eCQM Title

Exclusive Human Milk Feeding

CMS ID

eCQM Version Number

15.0.000

CBE Number

Not Applicable

GUID

7d374c6a-3821-4333-a1bc-4531005d77b8

Measurement Period

January 1, 2027 through December 31, 2027

Measure Steward

Joint Commission

Measure Developer

Joint Commission

Endorsed By

None

Description

PC-05 Exclusive human milk feeding during the newborn's entire hospitalization. The measure is reported as an overall rate which includes all newborns that were exclusively fed human milk during the entire hospitalization.

Measure specifications are in the Public Domain. This material contains content from LOINC (http://loinc.org). LOINC is copyright (C) Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license at http://loinc.org/license. LOINC (R) is a registered United States trademark of Regenstrief Institute, Inc.

This material includes SNOMED Clinical Terms (R) (SNOMED CT [R]) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO). All rights reserved. SNOMED CT (R), was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.

Disclaimer

These performance measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.

Measure Scoring

Proportion

Measure Type

Process

Stratification

None

Risk Adjustment

None

Rate Aggregation

None

Rationale

Exclusive human milk feeding for the first 6 months of neonatal life has long been the expressed goal of World Health Organization (WHO), 2007, Department of Health and Human Services (DHHS), American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG). ACOG has recently reiterated its position (ACOG, 2018). A Cochrane review substantiates the benefits (Kramer & Kakuma, 2012). Much evidence has now focused on the prenatal and intrapartum period as critical for the success of exclusive (or any) human milk feeding (Centers for Disease Control and Prevention [CDC], 2020; McGuire, 2014). Exclusive human milk feeding rate during birth hospital stay has been calculated by the California Department of Public Health (2020) for the last several years using newborn genetic disease testing data. Healthy People 2020 (National Center for Health Statistics, 2021) and the CDC have also been active in promoting this goal.

Clinical Recommendation Statement

Exclusive human milk feeding for the first 6 months of neonatal life can result in numerous long-term health benefits for both mother and newborn (Feltner et al.,2018) and is recommended by a number of national and international organizations. Evidence suggests that the prenatal and intrapartum period is critical for the success of exclusive (or any) human milk feeding. Therefore, it is recommended that newborns are fed human milk only from birth to discharge.

Improvement Notation

Increased score indicates improvement

Reference

Reference Type: Citation

Reference Text:

ACOG Committee Opinion No. 756 summary: Optimizing support for breastfeeding as part of obstetric practice. (2018). Obstetrics & Gynecology, 132(4), 1086–1088. https://doi.org/10.1097/AOG.0000000000002891

Reference

Reference Type: Citation

Reference Text:

California Department of Public Health. (2020). In-hospital breastfeeding initiation data: Hospital of occurrence. https://www.cdph.ca.gov/Programs/CFH/DMCAH/Breastfeeding/Pages/Hospital-of-Occurrence-2020.aspx

Reference

Reference Type: Citation

Reference Text:

Centers for Disease Control and Prevention. Division of Nutrition, Physical Activity, and Obesity. (2022). Breastfeeding report card. https://www.cdc.gov/breastfeeding-data/breastfeeding-report-card/?CDC_AAref_Val=https://www.cdc.gov/breastfeeding/data/reportcard.htm

Reference

Reference Type: Citation

Reference Text:

Feltner, C., Weber, R. P., Stuebe, A., Grodensky, C.A., Orr, C., & Viswanathan, M. (2018). Breastfeeding Programs and Policies, Breastfeeding Uptake, and Maternal Health Outcomes in Developed Countries. https://www.ncbi.nlm.nih.gov/books/NBK525106/

Reference

Reference Type: Citation

Reference Text:

Kramer, M. S., & Kakuma, R. (2012). Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews, 2012(8). https://doi.org/10.1002/14651858.cd003517.pub2

Reference

Reference Type: Citation

Reference Text:

