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
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.
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.