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Breastfeeding Quality Improvement In Hospitals Learning Collaborative Increases Exclusive Breastfeeding

Monday, October 22, 2012: 1:45 PM
Room 346-347 (Morial Convention Center)
Barbara A. Dennison, MD1, Patricia A. Waniewski, RN, MS2, Stephanie Hisgen, RN, MPH2, Charles Homer, MD, MPH3, Patricia Heinrich, RN, MSN4 and Patricia Simino Boyce, RN, PhD5, (1)Division of Chronic Disease Prevention, NYSDOH, Albany, NY, (2)Bureau of Community Chronic Disease Prevention, NYSDOH, Albany, NY, (3)National Initiative for Children's Healthcare Quality, Boston, MA, (4)Heinrich LLC, Walthamm, MA, (5)LSI, Inc., Brooklyn, NY

Purpose:   Develop and implement an evidence-based intervention to improve maternity care practices and increase exclusive breastfeeding during the birth hospitalization and beyond.

Methods:   The New York State Department of Health partnered with the National Initiative for Children's Healthcare Quality to develop the 18-month NY Breastfeeding Quality Improvement in Hospitals (BQIH) Learning Collaborative, based on the Institute for Healthcare Improvement Breakthrough Series methodology and the WHO's Ten Steps to Successful Breastfeeding.  NY Hospitals (outside NYC) were eligible if they had >400 births/year; selection was based on infant feeding during birth hospitalization.  Ten hospitals with the lowest prevalence of exclusive breastfeeding and two “model” hospitals with the highest prevalence were selected to participate.  A repeated cross-sectional design was used, with each hospital submitting data every month for 18 months from a random sample of 50 “healthy” newborns (excluding infants admitted to the NICU or transferred to the hospital).  Multi-level models were used, to adjust for clustering within the hospital, to estimate changes in prevalence of exclusive breastfeeding (primary outcome) and changes in maternity care practices over time.   

Results:  The 12 selected hospitals had 25,100 “healthy” births, 27% non-White, 17% Hispanic, 28% publicly insured and 33% unmarried mothers (2008 data).  At each hospital, a 5-member team (including a pediatric/obstetric physician, nurse manager, and lactation counselor) participated in five Learning Collaborative sessions and monthly Action Periods, technical assistance and improvement coaching calls.  Over the 18-month intervention, there were significant improvements in targeted maternity care practices, including increases in maternity staff trained in providing breastfeeding support (63 to 100%); infants breastfed early  -vaginally-born infants within 1 hour of birth (66 to 83%); Cesarean born infants within 2 hours of birth (49 to 63%); breastfed >8 times per 24-hours (51 to 62%); and mother-infant rooming-in at least 3/4 of each shift (31 to 58%).  In addition, fewer mothers were given formula (59 to 5%) or formula company-produced educational materials (83 to 3%) at discharge.  There was a significant, 20% increase in the primary outcome; the percentage of “healthy” infants fed exclusively breast milk during the birth hospitalization increased from 34 to 41%.  

Conclusion:   The BQIH Learning Collaborative was successfully implemented in NY hospitals with the lowest prevalence of exclusive breastfeeding.  This was associated with significant improvement in maternity care practices and a 20% increase in the prevalence of exclusively breastfed infants during the birth hospitalization.  The NY BQIH is a model intervention that will be implemented in hospitals across NY and in other states through the Best Fed Beginnings Collaborative to ensure all new mothers are fully supported in providing their newborn infants the best start in life.  To continue these gains, additional breastfeeding support and protection is needed in the outpatient, community and work settings.