Skip to main content

The annual percentage of most or moderately effective contraceptive method users, among postpartum patients ages 15-44, excluding those who did not want to discuss their contraceptive needs

CBE ID
3682e
1.5 Project
Endorsement Status
1.0 New or Maintenance
1.1 Measure Structure
Previous Endorsement Cycle
Is Under Review
Yes
Next Maintenance Cycle
Spring 2025
1.6 Measure Description

Primary Measure - Most and Moderately Effective Contraceptive Provision or Use: Percentage of patients ages 15-44 assigned female at birth with a live birth delivery who received a most or moderately effective contraceptive, or were documented to use a most or moderately effective contraceptive method, in the postpartum period. The primary measure captures new provision as well as current use of most and moderately effective contraceptive methods to accurately capture postpartum contraceptive utilization even if provided in a different calendar year or a different health care site.

 

Sub-Measure - LARC-SINC: Percentage of patients ages 15-44 assigned female at birth with a live birth delivery who received LARC in the postpartum period. The sub-measure captures LARC provision to ensure access to these methods by identifying low provision rates (i.e., below 2%). 

 

For both measures: to focus on the population of postpartum patients interested in contraceptive services, the denominator excludes those individuals who did not receive or have documented use of a method if they indicated through a Self-Identified Need for Contraception screening question (SINC) they did not want these services

Measure Specs
General Information
1.7 Measure Type
1.3 Electronic Clinical Quality Measure (eCQM)
1.8 Level of Analysis
1.9b Other Care Setting
Community Health Center
1.10 Measure Rationale

Supporting postpartum patients to prevent pregnancy when they wish to do so has social and health benefits for individuals and their families (1,2). Achieving people’s reproductive goals depends on being able to achieve or prevent pregnancy when and how they want to (3). However, in 2015, based on National Survey of Family Growth (NSFG) data, only 47.9% of pregnancies were categorized as occurring at the desired time for the individual (4). In order to support patients to achieve their reproductive goals, facilities at which individuals receive their prenatal and postpartum care must ensure that contraceptive needs are assessed and met in the postpartum period. This includes ensuring that the most effective reversible methods of contraception – intrauterine devices (IUDs) and implants – are available in a timely fashion. Multiple commentaries have detailed how the use of performance measures related to contraceptive provision can improve health care quality and promote positive reproductive health outcomes (3–5). The University of California, San Francisco (UCSF) designed Contraceptive Use electronic clinical quality measure (eCQM, CU-SINC), Postpartum (CBE #3682e) to give health care organizations and facilities the opportunity to measure contraceptive use among postpartum patients who want contraceptive services. Specified for use with electronic health record (EHR) system data, CBE #3682e can be calculated in a wide array of health care settings, including systems that do not rely on administrative claims, and thus fills gaps of extant contraceptive provision measures (CBE #2902, #2903, and #2904), that rely on claims data. Specifically, administrative claims data have limitations affecting measure implementation in different care settings as well as assessment of previous contraceptive services received and patient preferences for contraception. The claims-based measures are designed for calculation in service delivery systems with a fee-for-services model. Thus, entities that use prospective payment systems, such as Federally Qualified Health Centers (FQHCs) easily employ CBE #2902, #2903, and #2904 to evaluate contraceptive services quality. Additionally, these measures of contraceptive provision do not always accurately identify which contraceptive method a woman is using following a visit (particularly LARC methods and sterilization, which are not captured in administrative claims if provided prior to the latest health care visit or during a previous measurement period), patient preferences for contraceptive services are not available in administrative data, and the claims-based measures cannot accurately parse which women need or want contraceptive services. 

