<?xml version="1.0" encoding="UTF-8"?><Measure xmlns="http://hl7.org/fhir"><id value="measure-exclusive-breastfeeding"/><text><status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml"><table class="grid dict"><tr><td><b>Id: </b></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;">Measure/measure-exclusive-breastfeeding</td></tr></table><p/><table class="grid dict"><tr><td><b>Identifier: </b></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;"><b>value: </b><span>exclusive-breastfeeding-measure</span></td></tr></table><p/><table class="grid dict"><tr><td><b>Title: </b></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;">Exclusive Breastfeeding Measure</td></tr></table><p/><table class="grid dict"><tr><td><b>Status: </b></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;">active</td></tr></table><p/><table class="grid dict"><tr><td><b>Description: </b></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;">Exclusive breastfeeding measure of outcomes for exclusive breastmilk feeding of newborns.</td></tr></table><p/><table class="grid dict"><tr><td><b>Purpose: </b></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;">Exclusive breast milk feeding for the first 6 months of neonatal life can result in numerous long-term health benefits for both mother and newborn 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) breast feeding. Therefore, it is recommended that newborns are fed breast milk only from birth to discharge.</td></tr></table><p/><table class="grid dict"><tr><td><b>Topic: </b></td></tr><tr><td style="padding-right: 25px;"><span style="padding-left: 25px;"><b>text: </b><span>Exclusive Breastfeeding</span><br/></span></td></tr></table><p/><table class="grid dict"><tr><td><b>Library: </b></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;"><b>reference: </b><span>Library/library-exclusive-breastfeeding-cqm-logic</span></td></tr></table><p/><table class="grid dict"><tr><td><b>Type: </b></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;">outcome</td></tr></table><p/><table class="grid dict"><tr><td><b>Group:</b></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;"><b>Identifier:</b><br/><span style="padding-left: 25px;"><b>value: </b><span>Population Group 1</span><br/></span></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;"><b>Population:</b><br/><p style="margin-bottom: 5px; padding-left: 25px;"><b>type:</b><span>initial-population</span></p><p style="margin-bottom: 5px; padding-left: 25px;"><b>Identifier:</b><br/><span style="padding-left: 25px;"><b>value: </b><span>initial-population-1-identifier</span><br/></span></p><p style="margin-bottom: 5px; padding-left: 25px;"><b>criteria: </b><span>InitialPopulation1</span></p></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;"><b>Population:</b><br/><p style="margin-bottom: 5px; padding-left: 25px;"><b>type:</b><span>denominator</span></p><p style="margin-bottom: 5px; padding-left: 25px;"><b>Identifier:</b><br/><span style="padding-left: 25px;"><b>value: </b><span>denominator-1-identifier</span><br/></span></p><p style="margin-bottom: 5px; padding-left: 25px;"><b>criteria: </b><span>Denominator1</span></p></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;"><b>Population:</b><br/><p style="margin-bottom: 5px; padding-left: 25px;"><b>type:</b><span>denominator-exclusion</span></p><p style="margin-bottom: 5px; padding-left: 25px;"><b>Identifier:</b><br/><span style="padding-left: 25px;"><b>value: </b><span>denominator-exclusions-1-identifier</span><br/></span></p><p style="margin-bottom: 5px; padding-left: 25px;"><b>criteria: </b><span>DenominatorExclusions1</span></p></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;"><b>Population:</b><br/><p style="margin-bottom: 5px; padding-left: 25px;"><b>type:</b><span>numerator</span></p><p style="margin-bottom: 5px; padding-left: 25px;"><b>Identifier:</b><br/><span style="padding-left: 25px;"><b>value: </b><span>numerator-1-identifier</span><br/></span></p><p style="margin-bottom: 5px; padding-left: 25px;"><b>criteria: </b><span>Numerator1</span></p></td></tr></table><table class="grid dict"><tr><td><b>Group:</b></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;"><b>Identifier:</b><br/><span style="padding-left: 25px;"><b>value: </b><span>Population Group 2</span><br/></span></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;"><b>Population:</b><br/><p style="margin-bottom: 5px; padding-left: 25px;"><b>type:</b><span>initial-population</span></p><p style="margin-bottom: 5px; padding-left: 25px;"><b>Identifier:</b><br/><span style="padding-left: 25px;"><b>value: </b><span>initial-population-2-identifier</span><br/></span></p><p style="margin-bottom: 5px; padding-left: 25px;"><b>criteria: </b><span>InitialPopulation2</span></p></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;"><b>Population:</b><br/><p style="margin-bottom: 