Using Data to Drive Change: California Continues to Increase In-hospital Exclusive Breastfeeding Rates A Policy Update on California Breastfeeding and Hospital Performance Produced by California WIC Association and the UC Davis Human Lactation Center Los Angeles County: 2015 Data Exclusive breastfeedng protects California’s success is driven by mothers' and babies' health evidence Breast milk provides all the nutrients infants need For more than 15 years, decision-makers and as well as specific factors needed to build a strong advocates in California have used hospital-level immune system.1 surveillance data to coordinate and monitor efforts to improve the quality of perinatal care. In-hospital support is crucial to breastfeeding mothers’ success.2-4 The greatest health benefits are Data show that mothers who experience more seen when exclusive breastfeeding continues for 6 supportive practices (such as early breastfeeding months. It is estimated that $3.0 billion in medical initiation and limited supplementation) are more costs would be saved if all U.S. infants were fed likely to breastfeed exclusively in the hospital and according to the current guidelines.5 beyond.6 Hospitals that have instituted Baby-Friendly policies California has the most Baby-Friendly Hospitals have high rates of breastfeeding, no matter where they in the nation and legislation requiring that all are located or what populations they serve.4,6 As more maternity hospitals adopt these or similar policies California hospitals have adopted these evidence- by 2025. (SB402, 2013) Improved policies and based reforms, in-hospital exclusive breastfeeding has practices have increased breastfeeding among all increased since 2010 from 56.6% to 68.6%.7 California mothers.7 Continued on page 4 The UC Davis Human Lactation Center used data reported by the California Department of Public Health Maternal, Child and Adolescent Health Program to create the following charts showing in-hospital breastfeeding rates.9 Los Angeles County In-Hospital Breastfeeding Rates, 2015 ANY BREASTFEEDING EXCLUSIVE BREASTFEEDING 100 89.9 92.6 89.3 96.5 91.9 74.1 80.1 76.9 80 71.6 57.3 60 41.9 43.4 34.9 40 20 11.9 0 ANTELOPE VALLEY BEVERLY CALIFORNIA CEDARS-SINAI CENTINELA CITRUS VALLEY COLLEGE MEDICAL PERCENTAGE HOSPITAL HOSPITAL HOSPITAL MEDICAL CENTER HOSPITAL MEDICAL CENTER- CENTER MEDICAL CENTER MEDICAL CENTER QUEEN OF THE VALLEY CAMPUS HOSPITAL (continued) 1 Los Angeles County In-Hospital Breastfeeding Rates, 2015 ANY BREASTFEEDING EXCLUSIVE BREASTFEEDING 100 91.5 93.1 95.4 94.4 94.1 97.7 91.2 84.0 75.9 80 54.5 55.3 53.6 60 40.9 43.8 41.1 40 22.4 20 0 PERCENTAGE EAST LOS FOOTHILL GARFIELD GLENDALE GLENDALE GOOD GREATER EL HARBOR-UCLA ANGELES PRESBYTERIAN MEDICAL ADVENTIST MEMORIAL SAMARITAN MONTE MEDICAL DOCTORS HOSPITAL CENTER MEDICAL HOSPITAL AND HOSPITAL HOSPITAL CENTER HOSPITAL CENTER HEALTH CENTER HOSPITAL 95.1 96.9 96.6 95.5 96.4 95.6 97.1 100 83.4 72.4 73.2 70.7 70.6 80 64.5 64.3 60 40 20 0 PERCENTAGE HENRY MAYO HOLLYWOOD HUNTINGTON KAISER - BALDWIN KAISER - DOWNEY KAISER - HARBOR KAISER - NEWHALL PRESBYTERIAN HOSPITAL PARK CITY (SOUTH BAY) PANORAMA CITY HOSPITAL MEDICAL CENTER HOSPITAL 100 97.8 94.9 95.4 90.4 98.1 92.7 93.2 73.1 74.8 76.5 78.9 80 53.4 60 44.2 40 20 <19 0 KAISER - SUNSET KAISER - WEST LOS KAISER - LAC+USC MEDICAL LOS ANGELES MARTIN LUTHER MEMORIAL PERCENTAGE ANGELES WOODLAND HILLS CENTER COMMUNITY KING, JR. HOSPITAL OF HOSPITAL AT LOS COMMUNITY GARDENA ANGELES HOSPITAL HOSPITAL 100 95.2 92.6 87.4 96.0 95.2 93.8 96.7 71.4 80 64.9 66.5 60.9 60 50.7 40 17.8 20 8.9 PERCENTAGE 0 PERCENTAGE METHODIST MILLER MONTEREY PARK NORTHRIDGE OLIVE VIEW-UCLA PACIFIC ALLIANCE PACIFICA HOSPITAL OF CHILDREN'S HOSPITAL HOSPITAL MEDICAL CENTER MEDICAL CENTER HOSPITAL OF THE SOUTHERN HOSPITAL MEDICAL CENTER VALLEY CALIFORNIA HOSPITAL (continued) 2 Los Angeles County In-Hospital Breastfeeding Rates, 2015 ANY BREASTFEEDING EXCLUSIVE BREASTFEEDING 100 85.5 93.8 90.4 95.8 96.4 92.4 97.8 75.7 78.4 79.4 80 61.0 60 45.6 48.1 40 25.9 20 0 PIH HEALTH PIH HEALTH POMONA VALLEY PROVIDENCE PROVIDENCE PROVIDENCE PROVIDENCE PERCENTAGE HOSPITAL - HOSPITAL - HOSPITAL HOLY CROSS LITTLE COMPANY LITTLE COMPANY SAINT JOHN'S DOWNEY WHITTIER MEDICAL CENTER MEDICAL CENTER OF MARY MEDICAL OF MARY-SAN HEALTH CENTER CENTER - PEDRO TORRANCE HOSPITAL 96.4 95.9 96.4 93.0 96.1 92.6 100 85.0 86.3 80 69.1 64.0 62.2 66.3 60 46.2 35.8 40 20 0 PERCENTAGE PROVIDENCE PROVIDENCE RONALD REAGAN- SAN DIMAS SAN GABRIEL ST. FRANCIS ST. MARY SAINT JOSEPH TARZANA UCLA MEDICAL COMMUNITY VALLEY MEDICAL MEDICAL CENTER MEDICAL CENTER MEDICAL CENTER MEDICAL CENTER CENTER HOSPITAL CENTER HOSPITAL 100 95.7 97.4 95.9 95.6 97.3 95.4 91.3 80.5 80 67.6 68.6 71.4 55.9 60 52.7 42.1 40 PERCENTAGE 20 0 TORRANCE UCLA MEDICAL USC VERDUGO VALLEY WEST HILLS WHITE MEMORIAL WHITTIER MEMORIAL CENTER - SANTA HILLS HOSPITAL