McGuire, S. (2014). Centers for Disease Control and Prevention. 2013. Strategies to prevent obesity and other chronic diseases: The CDC guide to strategies to support breastfeeding mothers and babies. Atlanta, GA: U.S. Department of Health and Human Services, 2013. Advances in Nutrition, 5(3), 291–292. https://doi.org/10.3945/an.114.005900

Reference

Reference Type: Citation

Reference Text:

Meek, J.Y., & Noble, L. (2022). Section on Breastfeeding. Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics, 150(1). https://doi.org/10.1542/peds.2022-057988

Reference

Reference Type: Citation

Reference Text:

National Center for Health Statistics. (2021). Healthy People 2020 Final Review. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/healthy_people/hp2020-final-review.htm

Reference

Reference Type: Citation

Reference Text:

World Health Organization. (2007). Indicators for assessing infant and young child feeding practices. World Health Organization. http://apps.who.int/iris/bitstream/handle/10665/43895/9789241596664_eng.pdf

Definition

None

Guidance

A discharge to a designated cancer center or children's hospital should be captured as a discharge to an acute care facility.

Data show that the majority of newborns with gestational age 37 weeks or more have a birth weight 3000 grams or more. Birth weight 3000 grams or more is a proxy to capture term newborns without gestational age recorded in EHR system. Only one birth weight value should be recorded. In cases where there is conflicting data, use the document recording the birth weight closest to the start of encounter.

If dextrose or glucose 40% gel is given, it is considered a medication not a feeding. This should be reflected as such in the newborn's EHR documentation.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

For newborns born in the hospital, the newborn's inpatient encounter begins at birth. Therefore, the inpatient admission date and time must match the newborn's birth date and time.

This version of the eCQM uses QDM version 5.6. Please refer to the eCQI Resource Center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

Transmission Format

TBD

Initial Population

Inpatient hospitalizations for single newborns with a principal diagnosis of a single live born newborn born in the hospital, with a discharge date during the measurement period, and with either of the following conditions:

Gestational age at birth of >= 37 weeks.
Birth weight >= 3000 grams without gestational age at birth.

Denominator

Equals Initial Population

Denominator Exclusions

Inpatient hospitalizations for newborns who were with any of the following conditions:

Admitted/transferred to the Neonatal Intensive Care Unit (NICU) or admitted/transferred to a regular intensive care unit (ICU).
Transferred to an acute care facility, or other health care facility.
Expired during the hospitalization.
A diagnosis of galactosemia.
Subject to parenteral nutrition.

Numerator

Inpatient hospitalizations for newborns who were fed human milk only since birth

Numerator Exclusions

None

Denominator Exceptions

None

Supplemental Data Elements

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Population Criteria
Definitions
Functions
Terminology
Data Criteria (QDM Data Elements)
Supplemental Data Elements
Risk Adjustment Variables

Population Criteria

Initial Population

  PCNewborn."Single Live Term Newborn Encounter"

- Denominator
  - "Initial Population"

Denominator Exclusions

  "Single Live Term Newborn Encounter With NICU Or ICU Admission Or Selected Discharge Disposition"
    union "Single Live Term Newborn Encounter With Galactosemia Or Parenteral Nutrition"

Numerator

  "Single Live Term Newborn Encounter With Newborn Fed Human Milk Only Since Birth"

- Numerator Exclusions
  - None

- Denominator Exceptions
  - None

- Stratification
  - None

Definitions

Denominator
- - "Initial Population"

Denominator Exclusions

  "Single Live Term Newborn Encounter With NICU Or ICU Admission Or Selected Discharge Disposition"
    union "Single Live Term Newborn Encounter With Galactosemia Or Parenteral Nutrition"

Initial Population

  PCNewborn."Single Live Term Newborn Encounter"

Numerator

  "Single Live Term Newborn Encounter With Newborn Fed Human Milk Only Since Birth"

PCNewborn.Single Live Birth Encounter With Birth Weight 3000 Grams Or More Without Gestational Age

