The PCCC is a four-item patient-reported outcome performance measure (PRO-PM) designed to assess the patient-centeredness of contraceptive counseling at the individual clinician/provider and facility levels of analysis. Patient-centeredness is an important component in all areas of health care, and is uniquely critical in the personal and intimate process of contraceptive decision-making. The PCCC is intended to provide health care organizations with a tool to measure the quality of interpersonal communication between clinician/provider and patient – a core aspect of patient-centeredness – in the context of contraceptive care specifically.
The PCCC is specifically designed to capture three key domains of contraceptive care quality, as described as high priorities by patients themselves in previous qualitative research conducted by our team [1]. These domains include interpersonal connection between health care provider and patient, support in the contraceptive decision-making process, and adequate information to make such a decision. The four-item PCCC captures the three domains of quality contraceptive quality and retains validity and reliability of the original 11-item scale. Patients are asked to rate how well their individual health care provider did at each of the following, with each item presented on a 5-point Likert scale with responses ranging from 1 (“Poor”) to 5 (“Excellent”):
• Respecting me as a person
• Letting me say what matters to me about my birth control
• Taking my preferences about my birth control seriously
• Giving me enough information to make the best decision about my birth control method
The target population for the PCCC is patients age 15-45, who were assigned female at birth, and who have received contraceptive counseling as part of their recent visit. The PCCC is visit-specific, and is given to patients who have been identified as having received contraceptive counseling during their visit.
An individual provider’s score is determined by the proportion of patients who gave the highest rating for all four question on the survey. Likewise, a facility’s score is calculated as the percentage of facility patients who gave the highest rating for all four questions.
References
[1] Dehlendorf C, Kimport K, Levy K, Steinauer J. A qualitative analysis of approaches to contraceptive counseling. Perspectives on Sexual and Reproductive Health. 2014;46(4):233-240.
Measure Specs
General Information
Numerator
The PCCC is a visit-specific measure of patient-centeredness in contraceptive counseling. It specifically measures how many patients report a top-box (i.e., the highest possible) score of patient experience in their contraceptive counseling interaction with a health care provider during their recent visit.
Denominator
The target population for the PCCC is patients age 15-45, who were assigned female at birth, who are not currently pregnant, and who received contraceptive counseling as part of their recent visit.
Exclusions
Pregnant patients are excluded from the denominator, based on two reasons. First, contraceptive counseling in the context of pregnancy is distinct from that provided to non-pregnant individuals. Specifically, perinatal contraceptive counseling often includes multiple conversations touches over the course of prenatal care and immediate postpartum care. This is appropriate as women, when pregnant, are not immediately at risk of an undesired pregnancy, and therefore there is less time sensitivity to this counseling, and is also consistent with women’s preferences for this care [1]. Given this difference in structure of counseling for pregnant women, the use of a visit-specific measure for contraceptive counseling is not appropriate.
Second, given distinct issues related to post-partum contraceptive use, including increased risk of blood clots, effect on lactation, and the health impact of birth spacing, counseling pregnant women about future contraceptive use has components distinct from that of non-pregnant women. For these conceptual reasons, the PCCC was designed for use with non-pregnant patients and has not been extensively tested with pregnant patients to determine whether it accurately captures their needs and desires for counseling.
References
[1] Yee LM, Farner KC, King E, Simon MA. What do women want? Experiences of low-income women with postpartum contraception and contraceptive counseling. Journal of Pregnancy and Child Health. 2015;2(5).
Public Comments