Using mpinc as a Tool for Improvement

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Amberly Foster
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Chronic Disease Preven/on and Health Promo/on Division of Nutri/on, Physical Ac/vity, and Obesity mpinc Survey Launched in 2007

1 Using mpinc as a Tool for Improvement Jennifer M. Nelson, MD, MPH Medical Epidemiologist Centers for Disease Control and Preven/on USBC Power Tools January 18, 2017 Na/onal Center for Chronic Disease Preven/on and Health Promo/on Division of Nutri/on, Physical Ac/vity, and Obesity mpinc Survey Launched in 2007 Administered every 2 years Census of all hospitals and birth centers BreasHeeding-related maternity care pracjces and policies Key informant Response rate >80% Benchmark report Total Score 7 domain sub-scores Using mpinc as a Tool for Improvement 1

2 Average Total mpinc Scores, Year Total Score Total mpinc Score, by state, 2015 DC Puerto Rico National average: 79 Range: /18/2017 > < 70 Island Territories (American Samoa, Guam, Saipan, and the U.S. Virgin Islands) Using mpinc as a Tool for Improvement 2

3 Hospitals in our state have many barriers in implemenjng evidence-based maternity care.resistant doctors, formula supplementajon, skin-to-skin care in the operajng room.just to name a few. How can we improve our overall mpinc score? Hospital A: Safety-Net Hospital Medically underserved populajon 25-35% uninsured; 40-60% underinsured Average annual income: <$15,000 96% Hispanic and Spanish-speaking 69% nulliparous Additional risk factors Safety-net hospital Remote location o Challenge to acquire physician and nurse resources 5,000 births (pre-2008) à 3,500 births (2012) o decrease in admissions was an administrator s nightmare Total mpinc score 65 (2011) à 92 (2013) How?? Using mpinc as a Tool for Improvement 3

4 Hospital A: SoluJon Maternal-Child Nurse Managers Sought and acquired knowledge on Baby- Friendly Hospital Initiative (BFHI) and mpinc survey Memberships to lactation organizations obtained o Obtained ideas and information Utilized BFHI Guidelines and mpinc survey o External benchmarks and defined data collection processes Plan-Do-Study-Act (PDSA) model Plan Do Act Study Hospital A: Selected Challenges Staff Training Trained 443 individuals and verified 5,035 hours of training Established on-going process for training and education Beyond required 20 hours to develop own experts Newborn Hypoglycemia Protocol Worked with pediatric team All newborns è routine only for at-risk or symptomatic newborns o Reduced glucose testing for 46% of newborns Non-breast milk products Los dos ( the two ) Nurse education Maternal choice form Chart review for nursing/physician documentation Electronically linking formula distribution to individual staff Using mpinc as a Tool for Improvement 4

5 Hospital A: Results Vaginal deliveries 97% had skin-to-skin contact 92% received breast milk as first feed 95% mother-infants transferred together Stable C-secJons 40% were couplets o 90% had skin-to-skin contact o 83% received breast milk as first feed o 91% mother-infants transferred together Exclusive BreasHeeding rates 16% (2012) à 42% (2015) Total mpinc score 65 (2011) à 92 (2013) Hospital A: Keys to success A change process that was driven by nurse leaders with the authority, mojvajon, and resources to move pracjce forward Having 3 nurses pass the IBCLC exam Strong message of success to the entire nursing staff Data collecjon plan crijcal for early and ongoing success Multi-team process o Each unit leader played a role in data collection Customized form to capture BFHI and mpinc data elements o Initiated in L&D, used for patient hand-off o Data abstracted daily, analyzed monthly Using mpinc as a Tool for Improvement 5

.the mpinc survey provided external benchmarks used to guide the transformation of

Becoming Baby-Friendly and Transforming Maternity Care in a Safety-Net Hospital on

6 .the mpinc survey provided external benchmarks used to guide the transformation of our maternity care and to define our data collection processes. Eganhouse, DJ, et al. Becoming Baby-Friendly and Transforming Maternity Care in a Safety-Net Hospital on the Texas-Mexico Border. Nurs Womens Health. 2016;20(4): *Logo credit: mpinc Sub-Scores Using mpinc as a Tool for Improvement 6

7 Average Labor & Delivery Care Sub-Scores, Year Total Score Labor & Delivery Care mpinc Sub-score, by state, 2015 DC Puerto Rico National average: 85 Range: /18/2017 > < 70 Island Territories (American Samoa, Guam, Saipan, and the U.S. Virgin Islands) Using mpinc as a Tool for Improvement 7