  "Single Live Birth Principal Encounter" SingleLiveBornEncounter
    without ["Assessment, Performed": "Gestational age--at birth"] GestationalAge
      such that Global."EarliestOf" ( GestationalAge.relevantDatetime, GestationalAge.relevantPeriod ) during SingleLiveBornEncounter.relevantPeriod
        and GestationalAge.result is not null
    where "FirstBirthWeight"(SingleLiveBornEncounter)>= 3000 'g'

PCNewborn.Single Live Birth Encounter With Gestational Age 37 Weeks Or More

  "Single Live Birth Principal Encounter" SingleLiveBornEncounter
    with ["Assessment, Performed": "Gestational age--at birth"] GestationalAge
      such that GestationalAge.result >= 37 weeks
        and Global."EarliestOf" ( GestationalAge.relevantDatetime, GestationalAge.relevantPeriod ) during SingleLiveBornEncounter.relevantPeriod

PCNewborn.Single Live Birth Principal Encounter

    ["Encounter, Performed":"Encounter Inpatient"] InpatientEncounter
    where exists ( InpatientEncounter.diagnoses EncounterDiagnoses
        where EncounterDiagnoses.code in "Single Live Born Newborn Born in Hospital" 
        and EncounterDiagnoses.rank = 1
    )
      and InpatientEncounter.relevantPeriod ends during day of "Measurement Period"

PCNewborn.Single Live Term Newborn Encounter

  ( "Single Live Birth Encounter With Gestational Age 37 Weeks Or More"
      union "Single Live Birth Encounter With Birth Weight 3000 Grams Or More Without Gestational Age"
  )

SDE Ethnicity

  ["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

  ["Patient Characteristic Payer": "Payer Type"]

SDE Race

  ["Patient Characteristic Race": "Race"]

SDE Sex

  ["Patient Characteristic Sex": "Federal Administrative Sex"]

Single Live Term Newborn Encounter With Galactosemia Or Parenteral Nutrition

  ( PCNewborn."Single Live Term Newborn Encounter" QualifyingEncounter
      with ( ["Procedure, Performed": "Parenteral Nutrition"]
        union ["Medication, Administered": "Total Parenteral Nutrition"] ) ParenteralNutrition
        such that Global."NormalizeInterval" ( ParenteralNutrition.relevantDatetime, ParenteralNutrition.relevantPeriod ) starts during QualifyingEncounter.relevantPeriod
  )
    union ( PCNewborn."Single Live Term Newborn Encounter" QualifyingEncounter
        where exists ( QualifyingEncounter.diagnoses BirthEncounterDiagnoses
            where BirthEncounterDiagnoses.code in "Galactosemia"
        )
    )

Single Live Term Newborn Encounter With Newborn Fed Human Milk Only Since Birth

  PCNewborn."Single Live Term Newborn Encounter" QualifyingEncounter
    with ["Substance, Administered": "Human Milk"] HumanMilkFeeding
      such that Global."NormalizeInterval" ( HumanMilkFeeding.relevantDatetime, HumanMilkFeeding.relevantPeriod ) starts during QualifyingEncounter.relevantPeriod
    without ["Substance, Administered": "Dietary Intake Other than Human Milk"] OtherFeeding
      such that Global."NormalizeInterval" ( OtherFeeding.relevantDatetime, OtherFeeding.relevantPeriod ) starts during QualifyingEncounter.relevantPeriod

Single Live Term Newborn Encounter With NICU Or ICU Admission Or Selected Discharge Disposition

  PCNewborn."Single Live Term Newborn Encounter" QualifyingEncounter
    where exists ( QualifyingEncounter.facilityLocations Location
        where Location.code in "Neonatal Intensive Care Unit"
          or Location.code in "Intensive Care Unit" //in case newborn was transferred to regular Intensive Care Unit for special care.
    
