Rationale and Study Protocol for the Academy of Nutrition and Dietetics’ Breastfeeding Registry Study

Abstract

Background: Breastfeeding can improve public health and reduce the economic burden associated with illness, hospitalization, and mortality of infants and mothers. Despite the potential for registered dietitian nutritionists (RDNs) to contribute to this area of practice, there are no studies that have analyzed the influence of RDNs on breastfeeding-related health outcomes, such as breastfeeding duration. Objective: The Breastfeeding Registry study aims to describe the nutrition care and health-related outcomes of breastfeeding infants receiving care from RDNs. Design: This is a pilot prospective cohort registry study. Participants: Participants are breastfeeding infants receiving care from RDNs as well as RDNs providing care to enrolled infants. Data collection: RDNs will provide usual care and document for up to 6 months in an electronic Nutrition Care Process database (the Academy of Nutrition and Dietetics Health Informatics Infrastructure). The validated Nutrition Care Process-Quality Evaluation and Standardization Tool will assess documentation quality. RDNs will document initial and follow-up encounters for infants, aiming to analyze documentation from at least 60 infants. RDNs will be surveyed on site characteristics, individual education, training, and professional experience to account for possible confounding. Main outcome measures: The primary health outcome is breastfeeding duration. Secondary outcomes include the frequencies of NCP Terminology documented by NCP step, documentation quality, and rates of nutrition diagnosis resolution and goal attainment. Using the NCP framework, complete NCP cycles that demonstrate improvement in the most prevalent nutrition problems (defined as impactful care plans) will also be presented. Issues: Recruitment challenges and large variability in tracked indicators are anticipated, as is common in registry studies. Training and documentation requirements may limit enrollment.