CP23 - Quality Improvement Network for Contraceptive Access (QINCA) 2.0: Integrating Reproductive Justice Through a Contraceptive Access Quality Improvement Program

Poster Type: Innovation

Category: Expanding Access to Care and Other Services; Improving Care for Special Populations; Quality of Care and Quality Improvement; Workforce

Issue or Challenge: Access to high-quality, patient-centered contraceptive care is key to supporting individuals’ human right to make informed and autonomous decisions about their reproductive health. However, communities of color, LGBTQ+ and low-income communities frequently report receiving coercive or biased contraceptive counseling and reproductive health care. It is critical that clinical care settings address these inequities by intentionally implementing care practices that center contraceptive choice and reproductive autonomy. To this end, QINCA 2.0 supported NYC-based health care setting in implementing clinical and operational improvements to increase contraceptive access for all, specifically those at highest risk for reproductive coercion and/or discrimination.

Description of Innovation: QINCA 2.0, a 12-month quality improvement learning collaborative (QILC), was launched in 2019 in partnership between the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) and Public Health Solutions (PHS) to improve the quality of contraceptive care in primary care, post-abortion, and postpartum settings in NYC. QINCA 2.0 is based on the Institute for Healthcare Improvement (IHI) Breakthrough Series (BTS) model and guided by the sexual and reproductive justice (SRJ) framework, developed by women of color, which prioritizes individual choice and bodily autonomy within the context of historical events, lived experiences, sexualities, and social conditions.To support site-based improvements in contraceptive care, PHS and NYC DOHMH developed a quality improvement (QI) toolkit, including a set of SRJ-informed best practices called the Four Steps to Contraceptive Access. The Four Steps include assessing contraceptive need, ensuring same-day access, reducing cost as a barrier, and documenting care. QINCA 2.0 also applied a set of SRJ-aligned performance measures adapted from existing validated measures of contraceptive care, including the Person-Centered Contraceptive Counseling (PCCC) measure, that support monitoring of progress across the Four Steps. Throughout the collaborative, participating sites were provided targeted training, coaching and technical assistance on the Four Steps, the SRJ framework, patient-centered care strategies, and fiscal best practices to ensure sustainability of contraceptive care programs. Participating sites tested and implemented improvements using Plan-Do-Study-Act cycles, data collection on key measures, and collaboration with other teams at learning sessions. Following the start of COVID-19, activities were adapted to integrate a telehealth focus.

Impact or Result: Participants improved their setting’s contraceptive care practices through collaborative activities and site-based QI initiatives. Successes included: the introduction of new contraceptive services, integration of SRJ principles into care practices, optimization of contraceptive workflows, and implementation of a contraceptive counseling patient experience survey including the PCCC measure. Additionally, a total of 247 staff across seven health care organizations participated in an introductory training on SRH services and the SRJ framework, among other collaborative trainings.Results of participants’ pre-post self-assessment, which measured implementation of the Four Steps, revealed that average scores among the six completing teams increased by 27%, with the greatest improvements seen in sub-elements related to staff training, on-site stocking of contraceptives, updating policies and procedures, electronic health record (EHR) configuration, and standardized measure reports. Findings from the PCCC measure are inconclusive due to the impact of COVID-19 on service provision and challenges related to data collection from telehealth visits.

Replicating this Innovation: QINCA 2.0 materials are available upon request. Health care organizations can apply the QI framework used in QINCA 2.0 to design and implement similar quality improvements. Review of SRJ literature and engagement of local SRJ experts is foundational to this work and should inform all stages of planning and implementation. QI resources are available to support the application of this model, through IHI for example, and many health care organizations retain QI staff that can guide improvement efforts. Key first steps include assessing current clinical and operational practices, identifying specific areas for improvement, addressing gaps in staff knowledge and skill through training, and establishing infrastructure to support ongoing improvements, such as EHR re-configuration to document care and the adoption of key indicators of contraceptive care quality, including the PCCC measure. Early engagement of senior leadership and establishing a strong improvement team are also critical to the success of QI initiatives.

Author(s):

Julia Keegan, MPH, Collaborative Manager, Sexual and Reproductive Health Capacity Building, Public Health Solutions

Dayana Bermudez, Program Manager, Sexual and Reproductive Health Capacity Building, Public Health Solutions

Hestia Rojas, MPH, Quality Improvement Specialist, Public Health Solutions

Christina Ortiz, MPH, Training Manager, Sexual and Reproductive Health Capacity Building, Public Health Solutions

Allyna Steinberg, MPH, MAmSAT, Deputy Director, Sexual and Reproductive Health (SRH) Initiatives, NYC Department of Health and Mental Hygiene

Lindsey Gibson, MPH, Sexual and Reproductive Health Analyst, NYC Department of Health and Mental Hygiene

Kathryn Iglehart, MPH, Assistant Director, Sexual and Reproductive Health Capacity Building, Public Health Solutions

Joslyn Levy, MPH, President, Joslyn Levy & Associates, LLC

Natalie Tobier, MPH, LCSW, Senior Director, Sexual and Reproductive Health, Public Health Solutions

Kathryn Iglehart MPH

Assistant Director, Sexual and Reproductive Health Capacity Building, Public Health Solutions

Appearances