FIMR-HIV: New application of a proven methodology

National Fetal Infant Mortality Review (NFIMR) methodology has been successfully employed to analyze systems-level deficiencies surrounding fetal deaths for several years. Key contributors to the success of NFIMR include thorough data analysis, collaborative problem-solving between care system partners, and patient perception of events through personal interview, specific to the geographic area where analysis occurs. As part of a national learning community, the NFIMR Methodology was adapted to investigate opportunities for improvement regarding prevention of Mother to Child Transmission (MTCT) of Human Immunodeficiency Virus (HIV). Twelve sites were funded to employ the methodology, including a Midwestern state that had experienced a 400% increase in MTCT in the past three years. FIMR-HIV cases were thoroughly researched using detailed data abstraction of care records for both mother and baby, in addition to maternal interviews, which provided consumer perception of the care experienced. A multidisciplinary case review team (CRT) utilized SWOT analysis to identify strengths, weaknesses, opportunities, and threats to the system of care of HIV-positive mothers and their newborn children. The community action team (CAT) then compiled the results of CRT analysis, utilizing deliberation codes, prioritizing and determining appropriate actions to pursue to rectify deficiencies and improve systems. Implications include changes in legislation, care protocol development and adaptation, health informatics communications, epidemiological reporting and case management, among others, impacting an emerging and complicated subpopulation's quality of life. Lessons learned and suggestions for further adaptation, dissemination and support of the methodology are included.