by Marsha Walker
August 02, 2009

The launch of World Breastfeeding Week (August 1–7) is cause enough for celebration, but the recent decision by the Joint Commission to add exclusive breast milk feeding to its list of evidence-based measures has thrilled the breastfeeding community. The decision by the Joint Commission is one that many in the breastfeeding community thought would never come.

Standardization of hospital care began in 1910 when Ernest Codman, MD, proposed an “end result system” calling upon hospitals to track patient care long enough to determine whether treatments were effective. If not, hospitals were responsible for determining why.

In 1951, the American College of Physicians (ACP), the American Hospital Association (AHA), the American Medical Association (AMA), and the Canadian Medical Association (CMA) joined with the ACS to create the Joint Commission on Accreditation of Hospitals, an independent, not-for-profit organization whose primary purpose is to provide voluntary accreditation.

The Joint Commission accredits most US hospitals, and their performance measures have a strong influence on quality improvement priorities that hospitals undertake to maintain their accreditation.

Until recently, breastfeeding was not among the performance measures assessed during the accreditation process. But what was once a dream of the breastfeeding community has now become a reality. The Joint Commission recently announced the addition of exclusive breast milk feeding to its list of core measures.

“In late 2007, the Joint Commission’s Board of Commissioners recommended retiring and replacing the Pregnancy and Related Conditions (PR) measure set with an expanded set of evidenced-based measures. A technical advisory panel (TAP) comprising experts in the perinatal care field was convened in February 2009 to select the replacement set of measures from among those endorsed for national use by the National Quality Forum. This expanded measure set, now referred to as Perinatal Care (PC) comprises the following measures:

• Elective deliveries
• Cesarean sections
• Antenatal steroids
• Health care–associated bloodstream infections in newborns
• Exclusive breast milk feeding

Refinement of measure specifications has begun and will continue through most of 2009. It is anticipated the PC measure set will be available for implementation by the Joint Commission listed vendors by October 1, 2009 to support hospitals’ data collection beginning with April 1, 2010 discharges. If you have any questions about this measure set, please submit your question online.”

Multiple studies here and here have shown that maternity care affects breastfeeding outcomes. This new measure will require hospitals to report the rate of exclusive breast milk feeding among mothers who intend to breastfeed. The measure does not affect women who do not plan to breastfeed.

The 2007 CDC National Survey of Maternity Practices in Infant Nutrition and Care (mPINC) found that hospital practices can significantly affect breastfeeding rates and duration. Data show that giving formula to healthy breastfed infants was common, despite evidence that babies who receive formula in the hospital wean earlier than those who do not. More than half of U.S. mothers wean their babies earlier than intended, a disappointing statistic pointing to poor lactation care and services during the hospital stay. This new performance measure will prompt hospitals to adopt policies that have been shown to improve rates of exclusive breastfeeding and abandon non-evidence based interventions that increase the risk for unnecessary supplementation and premature weaning.