Att 8_Scoring Algorithm

Calculation of Item Scores: 2009 Survey of Maternity Practices in Infant Nutrition and Care (mPINC Survey)
Overall Materity Practices Score
Variable name for OVERALL MATERNITY PRACTICES SCORE: Total_score
Labor and Delivery Care Subscore
Measure

Initial skin-to-skin
contact

Initial
breastfeeding
opportunity

Explanation

Reports how many patients experience mother-infant skin-to-skin
contact for at least 30 minutes within 1 hour of uncomplicated
vaginal birth.
Reports how many patients experience mother-infant skin-to-skin
contact for at least 30 minutes within 2 hours for uncomplicated
cesarean birth.
Reports what percent of patients have the opportunity to
breastfeed within 1 hour of uncomplicated vaginal birth

Reports what percent of patients have the opportunity to
breastfeed within 2 hours of uncomplicated cesarean birth.

Mean of the 7 subscale scores.

Item
A5

Scoring algorithm
100=Most
70=Many
30=Some
0=Few

A11

100=Most
70=Many
30=Some
0=Few

A6

100=90%+
70=50-89%
30=10-49%
0=0-9%

A12

100=90%+
70=50-89%
30=10-49%
0=0-9%

Routine
procedures
Reports how often patients have routine infant procedures
A4
performed skin-to- performed while mother and infant are skin-to-skin.
skin
Labor and Delivery Care Subscale Score: LabDel_score
Labor and Delivery Care national percentile: LabDel_natl
Labor and Delivery Care state percentile: LabDel_state

100=Almost Always
70=Often
30=Sometimes
0=Rarely
Mean of the 5 item scores
Percentile rank of all scores in nation
Percentile rank of all scores in state
Percentile rank of all scores among
Labor and Delivery Care size percentile: LabDel_size facilities reporting similar number of births
per year

Feeding of Breastfed Infants
Measure

Explanation

Item

Reports what percent of breastfeeding patients receive breast milk
as their first feeding after uncomplicated vaginal birth.

A7

Initial feeding
received after birth
Reports what percent of breastfeeding patients receive breast milk
as their first feeding after uncomplicated cesarean birth.

Supplementary
feedings

Reports what percent of breastfeeding infants receive non-breast
milk feedings.

A13

A20

Reports whether breastfeeding patients receive glucose water
A21
and/or water.
Feeding of Breastfed Infants Subscale Score: FeedBF_score
Feeding of Breastfed Infants national percentile: FeedBF_natl
Feeding of Breastfed Infants state percentile: FeedBF_state
Feeding of Breastfed Infants size percentile: FeedBF_size

Scoring algorithm
100=90%+
70=50-89%
30=10-49%
0=0-9%
100=90%+
70=50-89%
30=10-49%
0=0-9%
100=0-9%
70=10-49%
30=50-89%
0=90%+
100=Answer to both is No
0=At least one answer is Yes
Mean of the 4 item scores
Percentile rank of all scores in nation
Percentile rank of all scores in state
Percentile rank of all scores among
facilities reporting similar number of births
per year

Breastfeeding Assistance
Measure

Explanation

Documentation of Reports how often infant feeding decisions are documented in
feeding decision hospital records.
Reports how many patients who are breastfeeding or intend to
breastfeed are provided advice and instructions about
breastfeeding.
Breastfeeding
advice &
counseling

Reports how many breastfeeding patients are taught to recognize
and respond to infant feeding cues instead of feeding on a set
schedule.
Reports how often breastfeeding patients receive instructions to
limit suckling at the breast to a specific length of time.

Assessment &
observation of
breastfeeding
sessions

Pacifier use

Item
A3

Scoring algorithm
100=Almost Always
70=Often
30=Sometimes
0=Rarely

A15

100=Most
70=Many
30=Some
0=Few

A16

100=Most
70=Many
30=Some
0=Few

A17

100=Rarely
70=Sometimes
30=Often
0=Almost always

Reports how many breastfeeding patients received a directly
observed breastfeeding assessment by hospital staff.

A18

Reports whether breastfeeding is assessed using a standardized or
adapted assessment tool.

A19

Reports how many breastfeeding patients are given pacifiers by
hospital staff.

