Family Interviews Improve Health Service Recommendations in Mortality Review Process: A Mixed-Methods Assessment.

Area of Science:

• Public Health
• Health Services Research
• Maternal and Child Health

Background:

• Limited evidence exists on the impact of family interviews in Fetal Infant Mortality Reviews (FIMR) on review team outcomes.
• There is a strong motivation and potential for expanding family interviews in FIMR and other review types.

Purpose of the Study:

• To assess the impact of FIMR family interviews on identifying health service gaps.
• To evaluate the effectiveness of FIMR family interviews in generating actionable improvements.

Main Methods:

• Mixed methods design utilizing quantitative case-control analysis and qualitative semi-structured interviews.
• Secondary analysis of FIMR administrative records (2015-2023) and qualitative interviews with FIMR administrators nationwide.
• Generalized Estimating Equation (GEE) analysis for quantitative outcomes and thematic analysis for qualitative experiences.

Main Results:

• Family interviews were associated with a 2.6-fold increase in identified stressors, particularly medical and socioeconomic (aOR=2.6).
• A 40% increase in recommendations was linked to family interviews, especially concerning patient-provider communication (aOR=1.4).
• Two-thirds of FIMR teams found family interviews 'Very Impactful' for system changes; key themes included implementation hurdles, completing the picture, and human connection.

Conclusions:

• Despite challenges in obtaining interviews, their value in identifying root causes is emphasized.
• Family interviews produce actionable healthcare service recommendations and motivate system improvements.
• The study highlights the critical role of family input in enhancing mortality review processes.