Healthy Start Coalition
of Miami-Dade

FIMR Project


Infant mortality is a complex issue that impacts everyone and has been widely used as an indicator of a community’s overall health for decades.

As this picture shows, there are several interrelated factors that influence infant mortality. Each requires our attention as we work to improve the health of the women, infants, children and families in our community.

There are many reasons professionals study fetal and infant deaths:

  • Health care providers: to implement peer review process;
  • Institutions: to monitor overall compliance with policies and procedures;
  • Medical Researchers: to develop insights into new medical treatments to prevent infant death; and,
  • County and State Health Officers: to aggregate vital statistics to document and quantify causes of death.

The Fetal and Infant Mortality Review (FIMR) enhances and complements all of these efforts. FIMR examines social, community and medical information in tandem, a combination of information not generally available through other efforts.

FIMR identifies strengths and areas for improvement in overall service systems and community resources for women, infants and families. FIMR also provides direction towards the changes in service systems and the development of new policies to safeguard them.

FIMR Process


 FIMR offers:

  • a warning system that can describe effects of health care systems change;
  • a method for implementing continuous quality improvement (CQI); and,
  • a means to implement needs assessment, quality assurance and policy development as well as essential public health functions

Valuable outcomes from the use of the FIMR methodology are:

  • For the family experiencing a fetal or infant loss the FIMR interview process itself may help move them through the stages of grief and improve their ability to cope with the loss.
  • For institutions and providers FIMR findings lead to improved quality of services; both duplication and gaps in services can be avoided.
  • For communities the FIMR process empowers the community to create solutions where none existed and can improve existing service systems and community resources for women, infants, children and families.

FIMR is completely confidential:

  • All information collected from medical records and the maternal interview is stored in locked files.
  • All identifying information, (the patients’ names, the providers’ names, hospital/clinic sites) is removed prior to review by the CRT.
  • All case review team members and Coalition (project) staff are required to sign a pledge of confidentiality which prohibits them from discussing reviews outside team meetings.

The reviews themselves are closed to the public.


In the FIMR process, the CRT examines fetal and infant deaths in order to achieve a better future for all children and families. Each case reviewed provides us with an opportunity to look more broadly at community and system circumstances. The CRT process includes:

  • Data abstraction from hospital, medical and vital records by a nurse/medical records abstractor.
  • Maternal interview.
  • De-identified fetal and infant death case review.

Sources of data may include vital records data, prenatal, delivery, neonatal and pediatric records, autopsy medical records, physician and hospital records along with those from home visits, Healthy Start, WIC and, additional social service records when available.

The role of the CRT is to determine whether:

  • The family received the services they needed?
  • Are there gaps in the system?
  • What can this case tell us about how families can best utilize existing local resources?

CRT members include a broad range of medicine and health professionals, organizations and public and private agencies (health, welfare, education and social services), consumers and maternal child health advocates.

The CRT:

  • reviews the case summaries to identify barriers to care, gaps in services, trends in service delivery and availability of community resources for families.
  • documents what opportunities for improvement exist.
  • reports their findings to the community action team.

FIMR Model



Typically, the CRT presents its recommendations to a team of individuals known as the Community Action Group (CAG). Typically, the CAG is composed of two types of members:

  • those who have the political will and fiscal resources to create large scale systems change, and
  • members who can define a community perspective on how best to create this change in the community.

Community Meeting

The CAG responds to issues that are broader, more politically complex and which may require extended time or resources in order to implement change.  The CAG translates the CRT recommendations into an action plan and participate in implementing community action. In response to findings reported jointly by these two groups, the community itself may act to develop of new coalitions, legislative committees or other local organizations to improve service delivery and community resources for women, infants and families.

CAG Role

  • New solutions and strategies;
  • Enhance credibility and visibility;
  • Implement interventions; and;
  • Identify changes in community needs.


“ Infant mortality is not a health problem.
Infant mortality is a social problem
with health consequences.”
– Marsden Wagner JPHP,1988

The Healthy Start Coalition of Miami-Dade Fetal and Infant Mortality Review (FIMR) Project is a countywide effort to better understand the issues associated with fetal and infant mortality and morbidity and to develop strategies that improve perinatal systems of care, locally and statewide.

FIMR began in 1990 as a collaborative effort between the American College of Obstetricians and Gynecologists (ACOG) and the Federal Maternal and Child Health Bureau (MCHB). Since it was first introduced in the late 1980’s, FIMR has been a dynamic, community process. FIMR has enjoyed continued growth and refinement as more communities have used it. Today, there are over two hundred FIMR programs.  While the basic methodology is the same in most programs, the specific recipe for actual operation is local. Funding sources vary from community to community. Different types of agencies sponsor the FIMR program including city and county health departments, local hospitals, regional perinatal centers and community based maternal and child health coalitions.

Florida adopted the FIMR model in 1992. The Healthy Start Coalition of Miami-Dade has been contracted by the State of Florida to implement FIMR locally. FIMR of Dade County is one of 14 FIMR projects statewide organized under Florida Statute 766.101 and funded by the State of Florida.

What is FIMR?

FIMR is:

  • a strategy to close the gap in health disparities at the community level;
  • a timely and valuable source of information about changing health care systems and how they affect real families trying to access them;
  • a community coalition that promotes volunteerism and good citizenship and will translate into local accountability;
  • a community coalition that can represent all ethnic and cultural views in the community;
  • a strategy that improves communication among health and human service providers;
  • a form of continuous quality improvement that allows communities to assess the performance of systems and the impact of changes in those systems;
  • a voice for local families who have lost their baby;
  • a tool that helps local health officials implement policies to safeguard families; and,
  • a program endorsed by the American College of Obstetricians and Gynecologists, the March of Dimes Birth Defects Foundation and the federal Maternal and Child Health Bureau.

Who is part of FIMR?

Potential members come from the entire community and include individuals and agency representatives who:

  • live in the community and use its resources;
  • provide health and human services;
  • set policy; and/or,
  • rely on the community as a source for workers and a good place to do business.

FIMR is composed of two groups, the Case Review Team (CRT) and theCommunity Action Group (CAG). A multi-disciplinary team of professionals, the CRT uses unidentified/patient blinded abstracted information from vital records (death and birth certificates), hospitals, clinics, physicians, police, Medical Examiner records and family/maternal interviews. The CAG is comprised of community leaders representing government, consumers, key institutions, health and human services organizations. The members of the CAG work collaboratively with the CRT to implement strategies that will improve fetal and infant outcomes within our community.

If you are interested in applying to become a FIMR Member, please click here to submit your FIMR Membership Application.

If your interested in attending an upcoming meeting, click here to view all upcoming meeting(s).

Click here to view the Fetal and Infant Mortality Review (FIMR) Project of Miami-Dade County 2007-2011 Community Report.