NYS Hospitals See Dramatic Results in Breastfeeding Collaborative

Recruitment is open for hospitals in New York State to join the state’s Breastfeeding Quality Improvement in Hospitals (BQIH) Learning Collaborative. If the results of the predecessor cohort of hospitals is any indication, these new recruits are in for some big changes.

“The amount of improvement we’ve seen from these first cohort hospitals in a short amount of time is really remarkable,” says NICHQ Improvement Advisor Amanda Norton. “Rarely do we see so many processes change in a short timeframe.”

The goal of the BQIH Learning Collaborative is to increase exclusive breastfeeding rates and the duration of any breastfeeding among new mothers, especially low-income women participating in WIC and Medicaid. To do that, hospitals are focusing on implementing evidence-based maternity care practices called the Ten Steps to Successful Breastfeeding. The practices include initiating breastfeeding within one hour of birth, allowing mothers and infants to remain together 24 hours a day (known as rooming in) and encouraging breastfeeding on demand, among others.

Aggregate results of the 12 hospitals in BQIH’s first cohort (October 2014 to November 2015) saw a 16 percent improvement in their exclusive breastfeeding rate, up to 59 percent. Babies going skin-to-skin with mothers after a vaginal birth increased 10 percent and is now happening in 86 percent of births, and skin-to-skin after a Cesarean section occurs 56 percent of the time, up 27 percent across these hospitals.

“The scary thing sometimes with data is that we shoot up and then plummet back down and maintain status quo,” says Norton. “I commend our participants because they shot up and then maintained and sustained that.”

The most drastic improvement—61 percent—was with the measure of mothers breastfeeding on demand. The average for participating hospitals is now 87 percent.

“I was pretty floored looking across this data,” says BQIH Faculty Co-Chair Cynthia Howard, MD, MPH. “When we started, teams said they felt overwhelmed for the first six to eight months. I’m very impressed what’s changed for all the teams. The changes result in huge health benefits for mothers and babies. From a public health standpoint, these are just the changes we need.”

And another benefit adds Howard, “Hospitals now have the tools to look at other things they want to change in their hospitals and make those changes.”

Many of these hospitals have already exceeded the New York State Prevention Agenda’s five year goal for exclusive breastfeeding, and two hospitals are meeting the Healthy People 2020 goal, according to Barbara Dennison, MD, of the New York State Department of Health. “That’s a major, major change. We know this work isn’t easy and we consider these teams successful in many ways.”

To date the NICHQ-led BQIH Learning Collaborative has reached nearly 17,000 children in 12 months. NICHQ and the New York State Department of Health are eager to continue to see that number grow when the next cohort of hospitals join the collaborative.

Measure Aggregate Percent Improvement from Baseline through 11/1/2015 Aggregate Rate (Three month aggregate average Sept-Nov)
Feeding on cue 61% 88%
Assessment of Breastfeeding 52% 81%
Breastfeeding initiating 2 hours 29% 49%
Skin-to-skin Caesarian 27% 62%
Rooming in 24% 61%
Exclusive breastfeeding 16% 60%
Breastfeeding initiation 1 hour 12% 80%
Skin-to-skin vaginal delivery 10% 90%
Any breast milk 5% 87%