 

ECQMs offer a way to measure reproductive health care quality by utilizing EHR system data (6). Unlike administrative claims, EHR systems can capture patient need for contraceptive and other health services and are utilized in a wider array of health care settings. To focus the measure on the population of women interested in contraceptive services, CBE #3682e, i.e. CU-SINC, Postpartum uses the Self-Identified Need for Contraception (SINC) data element to remove people who are not interested in contraception from the measure denominator, which helps guard against the possibility of directive or coercive counseling towards contraception that may be an unintentional result of use of a contraceptive use performance measure (7,8). CU-SINC, Postpartum is structured to have a primary measure that is the proportion of those who desire contraception who are documented to have those needs met across all methods. It intentionally includes methods that may have been provided in previous calendar years, such as IUD and implants, and methods provided at other sites, in order to capture an overall assessment of how well people’s needs are being met. Recognizing that there are unique barriers to provision of IUDs and implants, including procedural training, availability of medical equipment, stocking of methods, and implementation of billing practices, the measure includes the Long-Acting Reversible Contraception (LARC) LARC-SINC submeasure that captures provision of these methods at the actual site. Designed as a floor measure, this submeasure assesses whether these methods are available to those who want them.

 

In summary, CU-SINC, Postpartum can be used in settings that cannot use the claims-based contraceptive provision measures and provides improved measurement of whether patient’s postpartum contraceptive needs are being fulfilled. CBE #3682e will inform in quality improvement initiatives that help health care organizations better meet patients’ needs by increasing patient-centered access to contraception, a step towards the goal of reproductive autonomy and well-being for all. Moreover, improvement in the quality of contraceptive care has been shown to improve people’s ability to identify methods that they can use over time and to promote engagement with health care across the reproductive life course, which will improve people’s reproductive outcomes and therefore would also be expected to have a positive impact on health care costs.

 

REFERENCES

1.         Conde-Agudelo A, Rosas-Bermúdez A, Kafury-Goeta AC. Birth Spacing and Risk of Adverse Perinatal Outcomes: A Meta-analysis. JAMA. 2006 Apr 19;295(15):1809. 

2.         Conde-Agudelo A, Rosas-Bermúdez A, Kafury-Goeta AC. Effects of birth spacing on maternal health: a systematic review. American Journal of Obstetrics and Gynecology. 2007 Apr;196(4):297–308. 

3.         Gavin L, Frederiksen B, Robbins C, Pazol K, Moskosky S. New clinical performance measures for contraceptive care: their importance to healthcare quality. Contraception. 2017 Sep;96(3):149–57. 

4.         Gavin LE, Ahrens KA, Dehlendorf C, Frederiksen BN, Decker E, Moskosky S. Future directions in performance measures for contraceptive care: a proposed framework. Contraception. 2017 Sep 1;96(3):138–44. 

5.         Moniz MH, Gavin LE, Dalton VK. Performance Measures for Contraceptive Care: A New Tool to Enhance Access to Contraception. Obstetrics & Gynecology. 2017 Nov;130(5):1121–5. 

6.         Trussell J, Aiken ARA, Micks, E, Guthrie K. Efficacy, safety, and personal considerations. In: Contraceptive Technology. 21st ed. )Ayer Company Publishers, Inc.; 2018. p. 95–128. 

7.         Person-Centered Reproductive Health Program [Internet]. [cited 2024 Jul 18]. Self-Identified Need for Contraception (SINC). Available from: https://pcrhp.ucsf.edu/sinc

8.         Dehlendorf C, Perry JC, Borrero S, Callegari L, Fuentes L, Perritt J. Meeting people’s pregnancy prevention needs: Let’s not force people to state an “Intention.” Contraception. 2024 Jul;135:110400. 

1.20 Types of Data Sources
1.25 Data Source Details

CU-SINC, Postpartum uses electronically extracted data from structured fields within EHR systems, after data are collected from ambulatory, outpatient clinical encounters and entered into EHR structured fields. 

 

We implemented and tested CU-SINC, Postpartum in primary care settings through a quality improvement learning collaborative among federally qualified health centers (FQHCs). All value sets utilized in our measure rely on standardized coding systems and are published on VSAC. 

 

For more information on the feasibility of CU-SINC, Postpartum, see Section 4 Feasibility. To review our reliability and validity analyses methods and results, see Section 5, Scientific Acceptability.