Increasing Breastfeeding Efforts through Data and Quality Improvement in the U.S.

A key performance measure for the Federal Healthy Start Program is to increase the percentage of Healthy Start child participants whose parent/caregiver reports they were breastfed or fed breast milk at 6 months. Breastfeeding has many health benefits for both infants and mothers; the American Academy of Pediatrics recommends exclusively breastfeeding for the first six months of a baby’s life.

JSI manages the Healthy Start EPIC Center, which provides capacity building assistance to all 100 Healthy Start grantees to support their achievement of program goals: improved maternal and infant health outcomes. In this capacity, JSI has worked with two Healthy Start grantees, Detroit Healthy Start and Midwest Healthy Start, to improve performance on the breastfeeding measure.

The grantees’ first step was to learn about the current rates and drivers of performance. Both grantees took an ongoing quality improvement (QI) approach that is focused on the consumer, is data-informed, and involves all staff members. JSI staff working on the Healthy Start EPIC Center recently spoke with these two QI leaders to understand how they have applied core principles of QI in their settings.

All About the Consumer

The ultimate goal of both sites’ QI efforts is to improve their participants’ health outcomes, with breastfeeding as one pathway to better outcomes overall. Mothers who breastfeed have lower risk of health problems including Type II diabetes, certain types of breast cancer, and ovarian cancer. The health benefits to babies who are breastfed include lower risks of asthma, respiratory infections, sudden infant death syndrome (SIDS), childhood obesity and Type II diabetes.

At the beginning of Midwest Healthy Start’s QI effort, about 30% of participants initiated breastfeeding, and about 1% continued breastfeeding at 6 months. “We knew we wanted to increase those rates,” said Mary Curry, ND, the Program Coordinator and Prenatal Health Coordinator at Midwest Healthy Start. Midwest Healthy Start worked with the Healthy Start EPIC Center’s Technical Assistance team, receiving one-on-one support for their QI efforts.

The other site, Detroit Healthy Start, didn’t have strong baseline data, and this was a concern to them. They opted to participate in the Healthy Start EPIC Center-sponsored initiative, the Quality Improvement Peer Learning Network (QI PLN). “When the QI PLN started, it forced us to look at our current baseline, set goals for ourselves and meet those goals,” said Aimee Surma, MS, RN, Program Evaluator for Detroit Healthy Start.

Grounded in Facts and Data

The Detroit Healthy Start team evaluated their universal intake form and saw the forms as a first step to start the breastfeeding conversation by adding questions about breastfeeding. Using the Prioritization Matrix, a tool provided in the QI PLN, they explored which interventions could achieve a high impact on breastfeeding rates, at a relatively low cost. The prioritization matrix activity identified the Coeffective App as a low-resource, potentially high impact strategy, which they opted to pursue.