BORN ONTARIO PROVINCIAL ROUNDS · 2013-2014 2847 93.3 2658 93.6 156 90.2 33 84.6 2014-2015 133 94.3 127 95.5 6 85.7 0 0.0 A Infants exclusively breastfed (or fed human milk - maternal

1

BORN ONTARIO PROVINCIAL ROUNDS

CONTACT US: www.BORNOntario.ca [email protected] @BORNOntario Better Outcomes Registry & Network (BORN) Ontario

Live tweeting! Join the

conversation using

#BORNRounds

The presentation will begin momentarily.

BORN Provincial Rounds: ‘UPDATED’ BFI Statistics Report in the BORN

Information System

BORN Provincial Rounds

September 17th, 2015

Sandra Dunn, Acting Scientific Manager & KT Specialist, BORN Ontario

Linda Young, Lead, BFI Strategy for Ontario

3

Objectives

Describe the BFI Strategy for Ontario

Discuss the reporting requirements for the BFI designation

Outline the development process for revisions to the BFI Statistics Report

Review the components of the ‘updated’ BORN BFI Statistics Report

Review BFI Indicator rates for Ontario – 2014/15 FY

Preview of the new BFI Indicator Status Report – planned launch Oct 7th 2015

Growing a Baby-Friendly Ontario!

Launch of the BFI Statistics Report in BORN

Linda Young

Director, Director Maternal Newborn Child Mental Health,

Interprofessional Practice and Organizational Learning and Lead for the BFI Strategy

http://pcmch.on.ca/

Evidence proves…

Value of exclusive breastfeeding for infant development and maternal and infant health

Value of BFI to enhancing breastfeeding support in hospital

Value of ongoing health care provider support for breastfeeding success

Why Become Baby Friendly?

The World Health

Organization Ten Steps to

Successful Breastfeeding

BFI Implementation

WHO/ UNICEF International

Code of Marketing of

Breastmilk Substitutes.

• Practice standards and policies that enhance the successful

initiation and duration of breastfeeding

• Protect breastfeeding by ensuring that industry marketing of

breastmilk substitutes meets ethics standards.

Written breastfeeding policy

Education and implementation of

breastfeeding policy

Informing on importance and

process of breastfeeding

Skin-to-skin contact for at least an hour

Maintain lactation when separated

from infant

Exclusive breastfeeding for the

first six months 24 hour rooming-in

Baby-led or cue-based breastfeeding

No artificial teats or pacifiers

Transition from hospital to community


BFI Integrated 10 Steps Practice Outcome Indicators

for Hospitals and Community Health Services

MOH Commitment

Providing hospitals and

community health

organizations with training,

tools, guidance and resources

to help achieve World Health

Organization’s BFI designation

and adopt best practices that

meet BFI requirements

BFI Strategy for Ontario

BFI Implementation

• 36 Public Health Units

Current BFI Designated

3 hospitals - TEGH, SJ

Hamilton, Grand River

2 Community Health

Centres

15 Public Health Units

In the Beginning…

• 92 Hospitals

• 55 Community Health Centres

• 10 Aboriginal Health Access

Centres

• 25 NP-led clinics

• 160+ Family Health Teams

• 3 Birthing Centres

• Midwifery Practices

Increase the evidence-based support provided to women who

wish to breastfeed resulting in:

