What is the AMIMR?
The State of Alaska, Division of Public Health, Section of Maternal, Child and Family Health established the Alaska Maternal and Infant Mortality Review (AMIMR) in 1989. At the time, Alaska’s infant mortality was 1.2 times greater than reported in the United States. A collective concern by state and private health practitioners established the AMIMR to reduce this high infant mortality rate in Alaska. The AMIMR was formed under the guidelines of Alaska Statutes Section 18.23.010-18.23.070 as a medical review organization to retroactively evaluate the circumstances surrounding infant death and make recommendations for reducing Alaska’s high infant mortality rate. Over the last decade, the infant mortality in Alaska declined from 9.6 (1989-1991) per 1,000 to 6.1 (1998-2000) per 1,000 live births. The AMIMR scope has also been expanded to review fetal and maternal deaths as well. The AMIMR systematically collects medical and socioeconomic data on all fetal, infant, and maternal deaths in Alaska to better understand the circumstances contributing to these deaths. The AMIMR is one of 28 state fetal and infant mortality programs in the nation.
What is the purpose of the AMIMR?
The purpose of the AMIMR is to provide reliable and timely information on fetal, infant, and maternal deaths in Alaska. Accurate information on these types of deaths is important in evaluating current health initiatives and to make recommendations for future health initiatives to reduce these untimely deaths.
What are the goals and objectives of the AMIMR?
The goal of AMIMR is to reduce fetal, infant and maternal mortality in Alaska through a committee review process of all fetal, infant, and maternal death records. AMIMR goal has these specific objectives:
- To perform statewide epidemiological surveillance concerning
fetal, infant and maternal deaths in Alaska.
- To review all fetal, infant and maternal deaths in Alaska.
- To conduct annual comprehensive analyses.
- To translate results from analyses of AMIMR committee findings
for the purpose of public policy planning and evaluation of
established public health initiatives and programs.
- To document patterns of fetal, infant and maternal morbidity
in Alaska that result in mortality to detect changing etiologies
that may be preventable.
- To educate health care providers regarding diagnostic, therapeutic, and preventative strategies to reduce fetal, infant, and maternal mortality in Alaska.
Who are the partners in the AMIMR?
Agencies represented on the AMIMR committee are: Alaska Native Tribal Health Consortium (ANTHC); Alaska Neonatology Associates; Alaska State Troopers; Cook Inlet Tribal Council; Department of Air Force; Department of Army; Kodiak Area Native Association; Southeast Alaska Regional Health Corporation (SEARHC); State Bureau of Vital Statistics; State Division of Family and Youth Services; State Medical Examiner’s Office; Tribal Law & Policy Institute; and other private physicians/health practitioners of various specialties throughout the State of Alaska.
Other AMIMR partners are:
- Alaskan physicians, hospital health information system’s managers, clinics, public health nurses, and rural community health practitioners and aides.
- Alaska municipal police departments.
- Department of Health & Social Services, Section of Maternal Child and Family Health’s medical epidemiologist and Maternal Child Health Epidemiology staff.
- Healthy Families Alaska
- American College of Obstetricians & Gynecologists
- National Fetal-Infant Mortality Review Program
- National March of Dimes
- Out-of-state vital records
- Out-of-state hospitals and physicians.
How are data collected?
The Alaska Bureau of Vital Statistics generates a monthly report of fetal, infant and maternal deaths for the AMIMR project. Birth and death certificates are provided for each death. These certificates provide the vital information necessary for collecting medical information about the case. The Alaska State Troopers or municipal police departments, and State Medical Examiner’s Office may be requested to provide further information. A home interview may also be required. If so, a public health nurse from the appropriate region is requested to do the interview. Upon receipt of all medical and related documentation, the death record is abstracted for particular autopsy and medical data. The death record is then brought before the AMIMR monthly meeting to be reviewed by the presiding committee members. A consensus form is completed recording the committee’s findings for each death record. Abstracted and consensus information is then entered into a database for the purpose of completing the annual analysis. Confidentiality of records is maintained at all levels.
What information does the AMIMR collect?
The AMIMR abstraction and consensus forms collect the following:
- Birth/death information.
- Reproductive history
- Prenatal history/procedures
- Medications prescribed/taken during pregnancy
- Neonatal/infant health history
- Medical history
- External exam/general appearance
- Evidence of trauma/surgical intervention
- Congenital anomalies
- Organ weights/systems descriptive status
- Ancillary/special studies
- Most probable/contributing causes of death
How can data from the AMIMR be used?
Every year data are aggregated and an analysis is performed. Findings of the annual analysis can be used:
- To monitor progress towards the attainment of local, state and national health goals.
- To be utilized as the standard of public health decisions regarding public policy health improvements.
- To be utilized by the State of Alaska to evaluate the success of such campaigns as Back to Sleep and Never Shake a Baby.
- To identify potential areas of needed services.
- To detect and monitor changing etiologies for fetal, infant and maternal mortality in Alaska that may be preventable.
- To educate health professionals and the general public on the status of maternal and infant mortality issues in the state and ways to potentially prevent these deaths.