NU58DP007538

Champs National - Background: US breastfeeding rates are lowest among black infants due to institutional racism and poor perinatal care. Breastfeeding-supportive, evidence-based practices equitably applied increase hospital breastfeeding rates, especially in populations at highest risk of not breastfeeding.

Communities and Hospitals Advancing Maternity Practices (CHAMPS) has a track record of improving breastfeeding rates and is the only large US program to have significantly decreased racial inequities in hospital breastfeeding rates. CHAMPS National has substantial support from national and regional collaborators, and will activate a diverse team of interdisciplinary US experts to increase safe, equitable, hospital compliance with the 2018 Ten Steps to Successful Breastfeeding, using innovative approaches and partnerships with external quality assurance and regulating entities.

Purpose: CHAMPS National will enroll, train, and support 100 US hospitals to implement and sustain safe compliance with the Ten Steps using the IHI Breakthrough Series Model for Improvement. The program will integrate organizations representing individuals of color at all levels.

Short-term outcomes:
- 100 hospitals will be enrolled.
- At 50% of hospitals, at least 36% of births will be to African Americans.
- Clinicians will be trained to provide safe, evidence-based, breastfeeding-supportive prenatal and maternity care with cultural humility.
- Clinicians will be trained on QI methodology.

Intermediate outcomes enrolled hospitals will achieve:
- An increase of at least 60 percentage points in rates of skin-to-skin care.
- An increase of at least 60 percentage points in rooming in rates.

Long-term outcomes enrolled hospitals will achieve:
- An increase of at least 10 percentage points in breastfeeding initiation.
- A decrease in the rate of supplemental formula feeding of at least 11 percentage points.
- A decrease in the gap in breastfeeding initiation between black and white dyads of at least 15 percentage points.

Strategies and activities: We will identify target hospitals and regions by reviewing national datasets, and with help from our collaborators. A simple application form will assess candidate hospitals and provide demographics and baseline data. We will retain hospitals and collaborators through a dynamic network of training and events, and will nurture five organically related hubs (ORBS) to represent spheres of influence, perspective, and inclusion. We will train clinicians using evidence-based CHAMPS trainings led by experienced trainers with a focus on safely meeting the Ten Steps, delivered in a way that incorporates principles of adult learning. We will train clinicians in QI methodology. Trainings will always include trainers of color. The curriculum will cover the WHO's 16 competencies as well as safety and QI.

Evaluation: We will collect hospital population baseline data early in the process and annually. Based on successful prior experience, we will collect data on breastfeeding initiation and exclusivity, skin-to-skin care in the first hour of life, and rooming in rates, from the medical record. We will collect compliance data on all Ten Steps using a maternal questionnaire before discharge. Hospitals will submit de-identified, aggregate data monthly overall and by race/ethnicity, and CHAMPS will analyze all data project-wide and at specific sites using run charts. These data will be shared with hospital teams and the CDC.

Conclusion: CHAMPS is the only large-scale US program to have significantly decreased racial inequities in hospital breastfeeding rates. We have countless allies, supporters, and collaborators, and our success has inspired admiration and commitment from a national following in all sectors. CDC funding will allow us to make a national mark, not only on increasing breastfeeding rates and decreasing disparities, but in shaping the course of Ten Steps compliance in the US for decades to come.

Boston Medical Center Corporation

NOT APPLICABLE

93.439 - State Physical Activity and Nutrition (SPAN

CDC Office of Financial Resources (OFR) [HHS - CDC]

National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) [HHS - CDC]

Massachusetts United States

State-Wide

Hospital-based Quality Improvement Collaborative to Improve Maternity Care Practices Supportive of Breastfeeding (CDC-RFA-DP-23-0018)

Amendment Since initial award the total obligations have increased 200% from $2,000,000 to $6,000,000.