Standards of care in reproductive health services

Standards of care for all medical services are designed by and for professionals and generally follow medical professional society guidelines. Most managed care organizations rely on professional medical standards of practice, which provide broad guidelines to providers. Family planning agencies, on the other hand, generally follow Title X program guidelines, which provide specific standards of care. The Title X guidelines include detailed instructions about service delivery and program content. The differences between these two sets of standards result in a wide variation in practice guidelines across the spectrum of health care providers. From the patient perspective, evaluation of care is generally not related to professional standards, but instead focuses on quality measures related to access and interpersonal aspects of care. The member satisfaction surveys developed by some managed care organizations now have a large enough sample size to provide meaningful measures of patient satisfaction at the individual provider level. A uniform set of practice guidelines is needed for family planning services that incorporates the strengths of all three approaches and that link performance to generally accepted practice guidelines.