An increase in the number of health care organizations

pursuing BFI designation

An increase in the number of health care organizations

achieving BFI designation

A continuous improvement strategy for BFI designated

organizations to support BFI sustainability

Goals of the BFI Strategy

Increased rate for initiation of breastfeeding

Increased rate of exclusive breastfeeding at discharge from hospital

Decreased non medical supplementation in

hospital

Increased duration of breastfeeding

Increased number of organizations

with BFI designation

Expected Impact

Ultimately, a positive impact on the

health of infants and mothers in Ontario

Supporting

Breastfeeding in the

community


Many Paths

Becoming BFI

Designated Becoming

Baby-Friendly

Implementation Toolkit and workshops

20 Hour Toolkit and Workshops

Patient education materials-3 new resources

Baby Friendly 101 e learning module

Site visits for hospitals

Presentation templates

Micro site for information, resources and

advice

Clearing House

Resources to Help You

Tracking Progress with BFI

Tracking Your Progress

BFI Outcome Indicators

2 areas of change

Revised BORN data elements to match BCC changes

Developed new Born Report for BFI

Indicators now based on all births, not just 37 weeks+

Births by C/S without general anaesthesia

Births by C/S with general anaesthesia

Infants admitted to NICU or similar units

Infants exclusively fed human milk birth to discharge

Infants who received at least one feed not human milk for

documented medical reason

Infants who received at least one feed, not human milk

with no documented medical reason

BFI Breastfeeding Rates –

Hospitals & Birthing Centres

BCC Breastfeeding Rates

Total Births

Breastfed Infants

Exclusively breastfed infants

Non breastfed infants including replacement feeds for medical reasons

Breastfed who received at least one feed non human milk

Supplemented with documented medical reason

Supplemented – no documented medical reason

Growing a Baby -Fr iendly Ontar io !

Let us help you!

Linda Young [email protected]

Kristina Niedra [email protected]

20

BORN Revision Process

21

Collaboration – BORN & BFI Strategy

Implementation Committee Advisory Group

• Goal - ensure BORN data aligned with BFI Strategy to facilitate reporting and support QI

• Data element revisions (April 2015) – Intention to breastfeed

– Newborn feeding from birth to discharge

– Reasons for breast milk substitute

– Infant early attachment and feeding initiation

– Postpartum breastfeeding support

• BFI Statistics Report revisions

• New comparator report – BF Indicator Status Report

22

UPDATED BORN BFI

Statistics Report

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BFI Statistics Report - Details

• Based on the BCC (2012) BFI Integrated 10 Steps Practice Outcome Indicators for Hospitals – Appendix 6.3: Calculation of BF Rates, page 32

• Revised to report on all births – INBORN ONLY

• Stratifies cases – CS with and without general anesthesia,

– Admissions to NICU

– GA groupings (>37, 34-36, <34)

• Source of data – Postpartum Child (PPC) and NICU encounters

– Classifies babies as to feeding status (exclusive BF or supplemented)

24

BFI Statistics Report - Details

• Provides data to track rates over time by: – Fiscal year, quarter or month

• Provides information about missing data – Hotlinks to chart ID

• Includes the following BF Indicators – BF initiation

– BF exclusivity

– Supplementation (with and without medical indications)

– Adjusted BF rate (ABF) • Exclusively BF + those supplemented for medical indications

– Proportion reaching BFI 75% threshold (for exclusive and ABF rates)

25

Accessing the BFI Report

26


27


28

Select the Timeframe & Run

Report

29

Can’t find the report? Check with your local BORN Administrator to ensure you have the correct access permissions (i.e. clinical report access)

30

All live births Live births by gestational age groups

Full term

births

(≥37 weeks

GA)

Late preterm

births

(34-36 weeks

GA)

Preterm births

(<34 weeks

GA) Missing data

Key Criteria n % (col) n % (col) n % (col) n % (col) n % (col)

T Total number of live births 8963 100.0 8368 100.0 484 100.0 111 100.0

2013-2014 3053 34.1 2841 34.0 173 35.7 39 35.1 2014-2015 141 1.6 133 1.6 7 1.4 1 0.9

Births by C-section without general anesthesia 2352 26.2 2143 25.6 162 33.5 47 42.3

2013-2014 825 27.0 746 26.3 62 35.8 17 43.6

2014-2015 45 31.9 42 31.6 3 42.9 0 0.0

Births by C-section with general anesthesia 66 0.7 45 0.5 11 2.3 10 9.0

2013-2014 25 0.8 16 0.6 4 2.3 5 12.8

2014-2015 1 0.7 1 0.8 0 0.0 0 0.0

Infants admitted to NICU or SCN 984 11.0 617 7.4 262 54.1 105 94.6

2013-2014 377 12.3 236 8.3 102 59.0 39 100.0

2014-2015 15 10.6 10 7.5 4 57.1 1 100.0

Baby-Friendly Initiative (BFI) Statistics -

Summary Table

Hospital, Infants born from 01-Apr-2013 to 31-Mar-2015

31


Summary Table


BI Breastfeeding Initiation - Number of babies who receive at least one

breastfeed

8405 93.8 7872 94.1 444 91.7 89 80.2

2013-2014 2847 93.3 2658 93.6 156 90.2 33 84.6

2014-2015 133 94.3 127 95.5 6 85.7 0 0.0 A Infants exclusively breastfed (or fed human milk - maternal or donor milk)

from birth to discharge

6145 68.6 5929 70.9 162 33.5 54 48.6

2013-2014 1969 64.5 1907 67.1 44 25.4 18 46.2 2014-2015 90 63.8 90 67.7 0 0.0 0 0.0

