The university/public health link in reducing infant mortality in a high-risk population.

The Greater Cleveland Healthy Family/Healthy Start (HF/HS) Project Consortium 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 (IMRP) was instituted. This program has two important facets: an in-depth review of the circumstances of each death, and the development of scientifically-based, community-oriented interventions based on these reviews. To conduct the IMRP, a "hot line" connection with each hospital and the coroner's office was established to provide prompt notification of infant deaths and to enable timely data collection. A core review group determines actual cause of death and preventability, and identifies appropriate interventions. Recommendations issued by a technical oversight panel are disseminated to groups with the authority to institute changes in an effort to foster continuous quality improvement. Complete reviews of 243 of 319 deaths reported to date have resulted in 11 recommendations for presentation to community groups. The public health department's cooperation with other agencies has facilitated a process which ensures timely implementation. Cleveland's strongly committed consortium was able to link university and public health expertise to activate community groups and health care providers to implement recommended solutions. Demonstration of a measurable decline in the community's infant mortality rate (IMR) should provide concrete evidence of the value of such linkages. We suggest that a similar review mechanism be considered for other communities with high infant mortality rates.