Breastfeeding Measurement In The Outpatient Electronic-Books Pdf

Breastfeeding Measurement in the Outpatient Electronic
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Table of Contents, Executive Summary 3, Introduction 5. The Interviews 7, Participants 8, What We Learned 9. Subject Matter Experts 9, Community Healthcare Center Stakeholders 17. Summary 22, Recommendations 24, References Selected Resources 26. Acknowledgements 29, Page 2 of 29, Executive Summary.
The Lactation Supportive Environments LSE project aims to increase access to settings. that encourage breastfeeding initiation and duration Funded by First 5 San Diego LSE is. a project of the County of San Diego Health and Human Services Agency and is led by. the UC San Diego Center for Community Health An important component of the LSE. project s work in 2014 2015 has been partnering with six San Diego County community. healthcare centers CHCs to create more breastfeeding friendly venues for patients. and employees As part of their efforts the LSE project provides support training and. technical assistance to CHCs in ten key areas Electronic Health Records EHRs is one of. the key areas, Beyond the value to direct patient care expanded use of EHRs has the capacity to. inform quality improvement efforts and address larger questions important to. community and population health Given the growing use of EHRs throughout the. healthcare system this project sought to better understand current practices. challenges and opportunities around the inclusion of breastfeeding measures in. outpatient EHRs, We conducted a series of 18 in depth interviews with subject matter experts and key. stakeholders Our sample represents a diverse group affiliated with relevant local and. national agencies and organizations as well as four of the six CHCs that participate in. the LSE project, Discussions with CHC stakeholders largely substantiated the knowledge and opinions. shared by our thought leaders While local CHCs have made the transition to EHRs. there is variability across healthcare centers in EHR vendors and the ways in which. breastfeeding is or is not being measured Breastfeeding data currently obtained is. utilized predominantly for direct patient care or audit purposes other data use. opportunities e g quality improvement are mostly unexplored. Challenges identified by experts and stakeholders to greater inclusion of breastfeeding. measures in the EHR include lack of standardized breastfeeding related definitions and. corresponding measures absence of external mandates for breastfeeding data. healthcare provider concerns and EHR system constraints. Opportunities for improving EHR inclusion of breastfeeding measurement include. establishing a common set of breastfeeding related definitions and a core set of. measures enhancing clinician acceptance by aligning breastfeeding data with quality. improvement and creating a more robust market for breastfeeding data. Based on learnings from expert informants and CHC stakeholders short and longer. range recommendations are proposed, Page 3 of 29, This page was intentionally left blank. Page 4 of 29, Introduction, The Lactation Supportive Environments LSE project aims to increase access to settings.
that encourage breastfeeding initiation and duration Funded by First 5 San Diego LSE is. a project of the County of San Diego Health and Human Services Agency s Healthy. Works program Healthy Works is a cornerstone of the Building Better Health component. of Live Well San Diego the County of San Diego s vision for creating healthy safe and. thriving communities The LSE project is led by the UC San Diego Center for Community. An important component of the LSE project s work in 2014 2015 has been partnering. with six of the County s community healthcare centers CHCs to create more. breastfeeding friendly environments for the families they serve and the employees who. care for those families The collaboration is significant as CHCs are the main providers. of primary care for medically underserved communities and our most vulnerable. individuals While breastfeeding rates differ substantially by race socioeconomic and. other demographic factors breastfeeding can be an effective tool and low cost early. intervention toward reducing health disparities, Using a policy systems and environmental change approach the LSE project provides. support training and technical assistance to CHCs in ten key areas to promote. exclusive breastfeeding of infants until 6 months of age and continued breastfeeding. with appropriate complementary foods for at least 12 months Electronic Health. Records EHRs is one of the ten key areas, Lactation Supportive Environments project. 10 Key Areas for Breastfeeding Friendly Community Healthcare Centers Page 5 of 29. The 2014 report Best Practices Guide for Implementation of Newborn Exclusive Breast. Milk Feeding in Electronic Health Records 1 argues that the movement towards the use. of electronic health records provides many opportunities to optimize the collection of. healthcare delivery data A recent Institute of Medicine workshop Metrics that Matter. for Population Health Action 2 noted that data can be a call to action. Beyond the value to direct patient care expanded use of electronic health records has. the capacity to inform quality improvement efforts and address questions important to. public health maternal and child health In a presentation entitled Electronic Medical. Records and Public Health 3 author Cindy Hinton from the Centers for Disease Control. and Prevention suggests that EHRs can contribute to public health knowledge in the. following ways each directly relevant to breastfeeding and breastfeeding. measurement, Prevalence and incidence of disease, Outcomes and quality of life. Burden of disease and healthcare utilization, Education needs for patient family provider. Guidelines for care, A 2008 study that examined Electronic Health Records in an Outpatient Breastfeeding.