5px; padding-left: 25px;"><b>type:</b><span>denominator</span></p><p style="margin-bottom: 5px; padding-left: 25px;"><b>Identifier:</b><br/><span style="padding-left: 25px;"><b>value: </b><span>denominator-2-identifier</span><br/></span></p><p style="margin-bottom: 5px; padding-left: 25px;"><b>criteria: </b><span>Denominator2</span></p></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;"><b>Population:</b><br/><p style="margin-bottom: 5px; padding-left: 25px;"><b>type:</b><span>denominator-exclusion</span></p><p style="margin-bottom: 5px; padding-left: 25px;"><b>Identifier:</b><br/><span style="padding-left: 25px;"><b>value: </b><span>denominator-exclusions-2-identifier</span><br/></span></p><p style="margin-bottom: 5px; padding-left: 25px;"><b>criteria: </b><span>DenominatorExclusions2</span></p></td></tr><tr><td style="padding-left: 25px; padding-right: 25px;"><b>Population:</b><br/><p style="margin-bottom: 5px; padding-left: 25px;"><b>type:</b><span>numerator</span></p><p style="margin-bottom: 5px; padding-left: 25px;"><b>Identifier:</b><br/><span style="padding-left: 25px;"><b>value: </b><span>numerator-2-identifier</span><br/></span></p><p style="margin-bottom: 5px; padding-left: 25px;"><b>criteria: </b><span>Numerator2</span></p></td></tr></table></div></text><identifier><use value="official"/><value value="zKC0mnZ4iZ"/></identifier><version value="4.0.1"/><title value="Exclusive Breastfeeding Measure"/><status value="active"/><date value="2015-03-08"/><description value="Exclusive breastfeeding measure of outcomes for exclusive breastmilk feeding of newborns."/><purpose value="Measure of newborns who were fed breast milk only since birth"/><topic><text value="a3ExM0myO5o16WJb"/></topic><relatedArtifact><type value="documentation"/><citation value="American Academy of Pediatrics. (2005). Section on Breastfeeding. Policy Statement:Breastfeeding and the Use of Human Milk. Pediatrics.115:496-506."/></relatedArtifact><relatedArtifact><type value="documentation"/><citation value="American College of Obstetricians and Gynecologists. (Feb. 2007). Committee on Obstetric Practice and Committee on Health Care for Underserved Women. Breastfeeding: Maternal and Infant Aspects. ACOG Committee Opinion 361."/></relatedArtifact><relatedArtifact><type value="documentation"/><citation value="California Department of Public Health. (2006). Genetic Disease Branch. California In-Hospital Breastfeeding as Indicated on the Newborn Screening Test Form, Statewide, County and Hospital of Occurrence: Available at: http://www.cdph.ca.gov/data/statistics/Pages/BreastfeedingStatistics.aspx."/></relatedArtifact><relatedArtifact><type value="documentation"/><citation value="Centers for Disease Control and Prevention. (Aug 3, 2007). Breastfeeding trends and updated national health objectives for exclusive breastfeeding--United States birth years 2000-2004. MMWR - Morbidity &amp; Mortality Weekly Report. 56(30):760-3."/></relatedArtifact><relatedArtifact><type value="documentation"/><citation value="Centers for Disease Control and Prevention. (2014). Division of Nutrition, Physical Activity and Obesity. Breastfeeding Report Card. Available at: http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf"/></relatedArtifact><relatedArtifact><type value="documentation"/><citation value="Ip, S., Chung, M., Raman, G., et al. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: US Department of Health and Human Services. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf"/></relatedArtifact><relatedArtifact><type value="documentation"/><citation value="Kramer, M.S. &amp; Kakuma, R. (2002).Optimal duration of exclusive breastfeeding. [107 refs] Cochrane Database of Systematic Reviews. (1):CD003517."/></relatedArtifact><relatedArtifact><type value="documentation"/><citation value="Petrova, A., Hegyi, T., &amp; Mehta, R. (2007). Maternal race/ethnicity and one-month exclusive breastfeeding in association with the in-hospital feeding modality. Breastfeeding Medicine. 2(2):92-8."/></relatedArtifact><relatedArtifact><type value="documentation"/><citation value="Shealy, K.R., Li, R., Benton-Davis, S., &amp; Grummer-Strawn, L.M. (2005).The CDC guide to breastfeeding interventions. Atlanta, GA: US Department of Health and Human Services, CDC. Available at: http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf."/></relatedArtifact><relatedArtifact><type value="documentation"/><citation value="Taveras, E.M., Li, R., Grummer-Strawn, L., Richardson, M., Marshall, R., Rego, V.H., Miroshnik, I., &amp; Lieu, T.A. (2004). Opinions and practices of clinicians associated with continuation of exclusive breastfeeding. Pediatrics. 113(4):e283-90."/></relatedArtifact><relatedArtifact><type value="documentation"/><citation value="US Department of Health and Human Services. (2007). Healthy People 2010 Midcourse Review. Washington, DC: US Department of Health and Human Services. Available at: http://www.healthypeople.gov/2010/data/midcourse/?visit=1."