A24

Breastfeeding Assistance Score: BFAssist_score
Breastfeeding Assistance national percentile: BFAssist_natl
Breastfeeding Assistance state percentile: BFAssist_state
Breastfeeding Assistance size percentile: BFAssist_size

100=Most
70=Many
30=Some
0=Few
100=Yes
0=No
100=Few
70=Some
30=Many
0=Most
Mean of the 7 item scores.
Percentile rank of all scores in nation
Percentile rank of all scores in state
Percentile rank of all scores among
facilities reporting similar number of births
per year

Contact Between Mother and Infant
Measure

Explanation

Separation of
Reports how many minutes mother-infant patient pairs are
mother & infant separated after uncomplicated vaginal births during the transition
during transition from labor and delivery care to their receiving patient care units.

Item

A08a

Reports how many hours breastfeeding mother-infant patient pairs
are separated at night.

A28

Reports what percent of mother-infant patient pairs room together
≥23 hours per day.

A31

Patient rooming-in

Instances of
mother-infant
separation

Reports the number of reasons that infant patients are removed
from mothers’ rooms. Potential reasons for removal included:
pediatric rounds, change of shift, visiting hours, hearing test, heel
stick, infant photos, infant's bath, mother bathing, mother out of
room. Only "mother bathing" and "mother out of room" were
considered valid reasons for mother-infant separation. Individual
reasons are counted (Few infants removed for the reason=0;
Some/Many/Most infants removed for the reason=1) and then
summed.
Reports how many breastfeeding patients who are not rooming-in
receive their infant from the nursery for breastfeeding at night.

A30

A29

Contact Between Mother and Infant Subscale Score: Contact_score
Contact Between Mother and Infant national percentile: Contact_natl
Contact Between Mother and Infant state percentile: Contact_state
Contact Between Mother and Infant size percentile: Contact_size

Facility Discharge Care
Measure

Assurance of
ambulatory
breastfeeding
support

Explanation

Reports how many modes of post-discharge breastfeeding support
patients are offered. To get credit for the mode, at least one
support strategy within the mode had to be reported. Mode
1=Physical Contact (strategies: home visit, hospital postpartum
followup visit);
Mode 2=Active Reaching Out (strategy: followup phone call to
patient after discharge);
Mode 3=Referrals (strategies: hospital phone number to call,
hospital-based support group, other breastfeeding support group,
lactation consultant/specialist, WIC, outpatient clinic).

Distribution of
"discharge packs" Reports whether breastfeeding patients are given "discharge packs"
containing infant containing product marketing infant formula samples.
formula

Scoring algorithm
100: No separation
90: ≤30
70: 31-60
30: 61-90
0: >90
100: No separation
90: <3
70: 3-<5
30: 5-<8
0: ≥8
100=90%+
70=50-89%
30=10-49%
0=0-9%

100=0
70=1-3
30=4-6
0=7

100=Most or All
70=Many
30=Some
0=Few
Mean of the 5 item scores
Percentile rank of all scores in nation
Percentile rank of all scores in state
Percentile rank of all scores among
facilities reporting similar number of births
per year

Item

Scoring algorithm

A33

100=All 3 modes
90=Modes 1 and 2
75=Modes 1 and 3
65=Mode 1 only
35=Modes 2 and 3
25=Mode 2 only
10=Mode 3 only
0=No modes

A32

100=No
0=Yes

Facility Discharge Care Subscale Score: Dx_score
Facility Discharge Care national percentile: Dx_natl
Facility Discharge Care state percentile: Dx_state

Mean of the 2 item scores
Percentile rank of all scores in nation
Percentile rank of all scores in state
Percentile rank of all scores among
Facility Discharge Care size percentile: Dx_size facilities reporting similar number of births
per year

Staff Training
Measure

Explanation

Preparation of new Reports how many hours of breastfeeding education are received
staff
by new nurses and other birth attendants†.

Reports how many hours of breastfeeding education current nurses
and other birth attendants† received in the past year.
Continuing
education

Competency
assessment

Item

B1

B5

Reports how many nurses and other birth attendants† received any
breastfeeding education in the past year.

B4

Reports how often nurses and other birth attendants† are assessed
for competency in breastfeeding management and support.

