FALLING THROUGH THE CRACKS: Background

This study addresses a recommendation generated by the second of two infant mortality review projects in the Twin Cities. Project LID (Lower Infant Deaths) was a community-based infant mortality review project that closely examined infant deaths in Hennepin and Ramsey counties during a one-year period from May 1, 1996 through April 30, 1997. Six agencies worked collaboratively on the project [5]. Funding and technical support was provided by the Minnesota Department of Health (MDH) Infant Mortality Reduction Initiative.

Multidisciplinary, expert case review teams studied summary information gathered from vital records, medical records, and interviews of bereaved mothers who consented to participate. Infant mortality reviews demonstrated that, in many cases, services provided to families during pregnancy and infancy were poorly integrated and lacked coordination. Experienced professionals on the case review teams often expressed the opinion that inadequate care coordination was pervasive and that systems failures occurred for the population in general, not just for the families of infants who died. Based on these reviews, the teams developed recommendations for service systems—including public health, human services, and health systems—to address the problems identified.

The Project LID Task Force, consisting of representatives from each of the original collaborating partners, came together after the reviews were completed to plan for implementation of Project LID recommendations. The task force concluded that the most important recommendation was the need to improve and integrate perinatal care coordination. From the report, Lowering Infant Deaths: Promoting Change To Save Lives (1998), the first of the Recommendations for Health Systems is:

Assure that prenatal providers assess medical, social, and behavioral risk factors and identify patients with complex medical and social needs early in pregnancy. Provide case management and coordinated services throughout pregnancy, birth, and infancy based on the risk assessment (Fogarty & Sidebottom, p. 24).

In October, 1998, Project LID staff presented their findings and recommendations to the Minnesota Council of Health Plans’Community Health Committee. The Committee welcomed the presentation but concluded that a review of infant deaths, such as Project LID, did not provide sufficient information on the entire system of care to guide modification of their practices. Project LID Task Force members concurred and recommended that the information gap be addressed. Accordingly, the Perinatal Survey Team was formed and began developing plans to analyze perinatal care coordination in Hennepin and Ramsey counties.

FOOTNOTE

5. Minneapolis Department of Health and Family Support, Hennepin County Community Health Department, St. Paul-Ramsey County Department of Public Health, Bloomington Division of Public Health,Minnesota Sudden Infant Death Center, and the Minnesota Visiting Nurse Agency.

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