Breastfeeding Promotion and Support in the Colorado Region of Kaiser Permanente

Colorado Kaiser Permanente (KP) shares the advantages of an integrated medical care system with all of the Kaiser regions. We have the same electronic medical record system and the KP.org website. As a way of promoting health and wellness our providers practice evidence-based medical care, we are active in our contracting hospitals and worksite wellness, and we are moving toward improved provider breastfeeding discussions during medical visits.

As medical providers we are committed to evidence-based practice. We are able to research, develop, and implement clinical care guidelines with our practitioners in the clinics and teams in our contracting hospitals. Colorado KP has our own outpatient clinics, and we contract with hospitals outside of the Kaiser system. This gives us the opportunity to work with and influence various physician and insurance groups. Through these partnerships, Colorado KP physicians have had a substantial impact on hospital practice and routines. And, we have played a pivotal role in newborn hospital care guideline development, including breastfeeding, skin-to-skin, transition care, and care of the late preterm newborn.

Our providers are highly active in hospital multidisciplinary teams that determine care practices. Through our experiences we have found that teams based on the methodology developed at the Dartmouth-Hitchcock Medical Center (Lebanon, NH) that consists of frontline nurses, physicians, nurse assistants, respiratory therapists, and unit secretaries can effect tremendous change. This is an example of the use of this powerful methodology. A multidisciplinary team of the Mother Baby Unit at Exempla Saint Joseph Hospital in Denver, CO, one of our contracting hospitals, was called upon to try to decrease the average length of stay of delivering mothers. Saint Joseph is the largest birthing hospital in the state of Colorado with approximately 5,000 deliveries per year. It was my privilege to work with this team as physician lead. The staff identified processes and behaviors that could be changed and implemented the changes. The variation in days around the national average came down below average, the cost savings was approximately $2.5 million in 11 months, and patient satisfaction increased.

In addition to our work with frontline medical care providers and contracting hospitals, Colorado KP partners with employer groups via numerous worksite wellness programs. KP has a toolkit to help employers support breastfeeding in the workplace. We will also utilize the program recently developed by the Colorado Breastfeeding Coalition to educate employers with Kaiser Insurance about the Colorado state workplace breastfeeding laws.

The Colorado region of KP is developing a comprehensive plan for breastfeeding education and support among our providers and members accenting consistent messages during visits. We share resources (newsletters, web information, DVDs, etc.) with other Kaiser regions, but as evidence has shown, discussions with providers about breastfeeding during prenatal visits, hospital admission, and “well child” visits in the clinics can make a substantial difference in the initiation and duration of breastfeeding. Our coup de grace in the Colorado region is our Perinatal Hospital and Home Care Department. These nurses are all Certified Lactation Consultant or International Board Certified Lactation Consultant trained and visit all mothers and babies at home within the first 3 days after hospital discharge.

KP's commitment to health and wellness and its integrated medical care system is an ideal environment to promote and support breastfeeding.