PRESBYTERIAN HOSPITAL MEDICAL CENTER HOSPITAL HOSPITAL MONICA HOSPITAL MEDICAL CENTER HOSPITAL Los Angeles County Baby-Friendly Hospitals Twenty-seven Baby-Friendly hospitals: Antelope Valley Hospital, East Los Angeles Doctors, Glendale Memorial Hospital and Health Center, Greater El Monte Hospital, Harbor-UCLA Medical Center, Henry Mayo Newhall Hospital, Hollywood Presbyterian Medical Center, Kaiser Baldwin Park, Kaiser Downey, Kaiser Los Angeles, Kaiser Panorama City, Kaiser South Bay, Kaiser West Los Angeles, Kaiser Woodland Hills, LAC+USC Medical Center, Olive View-UCLA Medical Center, Pacific Alliance Medical Center, Pomona Valley Hospital Medical Center, Providence Holy Cross Medical Center, Providence Little Company of Mary San Pedro, Providence Little Company of Mary Torrance, Providence St. Joseph Medical Center, San Gabriel Valley Medical Center, St. Francis Hospital, St. Mary Medical Center, Valley Presbyterian Hospital, White Memorial Medical Center (continued) 3 Data are needed to improve Without consistent, comparable data, breastfeeding rates after discharge policy makers cannot coordinate and The Centers for Disease Control and Prevention (CDC) monitor hospital practices at the state and evaluate quality improvement efforts national level. Since 2009, the state’s average quality score has risen from 73 to 83 points and California effectively. hospitals are now ranked 7th in the nation. However, With the increase in electronic health records and scores for discharge care remain relatively low.8 recent requirements for more research groups to Data related to infant-feeding practices after hospital share data,10 there is greater opportunity to evaluate discharge are limited and often not comparable the collective impact of local and regional efforts to because of differences in collection methods. Without increase breastfeeding duration. consistent, comparable data, policy makers cannot With common goals and outcomes, researchers and coordinate and evaluate quality improvement evaluators can build on the momentum acheived in efforts effectively, nor can they use collective impact improving in-hospital breastfeeding rates and identify methodology that has been successful in guiding and important factors influencing mothers’ abilities to monitoring multisector efforts to prevent childhood reach their breastfeeding goals. obesity.9 Los Angeles County Breastfeeding and Hospital Performance County average breastfeeding rates: Any – 93.8% Exclusive – 60.2% County ranked 41st in the state for exclusive breastfeeding Eight hospitals among the 15 lowest-scoring in the state: Monterey Park Hospital, Downey Regional Medical Center, California Hospital Medical Center, St. Francis Hospital Lynwood, Glendale Memorial Hospital and Health Center, Whittier Hospital, San Dimas Community Hospital, LAC Harbor-UCLA Medical Center Highest performing hospital in county: Ronald Reagan-UCLA Medical Center NOTES: • All nonmilitary hospitals providing maternity services are required to complete the Newborn Screening Test Form [Version NBS-I(D) (12/08)]. • Infant-feeding data presented in this report include all feedings since birth to time of specimen collection, usually 24 to 48 hours since birth. Upon completing the form, staff must select from the following three categories to describe ‘all feeding since birth’: (1) Only Human Milk; (2) Only Formula; (3) Human Milk & Formula. • The numerator for “Exclusive Breastfeeding” includes records marked “Only Human Milk.” The numerator for “Any Breastfeeding” includes records marked “Only Human Milk” or “Human Milk & Formula.” The denominator excludes cases with unknown method of feeding and those receiving TPN at time of specimen collection. Statewide, approximately 1.8% of cases have missing feeding information and/or are on TPN at time of specimen collection. • Excludes data for infants who were in a Neonatal Intensive Care Unit (NICU) nursery at the time of specimen collection. • Excludes cases that were not collected by facilities listed as “Kaiser” and/or “Regular” maternity hospitals in the newborn screening database. • Data for counties include information for all births occurring in a ‘Regular’ or ‘Kaiser’ facility providing maternity services in that county. Counties and facilities with fewer than 50 births with known type of feeding are not shown. REFERENCES: 1. U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. (http://www.surgeongeneral.gov) 2. Perrine CG, et al. Baby-friendly hospital practices and meeting exclusive breastfeeding intention. Pediatrics. 2012 Jul; 130(1):54-60. 3. Grummer-Strawn LM, et al. Maternity care practices that support breastfeeding: CDC efforts to encourage quality improvement. J Womens Health (Larchmt). 2013 Feb;22:107-12. 4. Bartick M, et al. Closing the quality gap: promoting evidence-based breastfeeding care in the hospital.