The Iowa Experience: Increasing Access to BreasHeeding Friendly Hospitals Iowa s Labor & Delivery Care sub-score: 50 (2007) à 85 (2015) Skin-to-skin (Cesarean births): 16% à 73% Procedures performed

8 The Iowa Experience: Increasing Access to BreasHeeding Friendly Hospitals Iowa s Labor & Delivery Care sub-score: 50 (2007) à 85 (2015) Skin-to-skin (Cesarean births): 16% à 73% Procedures performed skin-in-skin: 9% à41% Iowa Department of Public Health Targeted rural hospitals with large proportion of Medicaid births Met with key stakeholders Reviewed policies and mpinc results Hosted training (6 Steps 4 Success) Additional efforts in 4-5 hospitals annually o Rural location with large proportion of Medicaid births o mpinc score less than state average o Assistance in reviewing mpinc results o Determine opportunities for improvement o Develop improvement plan for > 2 dimensions of care h]p://healthyamericans.org/health-issues/preven/on_story/increasing-access-to-breas_eeding-friendly-hospitals-the-iowa-experience/ Average Feeding of BreasHed Infants Sub-Scores, Year Total Score Using mpinc as a Tool for Improvement 8

and the U.S. Virgin Islands) California County- and Region-specific Benchmark Reports h]ps://www.

9 Feeding of Breastfed Infants mpinc Sub-score, by state, 2015 DC Puerto Rico National average: 87 Range: /18/2017 > < 70 Island Territories (American Samoa, Guam, Saipan, and the U.S. Virgin Islands) California County- and Region-specific Benchmark Reports h]ps:// Using mpinc as a Tool for Improvement 9

10 h]ps:// Average BreasHeeding Assistance Sub-Scores, Year Total Score Using mpinc as a Tool for Improvement 10

Breastfeeding Assistance mpinc Sub-score, by state, 2015 DC Puerto Rico National average: 89 Range: 80-100 1/18/2017 > 90 80-89 70-79 < 70 Island Territories (American Samoa, Guam, Saipan, and the U.

11 Breastfeeding Assistance mpinc Sub-score, by state, 2015 DC Puerto Rico National average: 89 Range: /18/2017 > < 70 Island Territories (American Samoa, Guam, Saipan, and the U.S. Virgin Islands) Massachusefs MA s BreasHeeding Assistance Sub-score: 86 (2007) à 95 (2015) Using standard assessment tool: 68% à 93% Rarely providing pacifiers: 35% à 74% Massachusefs Baby-Friendly CollaboraJve 4 facilities applying for Baby-Friendly designation Goal: to assist hospitals in achieving the Ten Steps by sharing information, ideas, support, and encouragement Summarized recommendations and specific actions taken o Use existing tools to make small steps that really count o Keep pacifiers in a locked medication system Bar/ck, M, et al. The Massachuse]s Baby-Friendly Collabora/ve: Lessons Learned From an Innova/on to Foster Implementa/on of Best Prac/ces. J Hum Lact. 2010;26(4): Using mpinc as a Tool for Improvement 11

12 The mpinc survey offers an important opportunity for gathering internal stakeholders to complete the survey together and discuss what practices could be improved as well as brainstorm ways to change those practices in terms of attaining specific score gains for changed practices. It can serve as the missing catalyst to unite staff to improve performance on a specific goal tied to 1 or 2 questions on the mpinc survey. Bartick, M, et al. The Massachusetts Baby-Friendly Collaborative: Lessons Learned From an Innovation to Foster Implementation of Best Practices. J Hum Lact. 2010;26(4): /18/2017 Average Mother-Infant Contact Sub-Scores, Year Total Score Using mpinc as a Tool for Improvement 12

13 Mother-Infant Contact mpinc Sub-score, by state, 2015 DC Puerto Rico National average: 83 Range: /18/2017 > < 70 Island Territories (American Samoa, Guam, Saipan, and the U.S. Virgin Islands) Working for Equity in BreasHeeding in the Maternity Services of Puerto Rican Hospitals Yvefe Piovanel, Cindy Calderon, Gisela Castaner 2015 AAP conference abstract (Washington, DC) Puerto Rico (PR) Mother-Baby Summits Breastfeeding Coalition of the PR Health Department 67% of hospitals represented Goals: o Encourage mpinc participation o Encourage improved maternity care practices Initial Assessment 12-month Follow-up mpinc Participation 8 hospitals (<30%) 12 hospitals (42%) Breastfeeding policy 85% 94% Rooming-in offered 75% 95% h]ps://aap.confex.com/aap/2015/webprogrampress/paper29421.html Using mpinc as a Tool for Improvement 13

