The relation of FIMR programs and other perinatal systems initiatives with maternal and child health activities in the community.
OBJECTIVE
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.
Strobino
Donna M
DM
Department of Population and Family Health Sciences, Women's and Children's Health Policy Center, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street. Room E4151, Baltimore, Maryland 21205, USA. dstrobin@jhsph.edu
Baldwin
Katherine M
KM
Grason
Holly
H
Misra
Dawn P
DP
McDonnell
Karen A
KA
Liao
Mira
M
Allston
Adam A
AA
D016009:Chi-Square Distribution; D002662:Child Health Services / Q000458:organization & administration*; D003153:Community Health Services / Q000592:standards / Q000639:trends; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D005313:Fetal Death; D005544:Forecasting; D006285:Health Planning / Q000458:organization & administration; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008427:Maternal Health Services / Q000458:organization & administration*; D016017:Odds Ratio; D018743:Perinatal Care / Q000592:standards / Q000639:trends; D011050:Policy Making; D011247:Pregnancy; D016730:Program Development; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D017749:Total Quality Management; D014481:United States / Q000453:epidemiology