Overview of the mPINC Scoring Algorithm

mPINC

We sent every hospital and birth center in the United States an mPINC survey and asked that it be completed by the person most knowledgeable about that facility’s maternity care practices. The survey includes a total of 52 questions, of which 33 relate to hospital/birth center practices (Section A); 13 relate to training, personnel, and policy (Section B); and 6 ask about characteristics of the hospital/birth center (Section C). Respondents could complete either a paper or a Web-based version of the questionnaire. Surveys were completed by 2690 facilities (82.0%). A copy of the survey can be found at http://www.cdc.gov/mpinc.

Information About the Derivation of the Scoring Algorithm

First, using the literature, previous similar surveys of maternity care practices (e.g., in Pennsylvania and Oregon),^1,2 and consultation with breastfeeding experts as a guide, we categorized 36 of the items as relating to birth facility characteristics or to one of seven maternity practice subscales (Labor and Delivery Care, Postpartum Breastfeeding Assistance, Contact Between Mother and Infant, Feeding of Breastfed Infants, Facility Discharge Care, Staff Training, and Structural & Organizational Aspects of Care).

The following is a general description of the process used to derive the maternity care practice scores for each facility. More detailed information on the scoring algorithm for each individual item and subscale, as well as for the composite quality practice score, can be found in Scoring Explanation for the 2007 CDC Maternity Practices in Infant Nutrition and Care (mPINC) Survey (PDF-351k).

We began by using the general rules below to assign specific points for facilities’ responses to each item. Exceptions are noted in the detailed scoring algorithm.

1. Categorical Response Options
Response options for most of the items were categorical in nature. For example, question A4 and its response options were as follows:

Approximately how many mothers are encouraged to hold their healthy full-term infants skin-to-skin for at least 30 minutes within an hour of birth for uncomplicated vaginal births?

Few	Some	Many	Most	Not Sure
(0%-9%)	(10%-49%)	(50%-89%)	(90%+)

Another type of categorical response, using the same percentage breakdowns, was:

Rarely	Sometimes	Often	Almost Always	Not Sure
(0%-9%)	(10%-49%)	(50%-89%)	(90%+)

In general, for these types of categorical responses, when a practice was considered to encourage breastfeeding, we assigned the following scoring algorithm:

Few / Rarely = 0; Some/Sometimes = 30; Many / Often = 70; Most / Almost Always=100.

The algorithm was reversed if the practice being asked about was considered detrimental to breastfeeding:

Few / Rarely =100; Some/Sometimes = 70; Many / Often =30; Most / Almost Always=0.

If a facility selected "not sure," "not applicable," or gave no response, that item was usually assigned a value of "missing." When we believed a facility should know the answer to a response, such as with question C5 (Does your facility record [keep track of] the number of mothers breastfeeding?), but none was given or they answered "not sure," we assigned a value of 0.

Sometimes an item score was derived from a combination of responses to multiple components of a question. For example, to create a score for "Separation of mother and newborn during transition to receiving patient care units," an item within the Contact Between Mother and Infant subscale, we combined responses to the first component of question A23 (Following uncomplicated vaginal births, are healthy full-term breastfed infants routinely taken to the nursery or other separate area for transition (e.g., processing as a pediatrics patient, vital signs, first bath?) and the second, follow-up component of A23 (If yes: On average, how long is the infant in this transition period?).

2. Yes / No Response Options
For Yes/No questions, we assigned 100 points to responses that indicated practices that encourage breastfeeding and 0 to responses that indicated practices that discourage breastfeeding. For example, question A29 was coded as follows:

Are discharge packs/bags containing infant formula samples given to breastfeeding mothers?

Yes	No
0	100

3. Lists / Multiple Response Options
When questions had multiple response options and respondents could check more than one option, we either summed up the number of response options, putting this on a 100 point scale, or categorized response options and assigned a certain number of points to these categories. Question A30, listed below, is an example:

What support does your hospital routinely (most of the time) offer to breastfeeding mothers at discharge? (Each response option was to be checked Yes or No or Not Sure)

a. Postpartum telephone call by hospital staff
b. Telephone number for patient to call
c. Postpartum follow-up visit at hospital after discharge
d. Home follow-up visit after discharge
e. Referral to hospital-based breastfeeding support group f. Referral to other breastfeeding support groups
g. Referral to lactation consultant/specialist
h. Referral to WIC (for those eligible)
i. Referral to an outpatient lactation clinic
j. List of resources for breastfeeding help
k. Breastfeeding assessment sheet
l. Other (please specify)_______________

For this question, we created three groups (modes of support) and assigned each item to one of the groups: Physical Contact (c,d), Active Reaching Out (a), and Referrals (b,e,f,g,h,i). Response options "j" and "k" were not included in any of the three groups and were thus scored as 0. The text of the "l" ("Other") responses was reviewed by two research team members and assigned to the appropriate group. The groups were assigned the following points:

Physical Contact = 65 Active Reaching Out = 25 Referrals = 10

If the facility indicated they provided at least one of the Physical Contact strategies, they received 65 points; if they provided support categorized as Active Reaching Out, they received 25 points; and if they provided at least one Referral, they received 10 points. Points for this item were summed across the three categories, forming their item score. For example, if a facility checked "yes" to postpartum telephone call by hospital (a), telephone number for patient to call (b), home follow-up visit after discharge (d), and referral to lactation consultant/ specialist (g), this facility would receive a score of 100 because they had at least one response in each of the modes of support. If more than half of the responses were missing (i.e., in the question above, ≥5 out of the 10 responses), the item was counted as missing and not included in the calculation of the subscale score.

Subscale Scores

To create a subscale score for each of the seven maternity care practice subscales, we obtained an average score by summing the scores for the individual items included under the subscale and dividing by the number of completed items in the subscale. If more than half the items in any subscale were missing, no subscale score was generated for the facility.

Composite Quality Practice Score

To obtain the Composite Quality Practice Score, we summed each of the subscale scores and divided by 7 (or the number of completed subscales). If more than half the subscale scores were missing, no composite score was generated for the facility.

References

¹Crivelli-Kovach A. Hospital breastfeeding policies in the Philadelphia area: a comparison with the Ten Steps to Successful Breastfeeding. Birth 24;41—48, 1997.

²Adler M, Kasehagen LJ, Stull J, Rosenberg KD, Liu J, Crivelli-Kovach A. Breastfeeding support in the newborn hospitalization: results of a survey of Oregon hospitals. Paper presented at American Public Health Association 133rd Annual Meeting: Philadelphia, PA; December 14, 2005.

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Page last reviewed: June 10, 2008
Page last updated: June 10, 2008
Content Source: Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion