{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:07:20Z","timestamp":1791234440498,"version":"4.1.0"},"reference-count":19,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Breastfeeding Medicine"],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To improve access to hospital-grade breast pumps for women with infants in the neonatal intensive care unit (NICU) by reducing delays in pump acquisition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>A quality improvement project using Lean Six Sigma DMAIC (Define\u2013Measure\u2013Analyze\u2013Improve\u2013Control) methodology to identify process gaps and streamline workflows.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting\/Local Problem:<\/jats:title>\n                    <jats:p>Level IV NICU at a large academic medical center in the western United States. Women with private or employer-sponsored insurance experienced acquisition delays and out-of-pocket costs compared with women covered by public assistance programs (e.g., Medi-Cal,\u00a0women, infants, and children [WIC]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients:<\/jats:title>\n                    <jats:p>Baseline cohort included 39 NICU families (April 2023): 12 with private insurance and 27 with public assistance coverage. During the 12-month follow-up period, 200 admissions were recorded. In addition, 47 staff members participated in the study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention\/Measurements:<\/jats:title>\n                    <jats:p>Baseline measures included pump ordering timelines, insurance coverage type, and out-of-pocket costs. Interventions included role clarification, durable medical equipment (DME)\u00a0vendor mapping, standardized communication protocols, staff education, and patient-facing handouts. An onsite WIC pump supply was established. Outcomes were monitored for 12 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>At baseline, 92% (11\/12) of privately insured women paid out of pocket for hospital-grade pumps, with delays of up to 21 days; women with public assistance coverage obtained pumps within 1\u20132 business days. After implementation, out-of-pocket rates declined to less than 5%, and median acquisition time decreased to 3.5 days (range: 1\u20137 days) for privately insured families. Improvements were sustained at 12 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Lean Six Sigma\u2013guided process redesign improved the efficiency and equity of hospital-grade breast pump access in the NICU, reducing delays and financial burden for privately insured families. Persistent payer exclusions highlight insurance-related barriers as a social determinant of lactation support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15568253261466537","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T06:54:47Z","timestamp":1782975287000},"page":"629-635","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Improving Access to Hospital-Grade Breast Pumps for Women with Infants in the Neonatal Intensive Care Unit"],"prefix":"10.1177","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0380-8733","authenticated-orcid":false,"given":"Mina Jasovic","family":"Ognjanovic","sequence":"first","affiliation":[{"name":"Department of Lactation Services, UCLA Ronald Reagan Medical Center, Los Angeles, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2016.11.005"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.3945\/an.116.013193"},{"issue":"33","key":"e_1_3_3_4_1","first-page":"725","article-title":"Racial disparities in access to maternity care practices that support breastfeeding\u2014United States, 2011","volume":"63","author":"Lind JN","year":"2014","unstructured":"3.Lind JN, , Perrine CG, , Li R, et al. Racial disparities in access to maternity care practices that support breastfeeding\u2014United States, 2011. 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