12/5/2016

1

Welcome to the Colorado

Baby-Friendly Hospital

Collaborative Webinar

Formula for

Success

December 6, 2016

The webinar will begin

shortly…

Please write your name in

the chat box so we know

everyone who is with us

participating today!

Objectives

• Understand the business case for becoming Baby-Friendly

designated

• Understand how to complete formula attestation form and

fair market value calculations

• Gain ideas for staff education in your facility

• Apply at least one idea shared during the webinar to your

hospital’s efforts in planning for designation

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Agenda

Business Case for becoming Baby-Friendly Designated

presentation

Sharing from:

o Andrea Tran from Boulder Community – Formula

Attestation and Fair Market Value calculations

o Pat Maass from St. Joseph Hospital – Staff Education

Denver Health and Delta County Memorial Hospital – on action plan!

Site visit for Estes Park end of January!

St. Francis had readiness call – site visit scheduled soon!

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Business Case for

Baby-Friendly Designation

Baby-Friendly Hospital Initiative

1991 - The Baby‐Friendly Hospital Initiative (BFHI) launched

United Nations Children's Fund (UNICEF)

World Health Organization (WHO)

Created to encourage and recognize hospitals that

demonstrate an optimal level of care for infant feeding and

mother/baby bonding

Adhere to The Ten Steps to Successful Breastfeeding

Institutional changes in maternity care practices has been

shown to significantly increase breastfeeding initiation and

duration rates.

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1. High quality care – improve long-term health of

families you serve

2. Reduce health care costs – improve your bottom

line

3. Evidence-based maternity care

4. Increase patient satisfaction

5. Enhance public image

Why Baby-Friendly?

Pediatric Cost Analysis

Excess costs resulting

from pediatric disease

at current

breastfeeding rates

compared with

projected costs if 90%

of US families could

comply with medical

recommendations to

breastfeed exclusively

for 6 months

(total: $12.97 billion

[2007 dollars]).

Pediatrics. May 2010.

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Improves Infant Health

Breastfeeding reduces risk of:

o Necrotizing enterocolitis (NEC) by 58% - 77% in preterms

exclusively fed human milk products

o Hospitalization for lower respiratory tract infections by

72% (if exclusively breastfed for >4 months)

o Nonspecific gastroenteritis by 64%

o Otitis media by 23%

o Adolescent and adult obesity by 15-30%

o SIDS by 36%

Improves health of mothers as well

Economic Benefits

If 90% of U.S. mothers breastfed exclusively for first 6 months,

cost savings = ~$13 billion ANNUALLY

o Additional savings from reduced parental absenteeism and

adult deaths from diseases acquired in childhood

Medicaid savings of breastfed infants compared to formula fed

infants:

o $111.63 per infant in the first 6 months

o $17.73 per infant in pharmacy expenditures ($16.83

breastfed, $34.56 formula-fed, p=0.001)

Successful breastfeeding can reduce newborn re-admissions due

to preventable infant morbidities.

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Stay Ahead of the Curve

Healthcare Reform Hospital Re-Admissions Reduction Program

(HRRP)

o Reimbursement is changing related to re-admission rates

o Meant to incentivize hospitals to reduce re-admission rates

Colorado Medicaid Quality Health Improvement program –

potential to incentivize Baby-Friendly designation and reduce

reimbursement for non-Baby-Friendly Designated hospital births

Blue Cross Blue Shield – Blue Distinction Centers+ for Maternity

Care designation

Joint Commission

Perinatal Care Core Measures

Mandatory measures for accredited hospitals with ≥300 births/yr:

o Elective delivery

o Cesarean section

o Use of antenatal steroids

o Newborn health care associated bloodstream infections

o Exclusive breast milk feedings = quality measure of

hospital’s performance

Implementing TJC Core Measure on Exclusive Breast Milk Feeding www.usbreastfeeding.org

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Patient Satisfaction

9 out of 10 Colorado mothers choose to breastfeed

Women make health care decisions for their family

Poudre Valley Hospital

Patient Satisfaction Scores

80.09

2008

68.98

2008

93.13

2008

83.17

2009

74.9

2009

93.16

2009

82.41

2010

75.1

2010

91.52

2010

83.48

2011

78.42

2011

96.59

2011

79.41

2011

72.16

2011

92.46

201165

70

75

80

85

90

95

100

Maternity Overall Score I learned how to feed my baby properly (breast feed or bottle feed) I w as able to have my baby w ith me often enough

Category/Question

To

p B

ox

Sc

ore

s

Top Box 2008

Top Box 2009

Top Box 2010

Top Box 2011

2011 National OB Comparison

PVH JCAHO Core

Measure – Exclusive

Breastfeeding:

2010 – 72.61

2011 – 76.55

What’s in it for your hospital?

Provide high quality care throughout your spectrum of maternity

services.

Improve long-term health of the families you serve, lowering

health care costs.

