Practice Based Learning

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Essential Activities

1. Objective #1 Assess Breastfeeding Knowledge:

• Review the Breastfeeding Curriculum Medical Knowledge and Patient Care modules and accompanying evaluation questions to assess for gaps in breastfeeding knowledge.
• Review an article related to equity in breastfeeding and deliver a presentation summarizing the article.
  • Suggested article: Petit M, Smart DA, Sattler V, Wood NK. Examination of Factors That Contribute to Breastfeeding Disparities and Inequities for Black Women in the US. J Nutr Educ Behav. 2021 Nov;53(11):977-986. doi: 10.1016/j.jneb.2021.08.013. PMID: 34763821.
  • Additional articles available in the Breastfeeding Medicine Special Issue on Breastfeeding and the Black/African American Experience.
• Research, develop, and deliver short presentations to a larger group on different reasons people discontinue breastfeeding. Include both community and behavioral factors.
  
  • Provide learners constructive feedback on their presentations.
  • Have learners facilitate a discussion on how those reasons for discontinuing could be prevented.
  • The Management of Common Breastfeeding Situations Presentation may be a helpful resource for this activity.

2. & 3. Objectives #2 & #3: Identify institution or practice-level breastfeeding rates.
Note: The AAP recommends that birth hospitals or centers implement maternity care practices that improve breastfeeding initiation, duration, and exclusivity, such as those in the WHO Ten Steps to Successful Breastfeeding, as monitored by the CDC. The following objectives can guide birth hospitals and centers to implement data collection strategies to evaluate maternity care practices.

• Perform an assessment of the local maternity facility using criteria as measured by the CDC Maternity Practices in Infant Nutrition and Care (mPINC) Survey tool, in accordance with site policy.
• Determine the hospital or outpatient practice breastfeeding rates. If rates are not available, create and implement a mechanism to collect breastfeeding initiation and duration rate data on a regular basis. Make sure to capture breastfeeding rates according to socio-demographic differences to identify and address gaps and disparities.
  
  • For tools to implement a measurement strategy, review page 14 of the Kaiser Permanente Care Management Institute Improving Hospital Breastfeeding Support Implementation Toolkit. Note: This toolkit was published in 2013 and references the previous Baby-Friendly Hospital Initiative “Ten Steps”.
• Have learners conduct patient surveys to understand levels of satisfaction and outcomes of meeting personal breastfeeding goals, in accordance with site policy.
• Have learners review hospital-level PC-05 data from Joint Commission
  
  • Measure definitions available on Centers for Medicare and Medicaid website
• If institution or practice-level rates are unavailable, learners could use other regional-level data that can be acquired at:
  
  • CDC’s National Immunization Survey (NIS): monitors breastfeeding rates (initiation, exclusivity, duration) at both national and state levels, by birth year.
    
    • Breastfeeding Rates: https://www.cdc.gov/breastfeeding/data/nis_data/index.htm
  • CDC’s National Vital Statistics System’s U.S. Standard Certificate of Life Birth:
    
    • Data to measure breastfeeding initiation by hospital discharge, including demographic information for the infant and parents. Exact dates or geographic identifiers (state, county, or city level) are considered restricted-use data and require approval from the National Center for Health Statistics for access.
    • Breastfeeding Initiation Rates and Maps by County: https://www.cdc.gov/breastfeeding/data/county/breastfeeding-initiation-rates.html
    • Restricted-Use Vital Statistics Data: https://www.cdc.gov/nchs/nvss/nvss-restricted-data.htm
  • CDC’s Maternity Practices in Infant Nutrition and Care (mPINC): is a national biennial survey of hospital-level infant feeding practices and policies completed by hospital staff.
    
    • https://www.cdc.gov/breastfeeding/data/mpinc/index.htm
  • CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS): is a site-specific, population-based survey on maternal attitudes and experiences before, during, and shortly after pregnancy.
    
    • https://www.cdc.gov/prams/index.htm

4. Objective #4 Implement a Quality Improvement Project: Have learners participate in or develop quality improvement plans, with a SMARTIE (Specific, Measurable, Achievable, Relevant, Time-Bound, Inclusive, Equitable) aim, to improve breastfeeding rates and support in the local clinic, practice, or hospital environment.

• Example SMARTIE Aim Statement: To increase the proportion of 6 month-old infants in the pediatric practice that are exclusively breastfed (EBF) from 25% to 35% and to eliminate the racial disparities currently at 15% for black infants compared to white and Asian infants (EBF rate is 10%) over a 2 year time frame, through a community-led breastfeeding champions initiative.
  
  • Specificity: 6-month old infants who are EBF
  • Measurable: rate of EBF total population of 6-month old infants in practice, and stratified by race.
  • Achievable: rates of increase doable over 2 years
  • Relevant: the community-based intervention and focus on exclusivity are relevant to national goals.
  • Time-bound: 2 years.
  • Inclusive: involvement of community-led champions to inform the change package
  • Equitable: goal to eliminate racial disparities
• For tools to implement a quality improvement project, review pages 77-83 of the Kaiser Permanente Care Management Institute Improving Hospital Breastfeeding Support Implementation Toolkit. Note: This toolkit was published in 2013 and references the previous Baby-Friendly Hospital Initiative “Ten Steps”.

Evaluation Strategies:

1. Measure the changes within the patient surveys to understand levels of satisfaction and outcomes of meeting personal breastfeeding goals.
2. Create an evaluation component in the quality improvement project, in accordance with site policy.

Resources:

• National Association policies on breastfeeding
  
  • AAP Breastfeeding and the Use of Human Milk Policy (2022)
  • AAP Technical Report: Breastfeeding and the Use of Human Milk (2022)
  • ACOG Optimizing Support for Breastfeeding as Part of Obstetric Practice Committee Opinion
  • AAFP Breastfeeding, Family Physicians Supporting (Position Paper)