Missoula Co: Assessment of Quality Assurance Strategy for Maternity Care Practices: Impact on Exclusive Breastfeeding Rates at Discharge
County: Missoula County, MT

Skill Area: Data Analysis and Monitoring

Internship summary
Missoula City-County Health Department, Health Services Division has implemented a multi-dimensional breastfeeding promotion and support program addressing the CDC Guide to Breastfeeding Interventions. We have coordinated breastfeeding training courses for professional and para-professions (public and private health care); conducted a social marketing campaign, provided leadership and strategy design to get breastfeeding legislation for public worksites passed; starting a Breastfeeding Peer Counselor Program; initiated the Missoula Breastfeeding Coalition and implemented a ongoing surveillance system to track changes in breastfeeding initiation, duration and exclusivity for infants born to Missoula mothers. Our 6 month exclusive breastfeeding rates have risen from 3% to 18% from 2005-2009. Our next focus will be assisting our local birthing hospital to identify practices which will further support breastfeeding success for those delivering babies in Missoula. Additionally, beginning January 2010, JACHO will assess hospital maternity practices relative to breastfeeding support and education. We are interested in how these changes will further serve to impact exclusive breastfeeding rates from birth through the first 6 months of life, looking at mothers enrolled in WIC and MCH Programs, and those not enrolled but giving birth and residing in Missoula County.

Purpose
Evidence shows that several specific practices in intrapartum medical care settings can significantly affect breastfeeding rates and duration of breastfeeding among women. Birth facility policies and practices that create a supportive environment for breastfeeding begin prenatally and continue through discharge. Develop and assist in implementing a quality assurance system to monitor adherence to recommended practices shown to improve breastfeeding success in the hospital.

Goals
Hospital routines can help or hinder new mothers and babies while they are learning to breastfeed. Evidence-based care is the responsibility of every facility that provides maternity services. Systematic practice improvement enables patients to make and carry out their own informed decisions, highlighting medical professionals’ role in providing patient-centered, evidence-based care. Supportive hospital practices include:
• Skin-to-skin contact: Doctors and midwives place newborns skin-to-skin with their mothers immediately after birth, with no bedding or clothing between them, allowing enough uninterrupted time (at least 30 minutes) for mother and baby to start breastfeeding well.
• Teaching about breastfeeding: Hospital staff teach mothers and babies how to breastfeed and to recognize and respond to important feeding cues.
• Early and frequent breastfeeding: Hospital staff help mothers and babies start breastfeeding as soon as possible after birth, with many opportunities to practice throughout the hospital stay. Pacifiers are saved for medical procedures.
• Exclusive breastfeeding: Hospital staff only disrupt breastfeeding with supplementary feedings in cases of rare medical complications.
• Rooming-in: Hospital staff encourage mothers and babies to room together and teach families the benefits of this kind of close contact, including better quality and quantity of sleep for both and more opportunities to practice breastfeeding.
• Active follow-up after discharge: Hospital staff schedule in-person breastfeeding follow-up visits for mothers and babies after they go home to check-up on breastfeeding, help resolve any feeding problems, and connect families to community breastfeeding resources.
The student will work with MCCHD and Missoula Community Medical Center maternity and quality improvement staff to assure development and training in policy related to maternity care practices.

Objectives
Develop a strategy and tools needed to assess adherence to agreed upon policy and procedure changes (using JACHO standards) and CDC recommendations. Determine impact of these practices on exclusive breastfeeding rates at discharge and at 6 months following discharge.

The student will work with a team including public health nutritionists and nurses; hospital maternity and quality assurance staff to develop the process to assess adherence to recommended maternity practices. The process will include a system for ongoing feedback to maternity staff and to enhance adherence. The hospital discharge records will be used to as the cohort (mothers and infants) to be tracked for breastfeeding initiation, duration and exclusivity.
1. Communicate directly with the hospital personnel most able to influence hospital practices and policies;
2. In the resulting assessment tool, hospital staff will address specific barriers to evidence-based maternity care related to breastfeeding in an objective, evidence-based, and positive manner; and
3. Increase prevalence of hospital practices and policies that are positively associated with improved breastfeeding outcomes

Data or analytic tasks and activities involved
Specific analytic tasks include the following (the work plan will be negotiable based on the student's interests and the time available):

-Merging WIC data and Public Health Nursing files with data on breastfeeding duration and timing of introduction of formula or solids
-Analyzing these indicators and preparing reports
-Developing a telephone survey instrument to gather information on breastfeeding duration from women not enrolled in WIC
-Training local public health students to administer this survey

Required data or analytic skills
Excel, principles of use of analytical tools and processes to achieve our program objectives, site test tool for usability, reliability, relevance and acceptance by hospital staff. Assure the Maternity and Quality Improvement hospital staff are willing and able to integrate process into their ongoing quality improvement system.

Begin date
06/01/2010

Public transportation available?
Bus station 3 blocks away. Bike friendly community

More information
We are a fun and energetic group of public and private health providers.

Attachments