14 Average Discharge Care Sub-Scores, Year Total Score Discharge Care mpinc Sub-score, by state, 2015 DC Puerto Rico National average: 69 Range: /18/2017 > < 70 Island Territories (American Samoa, Guam, Saipan, and the U.S. Virgin Islands) Using mpinc as a Tool for Improvement 14

15 Percentage of Hospitals DistribuJng Infant Formula Discharge Packs, mpinc % of hospitals distributing packs % point change ( ) Total Nelson, JM. et al. Trends in the prevalence of U.S. hospitals distribu/ng infant formula discharge packs to breas_eeding mothers from 2007 to Pediatrics Average Staff Training Sub-Scores, Year Total Score Using mpinc as a Tool for Improvement 15

Staff Training Sub-score, by state, 2015 DC Puerto Rico

Virgin Islands) Tennessee BreasHeeding Tool Kit Staff

16 Staff Training Sub-score, by state, 2015 DC Puerto Rico National average: 64 Range: /18/2017 > < 70 Island Territories (American Samoa, Guam, Saipan, and the U.S. Virgin Islands) Tennessee BreasHeeding Tool Kit Staff Training Sub-score: 47 (2007) à 63 (2015) h]p:// Using mpinc as a Tool for Improvement 16

17 Average Structural & OrganizaJonal Aspects of Care Delivery Sub-Scores, Year Total Score Structure & Organizational Aspects of Care Delivery Sub-score, by state, 2015 DC Puerto Rico National average: 77 Range: /18/2017 > < 70 Island Territories (American Samoa, Guam, Saipan, and the U.S. Virgin Islands) Using mpinc as a Tool for Improvement 17

Texas Ten Step: How Texas Hospitals Can Reduce Obesity Through BreasHeeding Policy Structure Sub-Score: 59 (2007) à 71 (2015)

pdf 2015 mpinc data availability Hospital-specific Benchmark Reports Hard copies mailed to: o Hospital Administrator/CEO o

Questions: mpinc@cdc.gov State-specific Reports Emailed to state-level organizations and others Available: https://www.cdc.gov/breastfeeding/data/mpinc/state_reports.

18 Texas Ten Step: How Texas Hospitals Can Reduce Obesity Through BreasHeeding Policy Structure Sub-Score: 59 (2007) à 71 (2015) Model policy: 7% à 32% h]p://texastenstep.org/wp-content/uploads/2012/11/right-from-the-start-2011.pdf 2015 mpinc data availability Hospital-specific Benchmark Reports Hard copies mailed to: o Hospital Administrator/CEO o Director of Obstetrics o Director of Pediatrics o Director of Quality Improvement o Mother-Baby Nurse Manager o Survey recipient Questions: mpinc@cdc.gov State-specific Reports ed to state-level organizations and others Available: NaJonal Web Tables Available: Using mpinc as a Tool for Improvement 18

Conclusion Hospital pracjces are improving Total and subscores increasing ConJnued areas for improvement Staff Training Structural and Organizational Aspects of Care Future direcjons Completely

19 Conclusion Hospital pracjces are improving Total and subscores increasing ConJnued areas for improvement Staff Training Structural and Organizational Aspects of Care Future direcjons Completely revised questionnaire o Web only Target 2018 launch For more informajon please contact: jmnelson@cdc.gov 1600 Clifon Road NE, Atlanta, GA Telephone: CDC-INFO ( )/TTY: Visit: Contact CDC at: CDC-INFO or The findings and conclusions in this report are those of the authors and do not necessarily represent the official posi/on of the Centers for Disease Control and Preven/on. Na/onal Center for Chronic Disease Preven/on and Health Promo/on Division Nutri/on, Physical Ac/vity, and Obesity Photo credit: Using mpinc as a Tool for Improvement 19

Best Fed BEGINNINGS. Improving Breastfeeding Support in Hospitals. Laurence Grummer-Strawn, PhD

Best Fed BEGINNINGS. Improving Breastfeeding Support in Hospitals. Laurence Grummer-Strawn, PhD Best Fed BEGINNINGS Improving Breastfeeding Support in Hospitals Laurence Grummer-Strawn, PhD Division of Nutrition, Physical Activity and Obesity California Breastfeeding Summit Anaheim, CA February 1,