/></relatedArtifact><relatedArtifact><type value="documentation"/><citation value="World Health Organization. (1991). Indicators for assessing breastfeeding practices. Geneva, Switzerland: World Health Organization. Available at: http://whqlibdoc.who.int/hq/1991/WHO_CDD_SER_91.14.pdf?ua=1."/></relatedArtifact><relatedArtifact><type value="predecessor"/><resource value="Measure/measure-predecessor-example"/></relatedArtifact><relatedArtifact><type value="derived-from"/><resource value="Measure/measure-predecessor-example"/></relatedArtifact><library value="Library/library-exclusive-breastfeeding-cqm-logic"/><disclaimer value="These performance measures are not clinical guidelines and 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."/><scoring><coding><code value="proportion"/></coding></scoring><type><coding><code value="process"/></coding></type><rationale value="Exclusive breast milk feeding for the first 6 months of neonatal life has long been the expressed goal of World Health Organization (WHO), 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, 2007). A recent Cochrane review substantiates the benefits (Kramer et al., 2002). Much evidence has now focused on the prenatal and intrapartum period as critical for the success of exclusive (or any) BF (Centers for Disease Control and Prevention [CDC], 2007; Petrova et al., 2007; Shealy et al., 2005; Taveras et al., 2004). Exclusive breast milk feeding rate during birth hospital stay has been calculated by the California Department of Public Health for the last several years using newborn genetic disease testing data. Healthy People 2010 and the CDC have also been active in promoting this goal."/><clinicalRecommendationStatement value="Exclusive breast milk feeding for the first 6 months of neonatal life can result in numerous long-term health benefits for both mother and newborn 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) breast feeding. Therefore, it is recommended that newborns are fed breast milk only from birth to discharge."/><improvementNotation><coding><system value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/><code value="increase"/></coding></improvementNotation><definition value="Gestational age is calculated using the ACOG ReVITALize guidelines with Estimated Due Date (EDD) http://www.acog.org/about_acog/acog_departments/patient_safety_and_quality_improvement/~/media/departments/patient%20safety%20and%20quality%20improvement/201213issuesandrationale-gestationalageterm.pdf. The exam used needs to be the most recent exam associated with this pregnancy"/><guidance value="A discharge to a designated cancer center or children's hospital should be captured as a discharge to an acute care facility. It is acceptable to calculate Gestational Age using the American College of Obstetricians and Gynecologists ReVITALize guidelines, which define Gestational Age as calculated using the best obstetrical Estimated Due Date (EDD) based on the formula: Gestational Age= (280-(EDD-Reference Date))/7 where Reference Date is the date on which you are trying to determine gestational age. For PC-05, Reference Date is the Birth Date. Note however that the calculation may yield a non-whole number and gestational age should be rounded off to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks."/><group id="PopulationGroup1"><population><code><coding><code value="initial-population"/></coding></code><criteria><language value="text/cql"/><expression value="InitialPopulation1"/></criteria></population><population><code><coding><code value="denominator"/></coding></code><criteria><language value="text/cql"/><expression value="Denominator1"/></criteria></population><population><code><coding><code value="denominator-exclusions"/></coding></code><criteria><language value="text/cql"/><expression value="DenominatorExclusions1"/></criteria></population><population><code><coding><code value="numerator"/></coding></code><criteria><language value="text/cql"/><expression value="Numerator1"/></criteria></population></group><group id="PopulationGroup2"><population><code><coding><code value="initial-population"/></coding></code><criteria><language value="text/cql"/><expression value="InitialPopulation2"/></criteria></population><population><code><coding><code value="denominator"/></coding></code><criteria><language value="text/cql"/><expression value="Denominator2"/></criteria></population><population><code><coding><code value="denominator-exclusion"/></coding></code><criteria><language value="text/cql"/><expression value="DenominatorExclusions2"/></criteria></population><population><code><coding><code value="numerator"/></coding></code><criteria><language value="text/cql"/><expression value="Numerator2"/></criteria></population></group></Measure>