Construction of quality-assured infant feeding process of care data repositories: definition and design (Part 1)

Abstract

This is the first paper of a series of two regarding the construction of data quality (DQ) assured repositories for the reuse of information on infant feeding from birth until two years old. This first paper justifies the need for such repositories and describes the design of a process to construct them from Electronic Health Records (EHR). As a result, Part 1 proposes a computational process to obtain quality-assured datasets represented by a canonical structure extracted from raw data from multiple EHR. For this, 13 steps were defined to ensure the harmonization, standardization, completion, de-duplication, and consistency of the dataset content. Moreover, the quality of the input and output data for each of these steps is controlled according to eight DQ dimensions: predictive value, correctness, duplication, consistency, completeness, contextualization, temporal-stability and spatial-stability. The second paper of the series will describe the application of this computational process to construct the first quality-assured repository for the reuse of information on infant feeding in the perinatal period aimed at the monitoring of clinical activities and research.

Introduction

The World Health Organization defines breastfeeding as the natural and healthiest way of feeding infants and young children. Exclusive breastfeeding is recommended for the first six months of life, while an adequate complementary feeding is recommended up to two years or older [1]. Currently, breastfeeding is considered one of the main determinants of maternal and child health. Having related to the prevention of risk factors for chronic diseases of childhood and preventable burden of disease [2]. However, European data show that less than 20% of babies are fed following these recommendations [3].

Given the significant health implications of these low rates, the European strategy for the protection, promotion and support of breastfeeding [4] proposes, among other actions, the widespread deployment of the Baby Friendly Hospital Initiative (BFHI), using global and coordinated actions, along with the development of control mechanisms that may facilitate its implementation. Nevertheless, the absence of these control mechanisms is the main cause of the existing gap between the evidence and the daily clinical practice [5].

In the “Virgen del Castillo” Hospital, the international guidelines described above materialized through an intervention in the improvement of the quality of maternal and child care, which allowed its accreditation as a baby friendly hospital and produced significant improvements in breastfeeding rates [6]. However, the sustainability of such interventions depends on the continuous adaptation to the local context and its systematic inclusion in routine workflows [7]. Thus the improvement group design the process of care of infant feeding (PCIF) (PIEMCA08/13 project) extending the scope to primary care to match the clinical practice from birth until two years of age to the recommendations of the evidence.

For monitoring the clinical process and activating research studies on the PCIF, it was decided to use population data from the Electronic Health Records (EHR) through the construction of a quality-assured data repository. Hence, the aim of the present work is to design the process to construct repositories on birth and infant feeding based on population data from the EHR. The construction process has been implemented by means of 13 quality-assured procedures to assess, recover or filter clinical data to enable their reuse in the monitoring of the PCIF and to study relevant questions on infant feeding.