title: A quality improvement project to increase breast milk use in very low birth weight infants.
abstract: OBJECTIVE
  To evaluate a multihospital collaborative designed to increase breast milk feeding in premature infants.
  
  
  METHODS
  Eleven NICUs in the California Perinatal Quality of Care Collaborative participated in an Institute for Healthcare Improvement-style collaborative to increase NICU breast milk feeding rates. Multiple interventions were recommended with participating sites implementing a self-selected combination of these interventions. Breast milk feeding rates were compared between baseline (October 2008-September 2009), implementation (October 2009-September 2010), and sustainability periods (October 2010-March 2011). Secondary outcome measures included necrotizing enterocolitis (NEC) rates and lengths of stay. California Perinatal Quality of Care Collaborative hospitals not participating in the project served as a control population.
  
  
  RESULTS
  The breast milk feeding rate in the intervention sites improved from baseline (54.6%) to intervention period (61.7%; P = .005) with sustained improvement over 6 months postintervention (64.0%; P = .003). NEC rates decreased from baseline (7.0%) to intervention period (4.3%; P = .022) to sustainability period (2.4%; P < .0001). Length of stay increased during the intervention but returned to baseline levels in the sustainability period. Control hospitals had higher rates of breast milk feeding at baseline (64.2% control vs 54.6% participants, P < .0001), but over the course of the implementation (65.7% vs 61.7%, P = .049) and sustainability periods (67.7% vs 64.0%, P = .199), participants improved to similar rates as the control group.
  
  
  CONCLUSIONS
  Implementation of a breast milk/nutrition change package by an 11-site collaborative resulted in an increase in breast milk feeding and decrease in NEC that was sustained over an 18-month period.
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143-0734, USA. hank45@gmail.com
authors.forename: Henry C
authors.initials: HC
authors.lastname: Lee
authors.forename: Paul S
authors.initials: PS
authors.lastname: Kurtin
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Wight
authors.forename: Kathy
authors.initials: K
authors.lastname: Chance
authors.forename: Tracey
authors.initials: T
authors.lastname: Cucinotta-Fobes
authors.forename: Tara A
authors.initials: TA
authors.lastname: Hanson-Timpson
authors.forename: Courtney C
authors.initials: CC
authors.lastname: Nisbet
authors.forename: William D
authors.initials: WD
authors.lastname: Rhine
authors.forename: Kate
authors.initials: K
authors.lastname: Risingsun
authors.forename: Matthew
authors.initials: M
authors.lastname: Wood
authors.forename: Beate H
authors.initials: BH
authors.lastname: Danielsen
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
mesh_terms: D000328:Adult; D002140:California; D003299:Cooperative Behavior; D020345:Enterocolitis, Necrotizing / Q000517:prevention & control; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008895:Milk, Human; D017063:Outcome Assessment, Health Care; D058996:Quality Improvement