eCQM Title | Exclusive Breast Milk Feeding |
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eCQM Identifier (Measure Authoring Tool) | 9 | eCQM Version Number | 9.5.000 |
NQF Number | 0480e | GUID | 7d374c6a-3821-4333-a1bc-4531005d77b8 |
Measurement Period | January 1, 20XX through December 31, 20XX | ||
Measure Steward | The Joint Commission | ||
Measure Developer | The Joint Commission | ||
Endorsed By | National Quality Forum | ||
Description |
PC-05 Exclusive breast milk feeding during the newborn's entire hospitalization. The measure is reported as an overall rate which includes all newborns that were exclusively fed breast milk during the entire hospitalization. |
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Copyright |
LOINC(R) copyright 2004-2019 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms (R) (SNOMED CT[R]) copyright 2004-2019 International Health Terminology Standards Development Organisation. All Rights Reserved. Measure specifications are in the Public Domain |
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Disclaimer |
These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. |
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Measure Scoring | Proportion | ||
Measure Type | Process | ||
Stratification |
None |
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Risk Adjustment |
None |
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Rate Aggregation |
None |
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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 & Kakuma, 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, Hegyi, & Mehta, 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. |
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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. |
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Improvement Notation |
Improvement noted as an increase in the rate |
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Reference |
American Academy of Pediatrics. (2005). Policy statement: Breastfeeding and the use of human milk. Pediatrics, 115, 496-506. |
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Reference |
American College of Obstetricians and Gynecologists, Committee on Obstetric Practice and Committee on Health Care for Underserved Women. (2007). Breastfeeding: ACOG committee opinion 361—Maternal and infant aspects. Washington, DC: American College of Obstetricians and Gynecologists. |
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Reference |
California Department of Public Health. (2017). In-hospital breastfeeding initiation data: Hospital of occurrence. Retrieved from https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/BFP/BFP-Data-InHospital-Hospitals-2017.pdf |
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Reference |
Centers for Disease Control and Prevention. (2007, August 3). Breastfeeding trends and updated national health objectives for exclusive breastfeeding—United States birth years 2000–2004. Morbidity and Mortality Weekly Report, 56(30), 760-763. |
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Reference |
Centers for Disease Control and Prevention. Division of Nutrition, Physical Activity, and Obesity. (2017). Breastfeeding report card. Retrieved from https://www.cdc.gov/breastfeeding/data/reportcard.htm |
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Reference |
Ip, S., Chung, M., Raman, G., et al. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: U.S. Department of Health and Human Services. Retrieved from https://archive.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf |
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Reference |
Kramer, M. S., & Kakuma, R. (2002). Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews, (1). DOI: 10.1002/14651858.CD003517. |
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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), 92-98. |
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Reference |
Shealy, K. R., Li, R., Benton-Davis, S., et al. (2005). The CDC guide to breastfeeding interventions. Atlanta, GA: U.S. Department of Health and Human Services, CDC. Retrieved from http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf |
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Reference |
Taveras, E. M., Li, R., Grummer-Strawn, L., et al. (2004). Opinions and practices of clinicians associated with continuation of exclusive breastfeeding. Pediatrics, 113(4), e283-e290. |
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Reference |
U.S. Department of Health and Human Services. (2007). Healthy People 2010 midcourse review. Washington, DC: U.S. Department of Health and Human Services. Retrieved from https://www.healthypeople.gov/2010/Data/midcourse/default.htm |
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Reference |
World Health Organization. (2007). Indicators for assessing infant and young child feeding practices. Washington, DC, USA: World Health Organization. Retrieved from http://apps.who.int/iris/bitstream/handle/10665/43895/9789241596664_eng.pdf |
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Definition |
None |
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Guidance |
A discharge to a designated cancer center or children's hospital should be captured as a discharge to an acute care facility. It is acceptable to calculate Gestational Age using the American College of Obstetricians and Gynecologists ReVITALize guidelines, which define Gestational Age as calculated using the best obstetrical Estimated Due Date (EDD) based on the formula: Gestational Age= (280-(EDD-Reference Date))/7 where Reference Date is the date on which you are trying to determine gestational age. For PC-05, Reference Date is the Birth Date. Note however that the calculation may yield a non-whole number and gestational age should be rounded off to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks. Data shows that the majority of newborns with gestational age 37 weeks or more have a birth weight 3000 grams or more. Birth weight 3000 grams or more is a proxy to capture term newborns without gestational age recorded in EHR system. This eCQM is an episode-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM. |