    )
      or QualifyingEncounter.dischargeDisposition in "Patient Expired"
      or QualifyingEncounter.dischargeDisposition in "Discharge To Acute Care Facility"
      or QualifyingEncounter.dischargeDisposition in "Other Health Care Facility"

Functions

Global.Earliest(period Interval<DateTime>)

  if ( HasStart(period)) then start of period 
    else 
  end of period

Global.EarliestOf(pointInTime DateTime, period Interval<DateTime>)
- - Earliest(NormalizeInterval(pointInTime, period))

Global.HasStart(period Interval<DateTime>)

  not ( start of period is null
      or start of period = minimum DateTime
  )

Global.NormalizeInterval(pointInTime DateTime, period Interval<DateTime>)

  if pointInTime is not null then Interval[pointInTime, pointInTime]
    else if period is not null then period 
    else null as Interval<DateTime>

PCNewborn.FirstBirthWeight(Encounter "Encounter, Performed")

  First(["Assessment, Performed": "Birth Weight"] BirthWeight
      where Global."EarliestOf"(BirthWeight.relevantDatetime, BirthWeight.relevantPeriod)during Encounter.relevantPeriod
        and BirthWeight.result is not null
      sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
  ).result as Quantity

Terminology

code "Gestational age--at birth" ("LOINC Code (76516-4)")
valueset "Birth Weight" (2.16.840.1.113762.1.4.1029.194)
valueset "Dietary Intake Other than Human Milk" (2.16.840.1.113883.3.117.1.7.1.27)
valueset "Discharge To Acute Care Facility" (2.16.840.1.113883.3.117.1.7.1.87)
valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "Federal Administrative Sex" (2.16.840.1.113762.1.4.1021.121)
valueset "Galactosemia" (2.16.840.1.113883.3.117.1.7.1.35)
valueset "Human Milk" (2.16.840.1.113883.3.117.1.7.1.30)
valueset "Intensive Care Unit" (2.16.840.1.113762.1.4.1029.206)
valueset "Neonatal Intensive Care Unit" (2.16.840.1.113762.1.4.1029.205)
valueset "Other Health Care Facility" (2.16.840.1.113762.1.4.1029.67)
valueset "Parenteral Nutrition" (2.16.840.1.113883.3.117.1.7.1.38)
valueset "Patient Expired" (2.16.840.1.113883.3.117.1.7.1.309)
valueset "Payer Type" (2.16.840.1.114222.4.11.3591)
valueset "Race" (2.16.840.1.114222.4.11.836)
valueset "Single Live Born Newborn Born in Hospital" (2.16.840.1.113883.3.117.1.7.1.26)
valueset "Total Parenteral Nutrition" (2.16.840.1.113762.1.4.1110.54)

Data Criteria (QDM Data Elements)

"Assessment, Performed: Birth Weight" using "Birth Weight (2.16.840.1.113762.1.4.1029.194)"
"Assessment, Performed: Gestational age--at birth" using "Gestational age--at birth (LOINC Code 76516-4)"
"Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
"Medication, Administered: Total Parenteral Nutrition" using "Total Parenteral Nutrition (2.16.840.1.113762.1.4.1110.54)"
"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
"Patient Characteristic Payer: Payer Type" using "Payer Type (2.16.840.1.114222.4.11.3591)"
"Patient Characteristic Race: Race" using "Race (2.16.840.1.114222.4.11.836)"
"Patient Characteristic Sex: Federal Administrative Sex" using "Federal Administrative Sex (2.16.840.1.113762.1.4.1021.121)"
"Procedure, Performed: Parenteral Nutrition" using "Parenteral Nutrition (2.16.840.1.113883.3.117.1.7.1.38)"
"Substance, Administered: Dietary Intake Other than Human Milk" using "Dietary Intake Other than Human Milk (2.16.840.1.113883.3.117.1.7.1.27)"
"Substance, Administered: Human Milk" using "Human Milk (2.16.840.1.113883.3.117.1.7.1.30)"

Supplemental Data Elements

SDE Ethnicity

  ["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

  ["Patient Characteristic Payer": "Payer Type"]

SDE Race

  ["Patient Characteristic Race": "Race"]

SDE Sex

  ["Patient Characteristic Sex": "Federal Administrative Sex"]

Risk Adjustment Variables

None

Measure Set

eMeasure Perinatal Care (ePC)