B The number of breastfed infants who received at least one feed other than

human milk (human milk substitute, water, or other fluids with the exception

of medications, or vitamins or mineral drops) in the hospital because of

documented medical reason(s).

863 10.3 668 8.5 176 39.6 19 21.3

2013-2014 298 10.5 249 9.4 49 31.4 0 0.0 2014-2015 22 16.5 20 15.7 2 33.3 0 0.0

C The number of breastfed infants who received at least one feed other than

human milk (human milk substitute, water, or other fluids with the exception

of medications, or vitamins or mineral drops) in the hospital without any

documented medical reason(s).

1221 14.5 1166 14.8 54 12.2 1 1.1

2013-2014 430 15.1 415 15.6 15 9.6 0 0.0 2014-2015 16 12.0 14 11.0 2 33.3 0 0.0

A ≥

75%

The hospital data above indicates that at least 75% of the babies delivered

were exclusively breastfed or fed human milk from birth to discharge (A) by

completed fiscal year

- - - - - -

2013-2014 No - - - - - - 2014-2015 - - - - - - -


Full term

births

(≥37 weeks

GA)

Late preterm

births

(34-36 weeks

GA)

Preterm

births

(<34 weeks

GA)

Missing data


32


Summary Table



Full term

births

(≥37 weeks

GA)

Late preterm

births

(34-36 weeks

GA)

Preterm births

(<34 weeks

GA) Missing data


Adjuste

d BF

(ABF)

Rate

Babies who were exclusively breastfed or fed human milk from birth to

discharge, or if they received any feeds other than human milk, this was

because of documented medical reasons (A+B)

7008 78.2 6597 78.8 338 69.8 73 65.8

2013-2014 2267 74.3 2156 75.9 93 53.8 18 46.2 2014-2015 112 79.4 110 82.7 2 28.6 0 0.0

ABF

Rate ≥

75%

The hospital data above indicates that at least 75% of the babies delivered

were exclusively breastfed or fed human milk from birth to discharge, or if they

received any feeds other than human milk, this was because of documented

medical reasons (A+B) by completed fiscal year

- - - - - -

2013-2014 No - - - - - - 2014-2015 - - - - - - -

Missing - 'newborn feeding from birth to discharge'- missing data from PPC or

NICU

24 0.3 19 0.2 0.0 0.0 5 4.5

Missing - 'reasons for supplementation' 21 0.2 21 0.3 0.0 0.0 0.0 0.0 Missing - 'type of birth' 0.0 0.0 0.0 0.0 Missing - 'anesthesia for C-section ' 0.0 0.0 0.0 0.0

33

A Infants exclusively breastfed (or fed human milk - maternal or donor

milk) from birth to discharge

6145 68.6 5929 70.9 162 33.5 54 48.6

2013-2014 2218 70.7 2140 72.9 56 34.1 22 55.0 Q1 2013-2014 568 73.2 544 75.3 13 35.1 11 64.7 Apr 2013 158 68.1 154 71.0 3 25.0 1 33.3 May 2013 203 76.9 195 78.9 4 33.3 4 80.0 Jun 2013 207 73.9 195 75.6 6 46.2 6 66.7 Q2 2013-2014 596 75.0 574 77.2 21 46.7 1 16.7 Q3 2013-2014 521 65.4 506 67.9 10 21.7 5 83.3 Q4 2013-2014 533 69.2 516 71.4 12 33.3 5 45.5 2014-2015 1969 64.5 1907 67.1 44 25.4 18 46.2 Q1 2014-2015 537 65.9 517 69.3 17 32.7 3 17.6 Apr 2014 166 62.4 159 64.9 7 46.7 0 0.0 May 2014 186 65.3 180 69.5 5 25.0 1 16.7 Jun 2014 185 70.1 178 73.6 5 29.4 2 40.0 Q2 2014-2015 494 65.1 479 67.2 10 26.3 5 62.5 Q3 2014-2015 463 61.7 449 64.9 9 17.3 5 83.3 Q4 2014-2015 475 65.2 462 67.0 8 25.8 5 62.5