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Transmission Format |
TBD |
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Initial Population |
Inpatient hospitalizations for single newborns who were born in the hospital that ends during the measurement period, and with either of the following conditions: - An estimated gestational age at birth of >= 37 weeks - Birth weight >= 3000 grams without an estimated gestational age at birth |
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Denominator |
Initial Population |
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Denominator Exclusions |
Inpatient hospitalizations for newborns who were with any of the following conditions: • admitted to the Neonatal Intensive Care Unit (NICU) • transferred to an acute care facility, or other health care facility • expired during the hospitalization • a length of stay greater than 120 days that ends during the measurement period • a diagnosis of galactosemia • subject to parenteral nutrition |
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Numerator |
Inpatient hospitalizations for newborns who were fed breast milk only since birth |
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Numerator Exclusions |
Not Applicable |
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Denominator Exceptions |
None |
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Supplemental Data Elements |
For every patient evaluated by this measure also identify payer, race, ethnicity and sex |
"Single Live Term Newborn Encounter During Measurement Period"
"Initial Population"
"Single Live Term Newborn Encounter With Newborn to NICU or Discharge to Acute Care or Other Health Care Facility or Expired" union "Single Live Term Newborn Encounter With Length of Stay More Than 120 days" union "Single Live Term Newborn Encounter With Galactosemia or Parenteral Nutrition"
"Single Live Term Newborn Encounter With Newborn Fed Breast Milk Only Since Birth"
None
None
None
"Initial Population"
"Single Live Term Newborn Encounter With Newborn to NICU or Discharge to Acute Care or Other Health Care Facility or Expired" union "Single Live Term Newborn Encounter With Length of Stay More Than 120 days" union "Single Live Term Newborn Encounter With Galactosemia or Parenteral Nutrition"
"Single Live Term Newborn Encounter During Measurement Period"
"Single Live Term Newborn Encounter With Newborn Fed Breast Milk Only Since Birth"
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
["Encounter, Performed": "Encounter Inpatient"] InpatientEncounter where exists ( InpatientEncounter.diagnoses EncounterDiagnoses where EncounterDiagnoses.code in "Single Live Born Newborn Born in Hospital" )
"Single Live Birth Encounter" SingleLiveBirthEncounter without ["Assessment, Performed": "Gestational age--at birth"] GestationalAge such that GestationalAge.relevantDatetime during SingleLiveBirthEncounter.relevantPeriod and GestationalAge.result is not null with ["Assessment, Performed": "Birth Weight"] BirthWeight such that BirthWeight.relevantDatetime during SingleLiveBirthEncounter.relevantPeriod and BirthWeight.result >= 3000 'g'
"Single Live Birth Encounter" SingleLiveBirthEncounter with ["Assessment, Performed": "Gestational age--at birth"] GestationalAge such that GestationalAge.result >= 37 'wk' and GestationalAge.relevantDatetime during SingleLiveBirthEncounter.relevantPeriod
( "Single Live Birth Encounter With Gestational Age 37 Weeks or More" union "Single Live Birth Encounter With Birth Weight 3000 grams or More Without Gestational Age" ) SingleLiveTermEncounter where SingleLiveTermEncounter.relevantPeriod ends during "Measurement Period"
( "Single Live Term Newborn Encounter During Measurement Period" QualifyingEncounter with ["Procedure, Performed": "Parenteral Nutrition"] ParenteralNutrition such that ParenteralNutrition.relevantPeriod starts during QualifyingEncounter.relevantPeriod ) union ( "Single Live Term Newborn Encounter During Measurement Period" QualifyingEncounter where exists ( QualifyingEncounter.diagnoses BirthEncounterDiagnoses where BirthEncounterDiagnoses.code in "Galactosemia" ) )
"Single Live Term Newborn Encounter During Measurement Period" QualifyingEncounter where Global."LengthInDays" ( QualifyingEncounter.relevantPeriod ) > 120
"Single Live Term Newborn Encounter During Measurement Period" QualifyingEncounter with ["Substance, Administered": "Breast Milk"] BreastMilkFeeding such that BreastMilkFeeding.relevantPeriod starts during QualifyingEncounter.relevantPeriod without ["Substance, Administered": "Dietary Intake Other than Breast Milk"] OtherFeeding such that OtherFeeding.relevantPeriod starts during QualifyingEncounter.relevantPeriod
"Single Live Term Newborn Encounter During Measurement Period" QualifyingEncounter where exists ( QualifyingEncounter.facilityLocations NICU where NICU.code in "Neonatal Intensive Care Unit (NICU)" ) or QualifyingEncounter.dischargeDisposition in "Patient Expired" or QualifyingEncounter.dischargeDisposition in "Discharge To Acute Care Facility" or QualifyingEncounter.dischargeDisposition in "Other Health Care Facility"
difference in days between start of Value and end of Value
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
Measure Set |
eMeasure Perinatal Care (ePC) |
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