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.

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.

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.

None

None

None

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.

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.

Increase in the rate

American Academy of Pediatrics. (2005). Section on Breastfeeding. Policy Statement:
Breastfeeding and the Use of Human Milk. Pediatrics.115:496– 506.

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.

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.

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.

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.

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

Kramer, M.S. & Kakuma, R. (2002).Optimal duration of exclusive breastfeeding. [107 refs] Cochrane Database of Systematic Reviews. (1):CD003517.

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.

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.

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.

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.

World Health Organization. (1991). Indicators for assessing breastfeeding practices. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/child-adolescenthealth/new_publications/nutrition/who_cdd_ser_91.14.pdf.

None

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.

None

Single term newborns born in the hospital who did not have a diagnosis of galactosemia, were not subject to parenteral infusion, and had a length of stay less than or equal to 120 days.

PC-05 Single term newborns discharged from the hospital.
PC-05a Single term newborns discharged from the hospital.

PC-05 Newborns who were admitted to the Neonatal Intensive Care Unit (NICU), who were transferred to another hospital, or who expired during the hospitalization.
PC-05a Newborns who were admitted to the Neonatal Intensive Care Unit (NICU), who were transferred to another hospital, who expired during the hospitalization, or whose mothers chose not to exclusively breast feed..

PC-05 Newborns who were fed breast milk only since birth.
PC-05a Newborns who were fed breast milk only since birth.

Not applicable

None

Not applicable

Not applicable

For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

      ------ Population Criteria 1 ------

• Initial Patient Population 1 =
  • AND: "Occurrence A of Encounter, Performed: Encounter Inpatient" ends during "Measurement Period"
  • AND: "Occurrence A of Encounter, Performed: Encounter Inpatient (length of stay <= 120 day(s))"
  • AND:
    • AND: "Physical Exam, Finding: Estimated Gestational Age at Birth (result >= 37 week(s))" < 1 day(s) starts during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    • AND:
      • OR: "Diagnosis, Active: Single Live Birth" starts during "Occurrence A of Encounter, Performed: Encounter Inpatient"
      • OR: "Diagnosis, Active: Single Liveborn Newborn Born in Hospital" starts during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  • AND NOT: "Diagnosis, Active: Galactosemia" starts during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  • AND NOT: "Procedure, Performed: Parenteral Infusion" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
• Denominator 1 =
  • AND: "Initial Patient Population 1"
• Denominator Exclusions 1 =
  • AND:
    • OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (facility location: 'Neonatal Intensive Care Unit (NICU)')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    • OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (discharge status: 'Patient Expired')"
    • OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (discharge status: 'Discharge To Another Hospital')"
• Numerator 1 =
  • AND:
    • AND: "Substance, Administered: Breast Milk"
    • AND NOT: "Substance, Administered: Dietary Intake Other than Breast Milk"
    • during "Occurrence A of Encounter, Performed: Encounter Inpatient"
• Denominator Exceptions 1=
  • None

      ------ Population Criteria 2 ------

• Initial Patient Population 2 =
  • AND: "Occurrence A of Encounter, Performed: Encounter Inpatient" ends during "Measurement Period"
  • AND: "Occurrence A of Encounter, Performed: Encounter Inpatient (length of stay <= 120 day(s))"
  • AND:
    • AND: "Physical Exam, Finding: Estimated Gestational Age at Birth (result >= 37 week(s))" < 1 day(s) starts during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    • AND:
      • OR: "Diagnosis, Active: Single Live Birth" starts during "Occurrence A of Encounter, Performed: Encounter Inpatient"
      • OR: "Diagnosis, Active: Single Liveborn Newborn Born in Hospital" starts during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  • AND NOT: "Diagnosis, Active: Galactosemia" starts during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  • AND NOT: "Procedure, Performed: Parenteral Infusion" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
• Denominator 2 =
  • AND: "Initial Patient Population 2"
• Denominator Exclusions 2 =
  • AND:
    • OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (facility location: 'Neonatal Intensive Care Unit (NICU)')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    • OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (discharge status: 'Patient Expired')"
    • OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (discharge status: 'Discharge To Another Hospital')"
    • OR NOT: "Communication: From Patient to Provider: Feeding Intention-Breast" <= 1 hour(s) starts after start of "Patient Characteristic: Birth"
• Numerator 2 =
  • AND:
    • AND: "Substance, Administered: Breast Milk"
    • AND NOT: "Substance, Administered: Dietary Intake Other than Breast Milk"
    • during "Occurrence A of Encounter, Performed: Encounter Inpatient"
• Denominator Exceptions 2=
  • None

• "Communication: From Patient to Provider: Feeding Intention-Breast" using "Feeding Intention-Breast SNOMEDCT Value Set (2.16.840.1.113762.1.4.1045.29)"
• "Diagnosis, Active: Galactosemia" using "Galactosemia Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.35)"
• "Diagnosis, Active: Single Live Birth" using "Single Live Birth SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.25)"
• "Diagnosis, Active: Single Liveborn Newborn Born in Hospital" using "Single Liveborn Newborn Born in Hospital Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.26)"
• "Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient SNOMEDCT Value Set (2.16.840.1.113883.3.666.5.307)"
• "Patient Characteristic: Birth" using "Birth SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.70)"
• "Physical Exam, Finding: Estimated Gestational Age at Birth" using "Estimated Gestational Age at Birth SNOMEDCT Value Set (2.16.840.1.113762.1.4.1045.47)"
• "Procedure, Performed: Parenteral Infusion" using "Parenteral Infusion Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.38)"
• "Substance, Administered: Breast Milk" using "Breast Milk SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.30)"
• "Substance, Administered: Dietary Intake Other than Breast Milk" using "Dietary Intake Other than Breast Milk SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.27)"
• Attribute: "Discharge status: Discharge To Another Hospital" using "Discharge To Another Hospital SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.87)"
• Attribute: "Facility location: Neonatal Intensive Care Unit (NICU)" using "Neonatal Intensive Care Unit (NICU) SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.75)"
• Attribute: "Discharge status: Patient Expired" using "Patient Expired SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.309)"

• None

• "Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity CDCREC Value Set (2.16.840.1.114222.4.11.837)"
• "Patient Characteristic Payer: Payer" using "Payer SOP Value Set (2.16.840.1.114222.4.11.3591)"
• "Patient Characteristic Race: Race" using "Race CDCREC Value Set (2.16.840.1.114222.4.11.836)"
• "Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex AdministrativeSex Value Set (2.16.840.1.113762.1.4.1)"