Full term

births

(≥37 weeks

GA)

Late preterm

births

(34-36 weeks

GA)

Preterm births

(<34 weeks

GA) Missing data


BFI Summary- Missing data hyperlinked list

All live births

n n % n % n % n n

4,152 2,516 60.6 1,114 26.8 481 11.6 27 14

1,404 829 59.0 383 27.3 176 12.5 9 7

1,371 865 63.1 350 25.5 142 10.4 9 5

325 215 66.2 70 21.5 38 11.7 2 0

369 223 60.4 93 25.2 50 13.6 1 2

321 205 63.9 84 26.2 27 8.4 3 2

356 222 62.4 103 28.9 27 7.6 3 1

126 85 67.5 30 23.8 10 7.9 1 0

103 61 59.2 34 33.0 7 6.8 1 0

127 76 59.8 39 30.7 10 7.9 1 1

1,377 822 59.7 381 27.7 163 11.8 9 2

4,152 2,516 60.6 1,114 26.8 481 11.6 27 14

Report version: v 2.0 ( 10-Jun-2015 )

Although significant effort has been made to ensure the accuracy of the information presented in this report, neither the authors nor BORN Ontario nor any other parties make any

representation or warranties as to the accuracy, reliability or completeness of the information contained herein. The information in this report is not a substitute for clinical

judgment or advice.

Total all hospitals 0.7 0.3

Data source BORN Ontario, 2012-2015

Definition of

indicator

Number and percentage of all live births , distributed by type of feeding from birth to discharge (in a given place and time).

Mar 2014 0.8 0.8

2014-2015 0.7 0.1

Jan 2014 0.8 0.0

Feb 2014 1.0 0.0

Q4 2013-2014 0.8 0.3

Q3 2013-2014 0.9 0.6

Q2 2013-2014 0.3 0.5

2013-2014 0.7 0.4

Q1 2013-2014 0.6 0.0

Total Hospital X 0.7 0.3

2012-2013 0.6 0.5

Other Missing data

Feeding

% %

Definition of

indicator

The distribution of type of infant feeding from birth to discharge, expressed as a percentage of all live births (in a given place and time).

Report version: v 2.0 ( 10-Jun-2015 )

Although significant effort has been made to ensure the accuracy of the information presented in this report, neither the authors nor BORN Ontario nor any other parties make any

representation or warranties as to the accuracy, reliability or completeness of the information contained herein. The information in this report is not a substitute for clinical

judgment or advice.

Distribution of type of infant feeding from birth to discharge, by hospital of birth

Hospital X, Infants born from 01-Apr-2012 to 31-Mar-2015

Breast milk only Combination Breast milk

substitute only

Baby-Friendly Initiative Statistics

Proportion of infant feeding type from birth to discharge, by hospital of birth



n %

863 41.0

448 51.9

1 0.1

54 6.3

384 44.5

3 0.3

1 0.1

1 0.1

5 0.6

3 0.3

7 0.8

1 0.1

1,322 62.8

1,316 99.5

6 0.5

27 1.3

27 100.0

2,104 N/A

Distribution of breast milk substitute for medical or non-medical reasons, by hospital of birth

Hospital, Infants born from 01-Jul-2012 to 06-May-2015

Hospital

All live births

Total infants with Medical reasons for breast milk substitute

Infant Medical - Hypoglycemia

Infant Medical - Inborn Errors of Metabolism

Infant Medical - Significant weight loss in the presence of c linical

Infant Medical - Other c linical indications

Infant Medical - Pre-term (<32 weeks)

Infant Medical - Very low birth weight (<1500gms)

Maternal Medical - Additional Health Concerns

Infant Medical - Very low birth weight (<1500gms) (prior to April 2014)

Maternal Medical - Contraindicated maternal medication

Maternal Medical - Severe maternal illness

Birth mother not involved in care

Total infants with Non-Medical reasons for breast milk substitute

Informed Parent Decision to use any Breast Milk Substitute

Parental Consent not documented

Total infants who are missing data in the 'Reason for Breast Milk Substitute'

Missing data

Definition of

indicator

Number and percentage of all live births and feeding type from birth to discharge was combination, distributed by reason for breast milk substitute (in a given

place and time).

