Statewide quality improvement initiative to implement immediate postpartum long-acting reversible contraception

Area of Science:

• Reproductive Health
• Public Health Initiatives
• Healthcare Quality Improvement

Background:

• Women encounter significant barriers in accessing postpartum care and contraception.
• Tennessee data revealed high rates of unintended (56%) and short-interval (22.7%) pregnancies.
• A majority of women not planning pregnancy were not using contraception.

Purpose of the Study:

• To address unintended and short-interval pregnancies by enhancing access to immediate postpartum long-acting reversible contraception (LARC).
• To implement woman-centered counseling and ensure reimbursement for LARC devices.
• To leverage a policy change allowing TennCare beneficiaries access to immediate postpartum LARC.

Main Methods:

• A statewide quality improvement project involving 6 hospital sites from March 2018 to March 2019.
• Utilized the Institute of Health Improvement Breakout Collaborative model with an evidence-based toolkit.
• Conducted monthly huddles and addressed implementation barriers, including reimbursement challenges.

Main Results:

• Successfully provided 2012 LARC devices to eligible women across participating sites.
• Achieved near-universal offering of immediate postpartum LARC by March 2019.
• Identified and addressed reimbursement issues, which were a major statewide barrier, through dedicated team efforts.

Conclusions:

• Statewide quality improvement projects can effectively increase access to immediate postpartum LARC.
• Successful implementation necessitates dedicated teams, stakeholder coordination, and verified reimbursement.
• Long-term investigation is required to determine the impact on unintended and short-interval pregnancy rates.