Advancing Equitable, Person-Centered Contraceptive Care Using Data-Driven Quality Improvement

Expanding access to high-quality contraceptive care in primary care is key to achieving reproductive health equity. We assessed the impact of an equity-focused quality improvement learning collaborative (QILC) on contraceptive care at community health centers (CHCs) through innovative performance measurement.

We developed a 9-month QILC including monthly learning sessions on reproductive health equity and person-centered contraceptive care, supporting resources, peer-learning opportunities, and technical assistance. We assessed QILC impact through 3 performance measures collected prepost QILC: the Person-Centered Contraceptive Counseling (PCCC) measure that assesses contraceptive counseling; the Contraceptive Care Screening electronic clinical quality measure (eCQM) (CCS-SINC); and contraceptive use eCQM (CU-SINC). CHCs collected PCCC surveys from patients prepost QILC, and we extracted electronic health record data to calculate eCQMs. To assess intervention impact, we compared prepost PCCC scores and eCQM percentages.

Nine CHCs participated in the QILC. Assessing contraceptive care screening, median increase in CCS-SINC was 14.4% (Interquartile range [IQR]: 7.5%-40.4%) between baseline and endline. CHCs realized an increase in CU-SINC (median relative Δ: 4.9%; IQR [3.7%-22.3%). Compared with baseline, at endline, 5 of 9 CHCs improved their PCCC score (Δ 2.1% to 26.2%) and 3 of those surpassed the 80% benchmark for high-quality care. Greater improvement in performance measure scores was noted among CHCs with leadership buy-in and lower staff turnover.

Participation in an equity-focused and measurement-driven QILC led to improvements in person-centered contraceptive care delivery.