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Addressing Disparities in Mother's Milk for VLBW Infants Through Statewide Quality Improvement
Margaret G Parker1, Laura A Burnham2, Patrice Melvin3
1Department of Pediatrics, Boston Medical Center and School of Medicine, Boston University, Boston, Massachusetts; margaret.parker@bmc.org.
Pediatrics
|June 20, 2019
Summary
A quality improvement collaborative increased early human milk feeding practices for very low birth weight infants. However, it did not reduce racial and ethnic disparities in mother's milk provision at discharge.
Area of Science:
- Neonatal care
- Quality improvement science
- Health equity
Background:
- Provision of mother's milk is crucial for very low birth weight (VLBW) infants.
- Racial and ethnic disparities exist in human milk feeding for VLBW infants.
Purpose of the Study:
- To increase mother's milk provision at discharge for VLBW infants.
- To reduce racial and ethnic disparities in mother's milk provision.
Main Methods:
- Utilized the Institute for Healthcare Improvement Breakthrough Series framework.
- Focused on process measures: prenatal human milk education, early milk expression, and skin-to-skin care.
- Analyzed changes over time for all VLBW infants and racial/ethnic subgroups using control and run charts.
Main Results:
- Improvements were observed in all 3 process measures within the first month of hospitalization.
- Improvements in process measures were similar across racial and ethnic subgroups.
- Hospitals showed significant variation in mother's milk provision rates by race and ethnicity.
Conclusions:
- The collaborative successfully improved early human milk feeding practices across racial and ethnic groups.
- The study did not achieve its goal of reducing racial and ethnic disparities in mother's milk provision at discharge.
- Future initiatives should address factors influencing human milk provision later in hospitalization.