O2052: Communication Challenges and Care Barriers Identified in Fetal and Infant Deaths in the National Fatality Review-Case Reporting System

Background: Local Fetal/Infant Mortality Review (FIMR) teams have identified poor communication and barriers to care access as contributors to fetal and infant mortality. Communication challenges between parents and clinicians can lead to mistrust, conflict, poor care provision, and behaviors negatively impacting maternal and infant health. Little is known about whether and how poor communication is associated with fetal and infant mortality outcomes.

We sought to identify the frequency with which communication and care access barriers arise in fetal and infant mortality cases in the National Fatality Review-Case Reporting System de-identified data set, and associated outcomes (measured by the dichotomous preventability variable).

Methods: We conducted a descriptive, retrospective cross-sectional analysis to assess the impact of communication and care barriers on preventable fetal and infant deaths. The primary independent variables consisted of communication/care barriers-related stressors category and contributing factors. The dependent outcome variable was whether the death was determined as preventable by the FIMR Teams. Data were separated into fetal and infant groups for separate analyses with descriptive statistics and frequencies. We used Fisher-Exact and Chi-squared testing to compare stressors and present/contributory (P/C) factors determined by the review team associated with preventable deaths (PD) and non-preventable deaths (NPD) with two-sided statistical significance set at < .05.

Results: There were 5,865 deaths included in analysis (1,858 fetal and 4,007 infant). Demographics noted in table 1. Stressors and P/C factors related to communication and care barriers are in Table 2.

For fetal death reviews, FIMR teams were more likely to find inadequate information (p=0.02), poor provider-to-provider communication (p=0.002), poor provider-to-patient communication (p=0.001), and dissatisfaction with the medical team (p=0.007) as P/C in PDs than NPDs. Similarly, for infant death reviews, they were more likely to identify poor provider-to-provider communication (p=0.009) as P/C in PDs than NPDs.

PD cases were more likely to be non-White than White race for fetal (p=0.01) and infant (p < 0.001) deaths. Infants in PD cases were more likely to be insured by Medicaid than by private insurance (p < 0.001) and childbearing parents were more likely to be uninsured (p < 0.001) or to have Medicaid compared to private insurance (p < 0.001) in fetal PDs. Fetal PDs were more likely to have poverty identified as a stressor than NPDs (p < 0001); FIMR teams were more likely to find no prenatal care (p < 0.001), late prenatal care (p=0.001), and inadequate transportation (p=0.01) as present or contributory in fetal PD than NPD. Poverty was also identified as a stressor in infant PDs (p < 0.001); teams were more likely to identify no or late prenatal care (p < 0.001), as P/C in infant PDs than NPDs.

Conclusion: Several communication challenges and care barriers were more likely to be present in PD than NPD; this may disproportionately impact vulnerable marginalized populations.