Train staff using the highest standards in evidence-based care

Increase patient satisfaction

Enhance your public image.

Promote a public health priority

Don’t be left behind!

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Breastfeeding

in Colorado

Breastfeeding Report Card

Proportion of

infants

breastfed

Healthy People

2020 Target

U.S. National* Colorado*

Ever 81.9% 80.0% 88.6%

At 6 months 60.6% 51.4% 66.2%

At 1 year 34.1% 29.2% 40.6%

Exclusively

through 3

months

46.2% 43.3% 57.3%

Exclusively

through 6

months

25.5% 21.9% 26.4%

*CDC National Immunization Survey (NIS), 2013 births

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Breastfeeding Report Card

Proportion

of infants

breastfed

Healthy

People

2020 Target

U.S.

National*

Colorado* Colorado

WIC**

Ever 81.9% 80.0% 88.6% 80%

At 6 months 60.6% 51.4% 66.2% 27%

At 1 year 34.1% 29.2% 40.6% 23%

Exclusively

through 3

months

46.2% 43.3% 57.3% 26%

Exclusively

through 6

months

25.5% 21.9% 26.4% 13%

*CDC National Immunization Survey (NIS), 2013 births

**WIC Compass data for 2015

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81%

75%

70% 68%

64% 62%

58% 58%

53% 52% 50% 49%

44% 42%

39%

28% 25%

85%

80% 77%

74% 68% 67%

63% 62% 61%

56% 55% 55% 54%

49% 48% 48% 47% 44% 43% 43%

33%

92% 88%

85% 81%

76% 75% 72% 71%

69%

62% 61% 61% 61%

55% 54% 54% 54% 48% 46% 46%

35%

95% 92%

87% 84%

79% 77% 76% 75% 74%

67% 66% 66% 66%

61% 61% 60% 60%

52% 52% 52% 48%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Perc

ent

of

All M

oth

ers

Weeks Since Delivery

Colorado Breastfeeding Initiation and Duration Rates All Mothers, 1997, 2003, 2009, 2013

1997

2003

2009

2013

1 week 1 month 2 months 3 months 4 months

Colorado Pregnancy Risk Assessment Monitoring System (PRAMS) annual surveys. CDPHE

97% 96% 92% 90%

86% 85% 83% 82% 78% 77% 76%

71% 70%

59% 58%

91% 85%

80%

75% 66% 64% 63% 62% 60%

48% 44% 43%

39%

33%

89% 85%

83% 80%

76% 75% 71% 70% 69%

65% 64% 63%

58% 56%

55% 54%

35%

77%

69% 65%

60%

52% 51% 47% 47%

45%

37% 36% 36% 35% 31% 30% 30%

26% 23%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Perc

ent

of

All M

oth

ers

Weeks Since Delivery

Colorado Breastfeeding Initiation and Duration Rates, Medicaid and non-Medicaid, 2003 and 2013

non-Medicaid 2013

Medicaid 2013

non-Medicaid 2003

Medicaid 2003

1 week 1 month 2 months 3 months 4 months

Colorado Pregnancy Risk Assessment Monitoring System (PRAMS) annual surveys. CDPHE

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Colorado Can Do 5!

State breastfeeding initiative from 2009-2013

Implement 5 of The Ten Steps to Successful Breastfeeding:

1. Breastfeed in the first hour after birth (Step 4)

2. Fed only breast milk in the hospital (Step 6)

3. Rooming in (Step 7)

4. No pacifier use in the hospital (Step 9)

5. Breastfeeding telephone number provided before discharge (Step 10)

A national model for maternity care

Breastfeeding Excellence Starts Today (BEST) Award:

41 of 53 hospitals with maternity services

Colorado Can Do 5!

1. Babies breastfed in first hour – immediate skin-to-skin

• Increases breastfeeding success

• Reduces infant low blood glucose and risk for needing

oxygen

• Stabilizes infant body temperature and breathing

• Reduces infant crying and stress

• Improves maternal bonding and interactions

• Colonization with mother’s normal flora

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Colorado Can Do 5!

2. Infants only fed breast milk and receive no supplementation

• Increases breastfeeding success

• Promotes abundant milk supply

• Normal flora of infant’s GI tract maintained

3. Rooming in

• Increases maternal bonding

• Mothers learn about their infant, increases competence

and confidence

• Breastfeeding on demand

Colorado Can Do 5!