Medicine Clinic4 found no published guidelines on establishing an EHR system for. outpatient lactation clinics Current literature searches reveal no change since the. 2008 publication To date no national professional organization or government agency. has developed a model EHR breastfeeding template or core set of measures. Given the growing use of electronic health records throughout the healthcare system. this project sought to better understand current practices around the inclusion of. breastfeeding measures in outpatient EHRs as well as barriers and opportunities by. conducting a series of exploratory interviews with subject matter experts and local. community healthcare center stakeholders, Page 6 of 29. The Interviews, To plan for the interviews project staff from UC San Diego and the County of San. Diego s Health and Human Services Agency developed a list of organizations and. institutions from which representation was sought along with a list of potential contacts. at each organization The original goal was to interview at least one participant from. each of the six CHCs taking part in the LSE project as well as a number of local and. national thought leaders, Participant invitations were sent via email and included. a description of the project and a request for interview. Three experts approached for an interview declined. A semi structured interview guide, Additionally two informants invited to participate focused the content of each discussion. deferred to a colleague whom they believed more, qualified to address the topics of interest Two of the six Expert informant topics included.
invited CHCs did not complete an interview Perceptions of current EHR use for. breastfeeding measurement, Barriers to greater inclusion of. breastfeeding metrics in EHRs, From July 1 2015 to September 1 2015 we conducted. Breastfeeding measurement and, 18 in depth interviews A semi structured interview guide quality improvement. focused the content of each discussion and was shared Organizational supports for. with participants in advance of their interview breastfeeding measurement. Familiarity with CDC CDPH, Breastfeeding Friendly Clinic. Sixteen interviews were conducted by telephone one in Personal experience with EHRs if. applicable, person and one via email One interviewer L Radecki.
facilitated all interviews each session lasted between CHC Stakeholder topics included. 30 60 minutes All participants except the email, Current breastfeeding data. correspondent were read a standardized introductory collection and reporting EHR and. script at the start of the interview containing information other strategies. about project purpose and confidentiality Prior to the Organizational use of breastfeeding. start of discussion each participant was asked to data. Lactation education and support, verbally affirm their willingness to participate and grant provision documentation and. permission to be audio recorded Several interviewees reporting. agreed to speak only as a subject matter expert rather Breastfeeding measurement and. quality improvement, than as representatives of their institution or. organization Following each interview recordings were. transcribed verbatim for relevant content Transcripts. were analyzed for recurrent themes using Atlas ti, Page 7 of 29. Participants, The 18 individuals interviewed represent a diverse group of subject matter experts.
n 13 affiliated with relevant local and national agencies and organizations as well as. key stakeholders n 5 from CHCs participating in the LSE project The sample included. nine physicians and eight allied health professionals 10 participants were credentialed. as a Certified Lactation Counselor CLC or International Board Certified Lactation. Consultant IBCLC, AAP1 National, Other State AAP Chapter 3. Level project 1 1, Breastfeeding, Friendly Clinic, Expert Informant. Subject Matter Expert, Organizational ASPHN3 1, Affiliations. Association CDC4 3, SDCBC6 1 CDPH5 1, 1 American Academy of Pediatrics. 2 Academy of Breastfeeding Medicine, 3 Association of State and Territorial Public Health Nutrition Directors.
4 Centers for Disease Control and Prevention, 5 California Department of Public Health. 6 San Diego County Breastfeeding Coalition, 7 International Lactation Consultant Association. Page 8 of 29, What We Learned, Because discussion guides were customized with a different set of core questions for. subject matter experts and key stakeholders CHC representatives summary findings. from the interviews are presented separately for each group below beginning with the. expert informants, Expert Informants Subject Matter Experts. State of Breastfeeding Measurement in EHRs, Subject matter experts uniformly agreed in their.
assessment of breastfeeding measurement in outpatient. EHRs describing the current state with words like minimal. extremely limited spotty and nonexistent, Every time that somebody gets EHRs there seems to be a query on AAP or. ABM s listservs asking people for templates none of the major players. have anything pre scripted I m pretty sure that this is for most. people most of us are starting from scratch, when you go into general pediatric clinics I suspect it s more like are. you breastfeeding and if not when did you stop, we ve done some tailoring to get more breastfeeding information and. documentation into the EHR but it s very limited we didn t have access. to a breastfeeding template, Several noted that hospitals may be farther ahead in breastfeeding measurement via. EHR due to Baby Friendly Hospital Initiative requirements. In the hospital admission feeding is a key component of your medical. history especially for a newborn but there s a large gap in collecting the. type of information that we need for breastfeeding in outpatient EHRs. Barriers and Challenges to Greater Inclusion of Breastfeeding Measures in the EHR. Experts cited numerous reasons for the limited presence of breastfeeding measures in. EHRs that can be categorized into the following overarching themes. Lack of standardized definitions and measures, Absence of external mandates for breastfeeding data.
Healthcare provider concerns, EHR system constraints. Page 9 of 29, Lack of Standardized Definitions and Measures. Key informants concurred that a lack of common definitions to describe even the most. basic breastfeeding behaviors and outcomes and the consequent lack of a standard. accepted core set of questions hinders broader adoption of breastfeeding. measurement in EHRs, This is a major challenge We had started with Are you breastfeeding. and we found that that was a very confusing question because it didn t. tell us what the progression of breastfeeding was and then we used. breast bottle or both and that helped but it didn t tell us if the bottle. had breastmilk in it Definitions are a great need, In general collecting breastfeeding information is not consistent unless it s. in the newborn neonatal period, Just to use WIC as an example they grappled with what is the definition.
of partial breastfeeding Is it once a day or half the time they give. formula or is it 75 of the time and we don t always have the ability to. record that much detail It would be nice if there was some national. I think we can particularly with things like amount of breastfeeding and. duration of breastfeeding do a better job of more accurately reflecting. what s going on trying to quantify in a simple language what we re. Breastfeeding Measurement in the Outpatient Electronic Health Record Current Practices and Future Possibilities Report prepared April 2016 for Lactation Supportive Enviornments a project of the County of San Diego Healthy Works program implemented by UC San Diego Center for Community Health with funding from First 5 San Diego

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