title: The nationwide evaluation of fetal and infant mortality review (FIMR) programs: development and implementation of recommendations and conduct of essential maternal and child health services by FIMR programs.
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.
authors.affiliation: Department of Population and Family Health Sciences, Women's and Children's Health Policy Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
authors.forename: Dawn P
authors.initials: DP
authors.lastname: Misra
authors.forename: Holly
authors.initials: H
authors.lastname: Grason
authors.forename: Mira
authors.initials: M
authors.lastname: Liao
authors.forename: Donna M
authors.initials: DM
authors.lastname: Strobino
authors.forename: Karen A
authors.initials: KA
authors.lastname: McDonnell
authors.forename: Adam A
authors.initials: AA
authors.lastname: Allston
mesh_terms: D002662:Child Health Services / Q000458:organization & administration*; D005260:Female; D005313:Fetal Death; D005544:Forecasting; D006285:Health Planning / Q000458:organization & administration; D006287:Health Planning Guidelines; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D008297:Male; D008427:Maternal Health Services / Q000458:organization & administration*; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration; D016730:Program Development; D015397:Program Evaluation; D011634:Public Health; D014481:United States / Q000453:epidemiology