Total live births and feeding type from birth to discharge was combination


2015 version 2.0 of report:---(not crossAggregate Birth data element ,

Denominator:-Data Source for Data element: Aggregate Continuum Rules: Calculated the value for the first born.Filtering/Calculation:

-

-Data Source for Data element: Aggregate Filtering/Calculation: use

-Data Source for Data element: Aggregate Filtering/Calculation: use '(RPT0001)= "Combination"

(notmedical indications [infant medical

Definition of

indicator

The distribution of reasons for breast milk substitution, expressed as a percentage of the total live births (in a given place and time).

Report version: v 2.0 ( xx-May-2015 )


Distribution of breast milk substitute for medical or non-medical reasons, by hospital of birth



Definition of

indicator

The distribution of infant feeding from birth to discharge, by type of birth and parity, expressed as a percentage of the total live births (in a given place and

time).

Report version: v 2.0 ( xx-May-2015 )


Distribution of type of infant feeding from birth to discharge, by type of birth, parity, and hospital of birth

Hospital, 2012-2013


Distribution of type of infant feeding from birth to discharge, by type of birth, parity, and hospital of birth


Hospital

All Live Births

n %

Total Parity >0 5175 57.7

Vaginal 3,764 72.7

Breast milk only 2,813 74.7

Combination 706 18.8

Breast milk substitute only 232 6.2

Other 5 0.1

Missing Data Feeding 8 0.2

Cesarean 1,411 27.3

Breast milk only 732 51.9



Other 11 0.8


Total Parity =0 3786 42.2

Vaginal 2,780 73.4

Breast milk only 2,072 74.5



Other 7 0.3


Cesarean 1,006 26.6




Other 7 0.7


Total Missing data parity 2 0.0

Vaginal 1 50.0

Combination 1 100.0

Cesarean 1 50.0


Total live births 8,963 N/A


Definition of indicator Number and percentage of all live births, distributed by type of infant feeding from birth to discharge, type of birth, and parity (in a given place and time).

39

Breastfeeding Initiation Rates (by hospital [n= 93] and province) FY 2014-15

Ontario Rate

Median Rate

Data Source: BORN Ontario, 2014-2015

DEFINITION: Breastfeeding Initiation - Number of babies who are breastfed (or receive maternal or donor milk) from birth to

discharge

40

Exclusive Breastfeeding Rates (by hospital [n= 93] and province) FY 2014-15


DEFINITION: Number of infants exclusively breastfed (or fed human milk - maternal or donor milk) from birth to discharge

Ontario Rate

Median Rate

41

Supplementation Rates: with documented medical indications (by hospital [n= 93] and province) FY 2014-15


Ontario Rate

Median Rate

DEFINITION: The number of breastfed infants who received at least one feed other than human milk (human milk substitute,

water, or other fluids with the exception of medications, or vitamins or mineral drops) in the hospital because of documented

medical reason(s).

42

Supplementation Rates: NO documented medical indications (by hospital [n= 93] and province) FY 2014-15


Ontario Rate

Median Rate

DEFINITION: The number of breastfed infants who received at least one feed other than human milk (human milk substitute,

water, or other fluids with the exception of medications, or vitamins or mineral drops) in the hospital without any documented

medical reason(s).

