Best Fed Beginnings: A Nationwide Quality Improvement Initiative to Increase Breastfeeding
Lori Feldman-Winter1, Jennifer Ustianov2, Julius Anastasio2
1Department of Pediatrics, Children's Regional Hospital at Cooper-Cooper Medical School of Rowan University, Camden, New Jersey; winter-lori@cooperhealth.edu.
Insights
The Best Fed Beginnings initiative successfully increased Baby-Friendly designations in US hospitals, nearly doubling the national total. This quality improvement effort also significantly boosted exclusive breastfeeding rates among participating mothers.
Area of Science:
- Public Health
- Maternal and Child Health
- Quality Improvement Initiatives
Background:
- Low number of Baby-Friendly designated hospitals in the US prompted a national quality improvement initiative.
- The Centers for Disease Control and Prevention funded the National Institute for Children's Health Quality to lead the initiative.
- The Best Fed Beginnings initiative aimed to increase breastfeeding rates and Baby-Friendly designations.
Purpose of the Study:
- To evaluate the effectiveness of the Best Fed Beginnings initiative in increasing Baby-Friendly designations.
- To assess the impact of the initiative on breastfeeding and exclusive breastfeeding rates.
- To determine the feasibility of rapid, transformative changes in maternity care.
Main Methods:
- A nationwide quality improvement initiative involving 90 hospitals from 2011 to 2015.
- Intervention period from July 2012 to August 2014 with multidisciplinary teams, including parent partners.
- Data collection on process indicators (Ten Steps to Successful Breastfeeding) and outcome measures (breastfeeding rates).
Main Results:
- 80% (72 of 90) hospitals achieved Baby-Friendly designation by April 2016, nearly doubling the national total.
- Participation strongly correlated with designation (Pearson's r = 0.80, P < .01).
- Exclusive breastfeeding increased significantly from 39% to 61% (t = 9.72, P < .001).
Conclusions:
- A nationwide initiative effectively drove rapid, transformative changes in maternity care hospitals.
- The Best Fed Beginnings initiative successfully increased Baby-Friendly designations.
- The initiative was associated with significant improvements in exclusive breastfeeding rates.
Background And Objective:
In response to a low number of Baby-Friendly-designated hospitals in the United States, the Centers for Disease Control and Prevention funded the National Institute for Children's Health Quality to conduct a national quality improvement initiative between 2011 and 2015. The initiative was entitled Best Fed Beginnings and enrolled 90 hospitals in a nationwide initiative to increase breastfeeding and achieve Baby-Friendly designation.
Methods:
The intervention period lasted from July 2012 to August 2014. During that period, data on process indicators aligned with the Ten Steps to Successful Breastfeeding and outcome measures (overall and exclusively related to breastfeeding) were collected. In addition, data on the Baby-Friendly designation were collected after the end of the intervention through April 2016. Hospitals assembled multidisciplinary teams that included parent partners and community representatives. Three in-person learning sessions were interspersed with remote learning and tests of change, and a Web-based platform housed resources and data for widespread sharing.
Results:
By April 2016, a total of 72 (80%) of the 90 hospitals received the Baby-Friendly designation, nearly doubling the number of designated hospitals in the United States. Participation in the Best Fed Beginnings initiative had significantly high correlation with designation compared with hospital applicants not in the program (Pearson's r [235]: 0.80; P < .01). Overall breastfeeding increased from 79% to 83% (t = 1.93; P = .057), and exclusive breastfeeding increased from 39% to 61% (t = 9.72; P < .001).
Conclusions:
A nationwide initiative of maternity care hospitals accomplished rapid transformative changes to achieve Baby-Friendly designation. These changes were accompanied by a significant increase in exclusive breastfeeding.
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