Preliminary Progress Toward a Statewide Quality Improvement Project to Enhance Prenatal Breastfeeding Promotion

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Case Report:

Through the Tennessee Initiative for Perinatal Quality Care (www.tipqc.org), four pilot prenatal (Family Medicine and OB-GYN) practices representing academic and private groups from across the state established primary improvement teams including relevant stakeholders. An online toolkit of evidence-based practices and published tools from the AAP, ACOG, ABM, and elsewhere was developed by an interdisciplinary team and provided to pilot practices. The toolkit included a menu of “potentially better practices” (PBPs) that could be implemented individually, or as a bundle. Success of this project relied on use of rapid Plan-Do-Study-Act (PDSA) cycles. Pilot practices were educated on basic QI procedures, data collection, toolkit content, etc. and shared experiences through monthly webinars called “Huddles”. Regional trainings were also provided at various intervals by the TIPQC staff.

Before implementation of a PBP, each practice collected their baseline breastfeeding rate at the 4-8 week postpartum visit. Practices used a web-based, HIPAA-compliant data-entry system through REDCap. The project was reviewed and approved by the Institutional Review Boards (IRBs) of participating pilots, and funded under an agreement with the state of Tennessee.

PBPs implemented by the pilot practices included:

- Providing resident and provider education

- Distributing written literature on breastfeeding benefits and advice

- Providing written breastfeeding prescriptions

- Having patients view educational breastfeeding videos

- Creating a breastfeeding-friendly office environment

Baseline pilot data revealed that at presentation for the first postpartum visit, 28.1%, 23%, and 49% of mothers were exclusively feeding breastmilk, feeding a mix of breastmilk and formula, and exclusively feeding formula, respectively (n=196).

Baseline data was successfully collected, and early data following the first PDSA has been collected across the four pilot participants. For participating practices, this is the first time they have systematically looked at their 6-week breastfeeding rates. Open communication and brainstorming across the various practices has been very helpful. A numbers of challenges have been cited, including time constraints related to large volumes of patients and inability to extract data electronically, coordination of efforts among large numbers of providers and staff who may be unfamiliar with breastfeeding, and a need for more family, hospital, and community provider support for breastfeeding.


This quality improvement prenatal breastfeeding promotion pilot project provides insight into the process of team building and use of thin data sets to drive practice level improvement, and lays the groundwork for statewide spread, where challenges encountered in the pilot centers can be addressed. Participants are now looking at the reliability of their implementation, and determining whether their initial selections from the menu/toolkit were effective.


New Orleans, LA

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