43

Overall Supplementation Rates: (by hospital [n= 93]

and province) FY 2014-15

0

10

20

30

40

50

60

70

80

90

100

Ontario

Ove

rall

Sup

ple

me

nta

tio

n R

ate

(%

)

Hospital

Key C

Key B

**Ontario

**

5.6


- NO Medical Indications

- Medical Indications 71.7

35.2

44

Adjusted Breastfeeding Rates (by hospital [n= 93] and province) FY 2014-15


Ontario Rate

Median Rate

DEFINITION: Number of babies who were exclusively breastfed or fed human milk from birth to discharge, or if they received any

feeds other than human milk, this was because of documented medical reasons (A+B) from birth to discharge

NEW BFI Indicator Status Report** Baby-Friendly Initiative Indicator Status Report


Hospital X Other same LOC hospitals Other similar volume of birth

hospitals LHIN Ontario

Key Breastfeeding Indicator n % (col) n % (col)

Hospitals

with

acknowledge

d data

submission

n % (col)

Hospitals

with

acknowledge

d data

submission

n % (col)

Hospitals

with

acknowledge

d data

submission

n % (col)

Hospitals

with

acknowledg

ed data

submission

T Total number of live births

BI Breastfeeding Initiation - Number of babies who receive at least

one breastfeed

A Infants exclusively breastfed (or fed human milk - maternal or

donor milk) from birth to discharge

B The number of breastfed infants who received at least one feed

other than human milk (human milk substitute, water, or other

fluids with the exception of medications, or vitamins or mineral

drops) in the hospital because of documented medical reason(s).

C The number of breastfed infants who received at least one feed

other than human milk (human milk substitute, water, or other

fluids with the exception of medications, or vitamins or mineral

drops) in the hospital without any documented medical

reason(s).

ABF Babies who were exclusively breastfed or fed human milk from

birth to discharge, or if they received any feeds other than

human milk, this was because of documented medical reasons

(A+B)

Missing - 'newborn feeding from birth to discharge'

Missing - 'gestational age '(GA)

Missing - 'reasons for supplementation'

**NOTE: Launch date scheduled for Oct 7th 2015

NEW BFI Indicator Status Report**

Baby-Friendly Initiative Indicator Status Report

Hospital X, Infants born from 01-Apr-2012 to 31-Aug-2015

Hospital X Other same LOC hospitals Other similar volume of

birth hospitals LHIN Ontario

Key Breastfeeding Indicator n % (col) n % (col)

Hospitals

with

acknowledg

ed data

submission

n % (col)

Hospitals

with

acknowledg

ed data

submission

n % (col)

Hospitals

with

acknowledg

ed data

submission

n % (col)

Hospitals

with

acknowled

ged data

submission

T Total number of live births

BI Breastfeeding Initiation - Number of babies who receive at

least one breastfeed

A Infants exclusively breastfed (or fed human milk - maternal

or donor milk) from birth to discharge

Full term births (≥37 weeks' GA)

2012-2013

Q1 2012-2013

Apr 2012

May 2012

Jun 2012

Q2 2012-2013

Q3 2012-2013

Q4 2012-2013

2013-2014

2014-2015

2015-2016

Late preterm births (34-36 weeks' GA)

Preterm births (<34 weeks' GA)

47

Acknowledgements

• BFI Strategy Implementation Committee – Advisory Group: – Linda Young – Lead, BFI Strategy for Ontario

– Kristina Niedra – Project Manager, BFI

– Lucy Gilmore

– Dr. Susan Hayward-Steeves

– Cindy-Lee Dennis

– Jo Watson

– Jackie Barrett

– Marie-Josee Trepanier

– And members of the BFI Strategy Implementation Committee

• Breastfeeding Committee for Canada – Marianne Brophy

– Kathy Ventor

• BORN – Enhancement Team

– BORN Coordinators

– Report Development Team • Sergio Miguel

• Nicole Robert, Geoff Barnum and Monica Prince

• Dan Bedard

– Dapasoft Report Developers • Kathy Xiao & Max Smirnov

48

Questions

Sandy Dunn Acting Scientific Manager & Knowledge

Translation Specialist, BORN

[email protected]

Linda Young Lead, BFI Strategy for Ontario

[email protected]

mailto:[email protected]

mailto:[email protected]

Documents

BORN ONTARIO PROVINCIAL ROUNDS · 2013-2014 2847 93.3 2658 93.6 156 90.2 33 84.6 2014-2015 133 94.3 127 95.5 6 85.7 0 0.0 A Infants exclusively breastfed (or fed human milk - maternal