THE UNIVERSITY PUBLIC-HEALTH LINK IN REDUCING INFANT-MORTALITY IN A HIGH-RISK POPULATION

The Greater Cleveland Healthy Family/Healthy Start (HF/HS) Project Con sortium was established to combine various resources in the Cleveland community in an effort to reduce the infant mortality rate by 50% over five years. As part of HF/HS, an Infant Mortality Review Program (IMR P) was instituted. This program has two important facets: an in-depth review of the circumstances of each death, and the development of scie ntifically-based, community-oriented interventions based on these revi ews. To conduct the IMRP, a ''hot line'' connection with each hospital and the coroner's office was established to provide prompt notificati on of infant deaths and to enable timely data collection. A core revie w group determines actual cause of death and preventability, and ident ifies appropriate interventions. Recommendations issued by a technical oversight panel are disseminated to groups with the authority to inst itute changes in an effort to foster continuous quality improvement. C omplete reviews of 243 of 319 deaths reported to date have resulted in 11 recommendations for presentation to community groups, The public h ealth department's cooperation with other agencies has facilitated a p rocess which ensures timely implementation. Cleveland's strongly commi tted consortium was able to link university and public health expertis e to activate community groups and health care providers to implement recommended solutions. Demonstration of a measurable decline in the co mmunity's infant mortality rate (IMR) should provide concrete evidence of the value of such linkages. We suggest that a similar review mecha nism be considered for other communities with high infant mortality ra tes.