Team-based Breastfeeding Support: A 6-point Practice Assessment

In a previous blog post, I highlighted the advantages of implementing team-based lactation consultant/primary care breastfeeding support. Now you might be wondering how to implement such support at your practice. In this post, I'll walk you through the first step: assessing your practice.

Start with a needs assessment

By understanding your practice’s culture, patient population, practice and community resources, and financial set-up you will be better equipped to initiate a quality improvement project to implement this practice change.

When considering how to design team-based LC/PCP support you are more likely to succeed if you are meeting the individual needs of your practice.

I recommend starting with assembling information specific to your practice about these six areas:

1. Breastfeeding initiation rate
2. Newborn volume 
3. Breastfeeding rates through the first year
4. Breastfeeding supports at your practice and in your community
5. Provider survey of practice and educational needs and barriers to breastfeeding success for families within your practice
6. Insurance and billing considerations specific to your practice 

We have described this six point practice assessment in our paper which presents a case study of successful implementation of the practice change at a Federally Qualified Health Center from experience gained when implementing team-based LC/PCP support at Senders Pediatrics. 

1. Breastfeeding Initiation

Knowing the initiation rate of breastfeeding for your practice helps identify a starting point. If you have a high breastfeeding initiation rate, your families are interested in breastfeeding and most likely know the key benefits. If initiation is low then prenatal discussions will be an important starting point. Knowing your initiation rate combined with knowledge of supports in your community will help identify if efforts should focus on prenatal education, in-hospital support at the time of delivery, or at the first visit after hospital discharge as our practice implemented.  

2. Newborn Volume

The number of newborns you or your practice sees per month is important for understanding how to budget resources. How many newborns are seen per month and day on average? Given providing extra breastfeeding support takes longer visits, knowing when and how frequently rooms will need to be available is important. This number, along with breastfeeding initiation rate, will help you create a budget on costs and expenses. You'll be able to better decide whether your practice can support a lactation consultant in addition to yourself as the medical provider, or if it makes more sense for you to receive more training as a lactation consultant to individualize this support initially when building the volume. 

3. Breastfeeding Rates

While breastfeeding initiation is critical for understanding the starting point, knowing breastfeeding rates through an infant’s first year helps adjust your practice's quality improvement efforts. Depending on if your practice is already collecting breastfeeding rates or not this step may take the longest to implement. Ideally, your electronic medical record allows you to accurately document if an infant is breastfeeding, formula feeding or doing a mix of both. This is information that should be gathered at each well child visit. If it is not then talk with your IT/EMR point person to see how easily this information can be obtained. If it is not a discrete field, but your practice records the information free form in text, you can start with a chart review. Or, you can take a month and have providers record the breastfeeding status at every well visit for that month, which gives you a rough idea of what percentage of the practice is breastfeeding. The CDC records breastfeeding at 3, 6, and 12 months on a national level. For infant primary care practices, the easiest time points to obtain breastfeeding rates is at the 2, 4, 6, 9 and 12 month well child visits. The decision on when and how to collect breastfeeding rates becomes a balance between practicality and feasibility and ideal. Not having this information does not need to stop your practice improvement efforts but working to establish a means to follow practice breastfeeding rates is important for the long term.

4. Breastfeeding Supports

What support do you and your practice already access? Each community has different support offerings, ranging from hospital and community breastfeeding support groups, to private practice lactation consultants, to WIC (Women Infant and Children program), to La Leche League, to practice or hospital system individual lactation consultant visits. Do your families deliver at BFHI hospitals? Identifying the available supports helps determine if there is availability to partner with others more efficiently or if additional time and training is needed.

5. Provider Survey

Administering a survey to providers in your practice will prompt necessary discussions. You will identify what resources others are using, potential barriers to implementing change, and any needed education. Given medical education is variable, it is important to assess knowledge base and comfort in assisting patients in basic breastfeeding counseling. This helps identify areas of collaboration with lactation consultants and focus topics for future education. 

6. Insurance and Billing

Understanding finances is a reality in creating sustainable practice changes. It is important to not only know about national resources regarding billing, such as the American Academy of Family Physicians (AAFP) article on billing, and Affordable Care Act (ACA) insurance requirements, but also your practice's insurance panel, your state’s Medicaid reimbursements, ability to bill for parent and baby, and licensing considerations for yourself and practitioners. 

~Ann M. Witt, MD, FABM, IBCLC