ASSESSING THE IMPACT OF HEALTH EQUITY-INFORMED QUALITY IMPROVEMENT ON CONTRACEPTIVE CARE SCREENING, COUNSELING, AND PROVISION

Abstract

Objectives

Improving contraceptive care quality is crucial to optimizing people’s reproductive health and achieving reproductive health equity. We assessed the impact of a health equity-focused quality improvement learning collaborative (QILC) on the quality of contraceptive care at community health centers (CHCs) through innovative, person-centered performance measurement.

Methods

We developed a nine-month QILC comprising monthly learning sessions on reproductive health equity and person-centered contraceptive care, supporting resources and strategies, peer-learning opportunities, and technical assistance. CHCs collected Person-Centered Contraceptive Counseling (PCCC) measure surveys from patients pre-post QILC to assess contraceptive counseling. CHCs implemented a novel health service needs-based contraception screening question, the Self-Identified Need for Contraception (SINC), into their EHRs. EHR data were extracted to calculate standardized electronic clinical quality measures (eCQMs) of contraceptive use. To assess intervention impact, we compared PCCC scores, percentage of eligible patients screened with SINC, and contraceptive use before and after the QILC.

Results

Baseline PCCC scores ranged from 30% to 94%. At endline, 6 of 10 CHCs improved their PCCC score (Δ 2% to 24%) and four of those surpassed the 80% benchmark for high-quality care. At baseline, few patients were screened with SINC (range: <1% - 36%). Across sites, median increase in percentage of eligible patients screened was 10% (range: <1% - 46%). Sites observed an increase in eCQMs for use of most or moderately effective contraceptive methods (mdn change: 2%; range: [<1% -9%).

Conclusions

Participation in an equity-focused and performance measures-driven QILC led to increased person-centered screening for contraceptive need and improved contraceptive counseling.