Assessment of Healthy Start Fetal and Infant Mortality Review recommendations.
OBJECTIVE
We examine the scope and nature of the recommendations that emerged from the Healthy Start Fetal and Infant Mortality Review (FIMR) projects and explore their use to promote systems change.


METHODS
The FIMR process of 16 of the 22 federal Healthy Start projects was reviewed. We analyzed data from a June 1996 survey developed and administered by the MCH Bureau which gathered information about recommendations produced by the FIMRs. We supplemented these data with information gathered through follow-up telephone interviews and by abstracting information from grant documents.


RESULTS
The 16 Healthy Start FIMRs reviewed approximately 1300 cases between 1991 and 1996. A total of 303 specific action strategies were recommended, reflecting eighteen specific substantive areas of concern. Overall, 65% of recommendations fell under the rubric of "program" functions, 31% under "practice," and 4% under "policy." Healthy Start itself was most commonly targeted for action. The second most frequent target for action were public and private provider institutions. Public policymaking entities were rarely targeted.


CONCLUSIONS
In the first several years of implementation, with few exceptions these FIMRs sought limited change. They worked almost exclusively within their own span of control to effect important, but limited changes in systems serving women and their infants. As public health professionals seek to monitor population health, the field must strengthen any and all vehicles that draw upon collaborative structures at the community level to not only uncover problems, but to address them as well.
Grason
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Women's and Children's Health Policy Center, Department of Population & Family Health Sciences, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland 21205, USA. hgrason@jhsph.edu
Misra
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D005313:Fetal Death; D006293:Health Promotion / Q000592:standards*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000592:standards*; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care; D018024:Peer Review, Health Care; D011050:Policy Making; D015397:Program Evaluation