B3

Staff Training Subscale Score: Train_score
Staff Training national percentile: Train_natl
Staff Training state percentile: Train_state
Staff Training size percentile: Train_size

Scoring algorithm
100: 18+
75: 8 to 17
50: 4 to 7
25: 1 to 3
0: <1
100: 5+
50: 1 to 4
0: <1
100=Most
70=Many
30=Some
0=Few
100: At least once a year
50: Less than once a year
0: Not assessed
Mean of the 4 item scores
Percentile rank of all scores in nation
Percentile rank of all scores in state
Percentile rank of all scores among
facilities reporting similar number of births
per year

†In free-standing birth centers, these questions were asked among "birth attendants" to accommodate the range of attendants to births in these facilities.

Structural and Organizational Aspects of Care Delivery
Measure
Explanation

Breastfeeding
policy

Reports the number of model written breastfeeding policy
elements in the facility's communication of breastfeeding policy.
Aspects include: a) in-service training; b) prenatal breastfeeding
classes; c) asking about mothers' feeding plans; d) initiating
breastfeeding w/in 60 mins of uncomplicated vaginal birth; e)
initiating breastfeeding after recovery for uncomplicated c-sections;
f) showing mothers how to express milk and maintain lactation if
separated from infant; g) giving only breast milk to breastfed
infants; h) 24 hr / day rooming-in; i) breastfeeding on-demand and
duration and frequency of feedings; j) pacifier use by breastfed
infants; k) referral of mothers with breastfeeding problems; l)
referral of mothers to appropriate community breastfeeding
resources at discharge. Aspects worth 10 points each except: 10
points given for 'd' and/or 'e'; 10 points given for 'k' and/or 'l'.

Reports how staff are informed about breastfeeding policies.
Strategies for informing staff were divided into two modes - "in
person" and "printed / online materials." Strategies categorized as
Communication of being "in person" included: in-service training, new staff
breastfeeding orientation, new staff training, and staff meeting. Strategies
policy
categorized as being "printed / online materials" included: policy is
posted and newsletter. At least one strategy from the mode had to
be reported for the mode to be counted.
Infant feeding
documentation
policy

Employee
breastfeeding
support

Scoring algorithm

B11

100=10
90=9
80=8
70=7
60=6
50=5
40=4
30=3
20=2
10=1
0=0

B12

100=In person & printed/online materials
70=In person only
30=Printed/online materials only
0=None

Reports the hospital’s policy for documentation of patient infant
feeding plans and practices.

C6

Reports how many of 3 critical and 4 additional supports are
provided to lactating staff after returning to work. Critical supports
are: room to express milk [a]; electric breast pump for staff use [c];
permission to use work breaks to express milk [d]). Additional
supports are: on-site child care [b]; breastfeeding support group for
staff [e]; lactation consultant/specialist available for consult [f]; paid
maternity leave other than accrued vacation or sick leave [g]. If yes
to all 3 critical supports: 100. If yes to ≤2 critical supports, 35 points
for each critical support and 5 points for each additional support.
0=no to all supports

B13

Facility receipt of Reports whether the facility receives infant formula free of charge
free infant formula from manufacturers.
Prenatal
breastfeeding
instruction
Coordination of
lactation care

Item

Reports whether breastfeeding is a component of prenatal patient
education opportunities.

100=Any point during or post-stay
25=At admission only
0=No / not sure
100=All 3 critical (with or without any
additional)
90=2 critical, 4 additional
85=2 critical, 3 additional
80=2 critical, 2 additional
75=2 critical, 1 additional
70=2 critical, 0 additional
55=1 critical, 4 additional
50=1 critical, 3 additional
45=1 critical, 2 additional
40=1 critical, 1 additional
35=1 critical, 0 additional
20=0 critical, 4 additional
15=0 critical, 3 additional
10=0 critical, 2 additional
5=0 critical, 1 additional
0=No supports

A25

100=No
0=Yes / Not sure

A01

100=Yes
0=No / Not Sure

100=Yes
0=No
Mean of the 7 item scores
Percentile rank of all scores in nation
Percentile rank of all scores in state
Percentile rank of all scores among
Structural & Organizational size percentile: Struct_size facilities reporting similar number of births
per year

Reports whether the facility has a designated person who oversees
B08
lactation care within the facility.
Structural & Organizational Subscale Score: Struct_score
Structural & Organizational national percentile: Struct_natl
Structural & Organizational state percentile: Struct_state