Alaska Maternal and Infant Mortality Review and Child Death Review (MIMR-CDR)
2015 Annual Review: Recommendations Report
The Alaska Maternal Infant Mortality Review - Child Death Review (MIMR-CDR) is a program based on a national evidence based model to systematically and comprehensively review deaths using a multi-disciplinary consensus decision making approach. This model specifically aims to identify causes and contributing factors to maternal, infant, and child deaths in Alaska and develop recommendations to prevent future deaths. This goal is accomplished through expert committee reviews of medical records, autopsy reports, death scene investigation reports, and other relevant information that is compiled for every death. MIMR-CDR has been in place since 1991. This program is federally funded by the Title V, MCH Block Grant and the Sudden Unexplained Infant Death (SUID) Grant, and is housed in the Alaska Division of Public Health, Section of Women’s, Children’s, and Family Health.
MIMR-CDR committee members serve on a voluntary basis and are approved by the DHSS Commissioner and Alaska Medical Board. Committee membership includes medical providers such as pediatricians, neonatologists, obstetricians, and nurses, as well as social workers, epidemiologists, tribal representatives, and children’s justice advocates. Efforts to expand membership are ongoing to ensure a broad spectrum of professionals and perspectives are represented at each review.
To learn more about membership requirement or nominate a potential committee member, please contact the MIMR-CDR Program Manager:
3601 C St Suite 358
Initially, the program only reviewed maternal, infant and occasionally fetal deaths. In 2015, the age criterion was expanded to include children up to 18 years of age, although for several years only children up to the age of 14 years were reviewed. Beginning in 2016, the MIMR/CDR program reviews all maternal, infant and child deaths ages 0 – 18 years that occur in Alaska. All reviews are conducted retrospectively (within 1 year of death).
Monthly reviews focus on cause-specific mortality (e.g. out-of-hospital infant deaths occurring in the sleep environment) with a goal of being extremely timely to allow for “real-time” prevention recommendations. Monthly reviews typically cover only a few cases with a subset of committee members present. The focus of annual review meetings is broader, allowing for more comprehensive agency/partner representation. The Annual Review consists of a two-day meeting during which multi-disciplinary teams review cases.
The deaths reviewed at the Annual Review have either not been previously reviewed, or need further clarification. Deaths are reviewed in topic-specific groups, allowing for in-depth analyses of risk factors for particular causes of death. This allows specialists to review cases that fall under their purview, and to focus on those deaths for which their expertise can best be put to use. This extensive and highly condensed process exposes a larger number of reviewers to the diverse events that may lead to maternal, infant, and child deaths in Alaska, and culminates in the creation of individual recommendations.
Goals and Objectives
The goal of MIMR-CDR is to reduce infant, child and maternal mortality in Alaska by better understanding the factors associated with each death through a committee review process. MIMR-CDR program objectives are:
- Perform statewide epidemiological surveillance concerning infant, child and maternal deaths in Alaska.
- Conduct annual comprehensive data analyses.
- Use MIMR-CDR committee findings to inform public policy and improve evaluation of established public health initiatives and programs.
- Document patterns of infant, child and maternal mortality that may be preventable.
- Educate health care providers regarding diagnostic, therapeutic, and preventative strategies to reduce infant, child and maternal mortality in Alaska.
Data Collection Process
The Alaska Bureau of Vital Statistics generates a monthly report of recent infant, child and maternal deaths and provides birth and death certificates for each death. MIMR-CDR staff then request additional information from the Alaska State Troopers or municipal police departments, Department of Juvenile Justice, Office of Children Services, hospitals, health clinics, and State Medical Examiner’s Office as appropriate.
Upon receipt of all documentation, the case files are abstracted for specific autopsy and medical data. The records are then brought before the MIMR-CDR monthly or annual meeting to be reviewed by the presiding committee members. MIMR-CDR utilizes standardized data reporting forms, which are completed for all reviews. All information on infant and child deaths is entered and stored in the national Child Death Review Reporting System. Maternal deaths are entered into an internal database. Confidentiality of records is maintained at all levels.
are published every two years with summary findings from the MIMR-CDR.
Additionally, topic-specific Epi Bulletins and other reports are published to inform the public about specific topics impacting infants, children, or mothers.
An example of an Epi Bulletin published on the subject of infant deaths occurring in the sleep environment can be found here: