particularly for data collection and quality assurance services, and some are unique to PSIs, for example those that involve interaction with other community agencies or groups. Performance of the essential MCH services also appears to be enhanced when both a FIMR program and a PSI are present in the community.
Subject(s)
Child Health Services/organization & administration , Fetal Death , Infant Mortality/trends , Maternal Health Services/organization & administration , Chi-Square Distribution , Community Health Services/standards , Community Health Services/trends , Confidence Intervals , Cross-Sectional Studies , Female , Forecasting , Health Planning/organization & administration , Humans , Infant, Newborn , Logistic Models , Male , Odds Ratio , Perinatal Care/standards , Perinatal Care/trends , Policy Making , Pregnancy , Program Development , Program Evaluation , Surveys and Questionnaires , Total Quality Management , United States/epidemiologyABSTRACT
Pediatric cancer patients from the US-associated Pacific Islands have the option of referral to the United States for diagnosis and treatment through historical governmental agreements. These patients and their families travel thousands of miles, relocating for extended periods of time, to complete treatment. The purpose of this study is to describe the characteristics of Pacific Islands children referred for treatment to a pediatric oncology clinic in Hawaii, the support services they utilized, and the difficulties they experienced during their relocation. The medical records of 100 children referred from the Pacific Islands to Kapiolani Women's and Children's Hospital in Honolulu, Hawaii, between 1981 and 2002 were abstracted to gather data on treatment and service utilization. Interviews were conducted with 17 of these families for a more qualitative description of their experiences. The study found that families face considerable financial, emotional, and cultural stressors when relocating from the Pacific Islands to Honolulu for pediatric cancer treatment. The support systems currently in place can only partly address the needs of this population.
Subject(s)
Attitude to Health , Hematologic Diseases/complications , Neoplasms/complications , Parents/psychology , Stress, Psychological , Adaptation, Psychological , Adolescent , Child , Child, Preschool , Cost of Illness , Female , Hawaii , Humans , Male , Needs Assessment , Nursing Methodology Research , Pacific Islands , Qualitative Research , Referral and Consultation , Retrospective Studies , Risk Factors , Social Support , Stress, Psychological/etiology , Stress, Psychological/psychology , Surveys and Questionnaires , TravelABSTRACT
This article examines whether pediatric cancer patients referred to Hawai'i from the Pacific Islands had poorer outcomes than Hawai'i residents treated at the same hospital. For children admitted from 1981 to 2002, we obtained data on patient demographics and outcomes from a review of medical charts and physician case reviews. We found that pediatric cancer patients referred from the Pacific Islands for treatment in Hawai'i had a higher relative risk of death, of not receiving treatment in a timely manner, of not completing treatment, and of being lost to follow-up than pediatric cancer patients that were residents of Hawai'i. The higher risk of poor outcomes for pediatric cancer patients referred from the Pacific Islands can be addressed by improving the health care systems in both the Pacific Islands and in Hawai'i.