4. No pacified or artificial nipples

• Infant’s sucking efforts are nutritive, promote milk

production and reinforce correct breastfeeding technique

prior to discharge

• Cost savings of 1-3 pacifiers per infant

• Appropriate to use pacifier during medical procedure or if

asked by parent

5. Staff gives mothers support number after discharge

• Support group, individual help ensures seamless transition

to the community

• Increases patient satisfaction with hospital experience

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100% 96%

90% 86%

81% 81% 79% 78%

76%

70% 68% 68% 67%

63% 62% 62% 62%

56% 56% 56% 53%

100% 99% 97% 96%

93% 92% 90% 90% 89%

86% 86% 86% 86%

81% 81% 79% 79%

71% 71% 71% 68%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Perc

ent

of

Moth

ers

of

Healt

hy B

reast

fed Infa

nts

Weeks Since Delivery

Mothers of Healthy Breastfed Infants, by Five Successful Hospital Breastfeeding Practices (Can Do 5!), 2012-2013

1 week 1 month 2 months 3 months 4 months

Mothers Experienced All Five Successful Practices

Mothers Did Not Experience All Five

Successful Practices

*Differences are statistically significant at weeks 1-19.

Colorado Pregnancy Risk Assessment Monitoring System (PRAMS) annual surveys. CDPHE

Mother Reported Hospital Gave Gift Pack with Formula

* Statistically significant change from previous year

Colorado Pregnancy Risk Assessment Monitoring System (PRAMS) annual surveys. CDPHE

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Colorado Baby-Friendly Hospital

Collaborative Goal = increase breastfeeding supportive maternity practices

2013- Present

State level support system:

o Training

o Technical assistance

o Financial assistance

o Collaboration

CDC and MCH grant funded

Baby-Friendly Pathway • Begin with

Discovery

• Pay fees

• Each phase = 1

year

• Portals and

tools for each

phase

• Baby-Friendly

wants you to

succeed!

• Collaborative

can help!

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9 Designated Facilities

3

Previously

Designated Good Samaritan – 2006

Poudre Valley – 2009

Medical Center of the

Rockies - 2011

6 CBFHC Designated Boulder Community – 10/2015

Aspen Valley – 12/2015

St. Anthony North – 5/2016

Valley View – 6/2016

Saint Joseph – 6/2016

Saint Mary’s – 8/2016

14 CBFHC On

Pathway 2 hospitals on Action Plans

2 Scheduled site visits

Second cohort started

Birth Certificate Data - 2015

Designated = 20.2% (13,287)

CBFHC on Path = 40.1% (26,328)

Other hospitals = 39.6% (26,024)

Once all CBFHC Designate = ~60% (39,615)

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Baby Friendly Nationally

395 facilities!

19.4% of annual U.S. births

(~773,500 births)

~1,100 facilities on the path

o Healthy People 2020 goal = 8.1%

o 2007 only 2.9% of annual U.S.

births

All Indian Health Services, Military

Facilities, California facilities

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Colorado Baby-Friendly Hospital Collaborative (CBFHC)) annual surveys. CDPHE

Colorado Baby-Friendly Hospital Collaborative (CBFHC)) annual surveys. CDPHE

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Colorado Baby-Friendly Hospital Collaborative (CBFHC)) annual surveys. CDPHE

Colorado Baby-Friendly Hospital Collaborative (CBFHC)) annual surveys. CDPHE

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Baby-Friendly Challenges

• What does it mean to be on the path to Baby-Friendly

designation?

• Challenges for your facility

• Staff and administration buy-in

• Remember – Baby-Friendly is not about making things more

difficult or about prohibiting formula or pacifiers . . .

Baby-Friendly is about educating staff and parents

Thank you ! ! !

I am here to help!

Contact me anytime with

questions, suggestions,

resources –

stacy.miller@state.co.us

or 303-692-2406

12/5/2016

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Formula Attestation

Andrea Tran, RN, MA, IBCLC

Lactation Consultant

Boulder Community Health

Staff Education

Pat Maass, RN, BSN, LCCE, CLC

Manager, Lactation and Education

Saint Joseph Hospital, Denver

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Provider Education

Meet with providers and practices who deliver babies at

your hospital to discuss Baby Friendly and what they should

be teaching their patients

Encourage them to chart education

If they are employed by your facility have IT add teaching

points to their current charting system

Review the Trimester checklist

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Affiliated clinics

Clinics owned by the hospital/system = where Baby-Friendly will do

prenatal interviews (= affiliated clinics)

Only private providers? = BF will interview patients from those

practices. (Encourage providers to schedule some patients over 32

weeks for the interviews.)

Teach to the Test = Have providers prep the patients you know

are coming in on the day of the site visit. (Give providers the

questions from the prenatal audit for them to prep the patients or make

the questions and answers in to a handout)

If not enough patients from the clinic or provider office = BF may

ask to go to Labor and Delivery to interview patients in early

labor or antepartum patients on your unit. (May want to prep these

patients on the day of the site visit as well)

Postpartum Patient Audits

Use the audit tools provided by Baby Friendly- do it

manually or put in Survey Monkey

Hand out audits to patients and collect them prior to

discharge (“Infant feeding survey for Moms”)

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Questions???

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Thank you ! ! !

I am here to help!

Contact me anytime with

questions, suggestions,

resources –

stacy.miller@state.co.us

or 303-692-2406