Improving breastfeeding care & support in a large, urban, pediatric primary care practice
Meg Kawan1, Emily F Gregory1, Diane L Spatz2
1Children's Hospital of Philadelphia, United States of America.
Insights
Implementing standardized measurement tools in pediatric primary care improved breastfeeding data tracking but did not significantly increase breastfeeding duration. Further resources are needed to enhance infant nutrition outcomes.
Area of Science:
- Pediatric primary care
- Infant nutrition
- Public health interventions
Background:
- Human milk/breastfeeding is optimal for infant nutrition.
- Pediatric primary care settings can influence breastfeeding exclusivity and duration.
- Accurate measurement and practice recommendations are key to supporting breastfeeding.
Purpose of the Study:
- To accurately measure breastfeeding indicators within a pediatric practice.
- To implement American Academy of Pediatrics (AAP) Breastfeeding-Friendly Pediatric Office Practice Recommendations.
Main Methods:
- A Quality Improvement project was conducted in a large, urban pediatric practice.
- Interventions included developing and implementing standardized documentation templates and tracking tools.
- Simultaneous interventions involved workflow redesign, staff education, and community partnerships for lactation support.
Main Results:
- Data from over 30,000 visits were analyzed, with 80% provider use of standardized templates.
- At the first newborn visit, 74% of infants were breastfed; at six months, 36% were breastfed (23% exclusively).
- While documentation improved, breastfeeding duration did not significantly increase.
Conclusions:
- Feasible measurement tools in primary care are crucial for understanding breastfeeding trends.
- Enhanced resources and targeted interventions are necessary to improve breastfeeding outcomes in pediatric settings.
Background And Specific Aims:
Human milk/breastfeeding is the gold standard for infant nutrition. Interventions in pediatric primary care could improve breastfeeding exclusivity and duration. Our specific aims were two-fold: 1) Accurately measure breastfeeding indicators and 2) Implement AAP Breastfeeding-Friendly Pediatric Office Practice Recommendations.
Materials And Methods:
In 2018, a single, urban, large primary care pediatric practice initiated a Quality Improvement project to improve breastfeeding outcomes. Stakeholders met to discuss metrics of interest, develop documentation templates, review data capture, and plan interventions to support breastfeeding. Practice based interventions to improve measurement included: piloting documentation templates, incorporation of default templates office-wide, and developing tracking tools for both use of templates and breastfeeding outcomes. Interventions to support breastfeeding occurred simultaneously and included workflow redesign to increase nurse-provided breastfeeding education, partnering with community-based lactation consultants for outpatient support, staff education, and National Breastfeeding Month activities.
Results:
Since initiation of the data analytic tool, breastfeeding data has been analyzed from over 30,000 visits (86% Medicaid-insured, 82% Black race). Currently, 80% of providers use default templates that allow standardized data capture. At first newborn visit, 74% of infants were breastfed. At six months, 36% of infants were breastfed; 23% exclusively. Standardized documentation of infant feeding status improved and has remained consistent. Breastfeeding duration did not significantly improve despite practice interventions.
Conclusions:
Pediatric primary care measurement tools are feasible and critical to understand breastfeeding continuation. Increased resources and interventions to support breastfeeding in Primary Care are necessary to improve outcomes.
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