eMeasure Title Exclusive Breast Milk Feeding
eMeasure Identifier
(Measure Authoring Tool)
9 eMeasure Version number 2
NQF Number 0480 GUID 7d374c6a-3821-4333-a1bc-4531005d77b8
Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Joint Commission
Measure Developer Joint Commission
Endorsed By National Quality Forum
Description
PC-05 Exclusive breast milk feeding during the newborn's entire hospitalization
PC-05a Exclusive breast milk feeding during the newborn’s entire hospitalization considering mother’s choice
Copyright
LOINC(R) is a registered trademark of the Regenstrief Institute.
 
This material contains SNOMED Clinical Terms (R) (SNOMED CT(c)) copyright 2004-2010 International Health Terminology Standards Development Organization. All rights reserved.
Disclaimer
None
Measure Scoring Proportion
Measure Type Process
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
Exclusive breast milk feeding for the first 6 months of neonatal life has long been the expressed goal of World Health Organization (WHO), Department of Health and Human Services (DHHS), American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG). ACOG has recently reiterated its position (ACOG, 2007). A recent Cochrane review substantiates the benefits (Kramer et al., 2002). Much evidence has now focused on the prenatal and intrapartum period as critical for the success of exclusive (or any) BF (Centers for Disease Control and Prevention [CDC], 2007; Petrova et al., 2007; Shealy et al., 2005; Taveras et al., 2004). Exclusive breast milk feeding rate during birth hospital stay has been calculated by the California Department of Public Health for the last several years using newborn genetic disease testing data. Healthy People 2010 and the CDC have also been active in promoting this goal.
Clinical Recommendation Statement
Exclusive breast milk feeding for the first 6 months of neonatal life can result in numerous long-term health benefits for both mother and newborn and is recommended by a number of national and international organizations. Evidence suggests that the prenatal and intrapartum period is critical for the success of exclusive (or any) breast feeding. Therefore, it is recommended that newborns are fed breast milk only from birth to discharge.
Improvement Notation
Increase in the rate
Reference
American Academy of Pediatrics. (2005). Section on Breastfeeding. Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics.115:496– 506.
Reference
American College of Obstetricians and Gynecologists. (Feb. 2007). Committee on Obstetric Practice and Committee on Health Care for Underserved Women.Breastfeeding: Maternal and Infant Aspects. ACOG Committee Opinion 361.
Reference
California Department of Public Health. (2006). Genetic Disease Branch. California In-Hospital Breastfeeding as Indicated on the Newborn Screening Test Form, Statewide, County and Hospital of Occurrence: Available at: http://www.cdph.ca.gov/data/statistics/Pages/BreastfeedingStatistics.aspx.
Reference
Centers for Disease Control and Prevention. (Aug 3, 2007). Breastfeeding trends and updated national health objectives for exclusive breastfeeding--United States birth years 2000-2004. MMWR - Morbidity & Mortality Weekly Report. 56(30):760-3.
Reference
Centers for Disease Control and Prevention. (2007). Division of Nutrition, Physical Activity and Obesity. Breastfeeding Report Card. Available at: http://www.cdc.gov/breastfeeding/data/report_card2.htm.
Reference
Ip, S., Chung, M., Raman, G., et al. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: US Department of Health and Human Services. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf
Reference
Kramer, M.S. & Kakuma, R. (2002).Optimal duration of exclusive breastfeeding. [107 refs] Cochrane Database of Systematic Reviews. (1):CD003517.
Reference
Petrova, A., Hegyi, T., & Mehta, R. (2007). Maternal race/ethnicity and one-month exclusive breastfeeding in association with the in-hospital feeding modality. Breastfeeding Medicine. 2(2):92-8.
Reference
Shealy, K.R., Li, R., Benton-Davis, S., & Grummer-Strawn, L.M. (2005).The CDC guide to breastfeeding interventions. Atlanta, GA: US Department of Health and Human Services, CDC. Available at: http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf.
Reference
Taveras, E.M., Li, R., Grummer-Strawn, L., Richardson, M., Marshall, R., Rego, V.H., Miroshnik, I., & Lieu, T.A. (2004). Opinions and practices of clinicians associated with continuation of exclusive breastfeeding. Pediatrics. 113(4):e283-90.
Reference
US Department of Health and Human Services. (2007). Healthy People 2010 Midcourse Review. Washington, DC: US Department of Health and Human Services. Available at: http://www.healthypeople.gov/data/midcourse.
Reference
World Health Organization. (1991). Indicators for assessing breastfeeding practices. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/child-adolescent-health/new_publications/nutrition/who_cdd_ser_91.14.pdf.
Definition
None
Guidance
Maternal reasons for not exclusively breastfeeding are limited to the following situations:
• HIV infection 
• Human t-lymphotrophic virus type I or II 
• Substance abuse and/or alcohol abuse 
• Active, untreated tuberculosis 
• Taking certain medications, i.e., prescribed cancer chemotherapy, radioactive isotopes, antimetabolites, antiretroviral medications and other medications where the risk of morbidity outweighs the benefits of breast milk feeding 
• Undergoing radiation therapy 
• Active, untreated varicella 
• Active herpes simplex virus with breast lesions 
• Admission to Intensive Care Unit (ICU) post-partum

A discharge to a designated cancer center or children’s hospital should be captured as a discharge to another hospital.

The unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization.

The logic phrase AND: “Occurrence A of Encounter, Performed: Inpatient Encounter (reason: 'Birth')” intends to capture admission type of newborn for the encounter. Where this information is available in existing EHR structured fields (e.g. data that is fed to UB 04, field location 14), it can be used to map the criterion specified in the logic.

The logic phrase AND: “Diagnosis, Active: Liveborn Born In Hospital” starts during “Occurrence A of Encounter, Performed: Inpatient Encounter” intends to capture the point of origin for the inpatient admission. Where this information is available in existing EHR structured fields (e.g. data that is fed to UB-04, field location 15), it can be used to map the criterion specified in the logic.
Transmission Format
None
Initial Patient Population
Single term newborns discharged from the hospital who has no diagnosis of galactosemia, no performed procedure of parenteral infusion, no diagnosis of premature newborn, and length of stay less than or equal to 120 days.
Denominator
PC-05 Single term newborns discharged from the hospital who has no diagnosis of galactosemia, no procedure of parenteral infusion, no diagnosis of premature newborn, and length of stay less than or equal to 120 days.
PC-05a Single term newborns discharged from the hospital excluding those whose mothers chose not to breast feed, who has no diagnosis of galactosemia, no procedure of parenteral infusion, no diagnosis of premature newborn, and length of stay less than or equal to 120 days.
Denominator Exclusions
PC-05 Admitted to the Neonatal Intensive Care Unit (NICU) at this hospital during the hospitalization; Experienced death; Had documented reason for not exclusively feeding breast milk; Patients transferred to another hospital.
PC-05a Admitted to the Neonatal Intensive Care Unit (NICU) at this hospital during the hospitalization; Experienced death; Had documented reason for not exclusively feeding breast milk; Patients transferred to another hospital; Parental Refusal.
Numerator
PC-05 Newborns that were fed breast milk only since birth
PC-05a Newborns that were fed breast milk only since birth
Numerator Exclusions
Not applicable
Denominator Exceptions
None
Measure Population
Not applicable
Measure Observations
Not applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents


Population criteria

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Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements




Measure Set
eMeasure Perinatal Care (ePC)