Eisner Health is a Federally Qualified Health Center (FQHC) in downtown Los Angeles whose patient population is 50% children. The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) in the first 6 months of life to achieve optimal growth, development, and health. Despite multiple interventions, only 30% of 6-month old infants at Eisner are being exclusively breastfed compared to the WHO target of 50%. First time mothers, mothers not planning to breastfeed, mothers with premature infants, and mothers not currently EBF have been identified as at-risk for low rates of breastfeeding using research previously done at Eisner.
This quality improvement project sets out to:
1) Assess the efficacy of Eisner’s newest intervention, a full-time lactation consultant.
2) Identify barriers to delivering lactation support to at-risk Eisner mothers.
3) Develop tools and interventions to increase the percentage of mothers maintaining EBF for the first six months of life.
To assess the efficacy of the full-time lactation consultant, the nutrition information of 3-6 month old infants who had an encounter with the lactation consultant was compared with 3-6 month olds without an encounter. A literature review was conducted to identify evidence-based breastfeeding interventions targeted to the pre-identified groups. Participant observations and interviews with Eisner Health staff were also conducted to identify potential areas of improvement in providing lactation support to at-risk mothers. The workflows studied included those of the lactation consultants, pediatricians,midwives, Women's Health Center (WHC) education specialists, hospital liaisons, patient referral coordinators, and the Comprehensive Perinatal Healthcare Workers (CPHWs).
Preliminary findings show that there is a positive correlation between the number of lactation consultations and EBF at six months.
We also found that resources were skewed to the prenatal period compared with the postnatal period. The following interventions were outlined for the senior staff team:
1) Expedite breast-pump ordering process for Eisner pregnant mothers by giving health educators, CPHWs, and lactation consultants pre-signed prescriptions for breast pumps to give to qualified HMO MediCal patients.
2) Intervene earlier in mothers with premature babies at California Hospital by making one-on-one lactation consultant referrals a part of the post-delivery order.
3) Standardize lactation consultations with the inclusion of Anticipatory Guidance checklists.
4) Increase longitudinal social support for pregnant and breastfeeding mothers with the creation of a peer support group.
To assist with the future pilot of a peer support group, a 5-item survey was developed to gauge interest in a mother’s peer support group. Surveys were administered in the waiting rooms of the WHC and Pediatrics departments. To date, responses from 20 mothers show that 85% have interest in a mothers group, 47% prefer groups in Spanish, 47% have interest in attending groups once a month, 77% prefer groups held on weekend mornings. The positive correlation between lactation consults and EBF is evidence for the need to expand this resources to all Eisner locations. For the remainder of our program we will continue to develop the aforementioned interventions
General recommendations for future evaluation of current and proposed interventions is to streamline the data collection process in the EHR system. We hope these findings will aid Eisner's efforts in expanding postnatal lactation services to ensure that Eisner infants are breastfed for at least 6 months and have the greatest opportunity to thrive.
*Access to data and personnel resources was challenging given Eisner Health’s EHR update