Systematic Preparation of Electronic Health Record Flowsheet Data to Develop Measures of Breastfeeding Intensity and Support During the Postpartum Hospital Stay

Electronic health records (EHR) provide high-volume data about postpartum breastfeeding care. Despite the importance of exclusive breastfeeding as a quality indicator, there is no standardized method for analyzing this data. Following a systematic approach, we applied an EHR preparation framework to flowsheet documentation to evaluate data quality and create indicators of breastfeeding support (number of documented support interactions/expected number of interactions = support ratio) and breastfeeding intensity (number of breastmilk feedings/total feedings). A stepwise framework of (1) data extraction, (2) cohort development, (3) variable compilation, and (4) analysis was applied to data from a single hospital system in Minnesota available through a clinical data repository. In all, 33,285 dyads were included in the analysis. The overall mean support ratio was 2.33; 1.0 indicates the minimum support goal was met. Mean breastfeeding intensity by hospital ranged from 0.62 to 0.90 (0.84 overall). Over 50% of dyads were missing documentation for lactation care indicators, and none had complete data for all indicators. The selected indicators may be used in future research as a standardized method of evaluating breastfeeding support and outcomes during the postpartum hospital stay, and may be adapted for other research where repeated flowsheet measures are used.