A statewide perinatal quality improvement collaborative to increase exclusive breastfeeding at hospital discharge

Background: Tennessee Initiative for Perinatal Quality Care (TIPQC) is a statewide quality improvement collaborative that elected to develop a project to address Tennessee's low breastfeeding rates, funded by the Tennessee Department of Health. Objective: To improve the health of Tennessee infants and mothers by increasing initiation and duration of breastfeeding through systematic implementation of high reliability (>90%) processes that promote and support breastfeeding in the delivery setting. Methods: A toolkit was created using the evidence-based practices of the Ten Steps to Successful Breastfeeding and the USBC's Toolkit, “Implementing The Joint Commission Perinatal Care Core Measure on Exclusive Breast Milk Feeding.” 11 hospitals in Tennessee are currently participating in the project. Results: Participating hospitals established an improvement team of stakeholders, and began reporting exclusive breastfeeding at hospital discharge, according to The Joint Commission (TJC) guidelines. The centers are implementing one or more of the 10 Steps to Successful Breastfeeding by using rapid Plan-Do-Study-Act (PDSA) cycles. Reliability of implementation is monitored by process measure audits. Web-based data-entry through REDCap provides on-demand run-charts. Monthly webinars facilitate sharing of best practices between geographically distant centers. Baseline data in the first 5 months of the project from over 7000 maternal-infant dyads highlights improvement opportunities on all 10 steps. Conclusions: This project serves as a model for how quality improvement methodologies may be combined with use of distance-learning and web-based data entry and reporting to facilitate implementation of evidenced based practices to increase breastfeeding rates across a large geographic area in a region of the country with disparately low rates of breastfeeding. Opportunities for leveraging project support from diverse stakeholders, including policy makers, insurers, and healthcare administrators will be discussed. Implementation and data collection challenges faced by hospital teams and workable solutions that emerged through the collaborative process will be outlined.