Contraceptive Care Screening eCQM

Percentage of patients assigned female at birth and ages 15-44 who were asked if they wanted to talk about contraception or pregnancy prevention during the measurement period (which is a calendar year); to focus on the preferences of the population of non-postpartum women, the denominator excludes those individuals who are eligible for postpartum contraceptive services during the measurement period.

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The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

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Health care systems and providers play a critical role in supporting patient’s reproductive goals and optimizing their reproductive health. However, competing priorities in healthcare can make it difficult to identify and address patients’ reproductive health needs, particularly in primary care settings. Using a screening tool can help detect these needs and close gaps in care. Unfortunately, many screening questions related to reproductive health, like One Key Question (OKQ) or the Pregnancy Intention Screening Question (PISQ), funnel all reproductive health needs through a single question about pregnancy intention.

This focus on future pregnancy intention is not optimal for assessing need for contraceptive services since it does not capture the immediate needs of individuals, as people who may desire pregnancy in the next year may also desire pregnancy prevention now. In addition, we know that pregnancy intention is not a concept that is universally salient or relevant, and that patients in fact prefer to be asked about which services they want at the time of their visit (Wingo & Dehlendorf, 2024; Dehlendorf, et. al., 2024). Further, patients may want to use contraception for many reasons besides pregnancy prevention, including acne treatment, period pain management, cycle regulation, and gender affirmation.  

The Self-Identified Need for Contraception (SINC) screening question was created to give providers an easy-to-use, patient-centered reproductive health screening tool that reflects patients’ feedback and centers their reproductive autonomy while assessing their needs for contraceptive care.

The Women's Preventive Services Initiative recommends that adolescent and adult women have access to the full range of female-controlled contraceptives to prevent unintended pregnancy and improve birth outcomes.  Contraceptive care should include contraceptive counseling, initiation of contraceptive use, and follow-up care (e.g., management, and evaluation as well as changes to and removal or discontinuation of the contraceptive method). The Women’s Preventive Services Initiative recommends that the full range of female-controlled U.S. Food and Drug Administration-approved contraceptive methods, effective family planning practices, and sterilization procedures be available as part of contraceptive care. Clinicians should consider the cultural and linguistic needs and priorities of each individual, and counseling should be consistent, respectful, affirming, and nonstigmatizing. 

The American College of Obstetricians and Gynecologists makes the following recommendations and conclusions:

Obstetrician–gynecologists (ob-gyns) should intentionally incorporate the reproductive justice framework into contraceptive counseling by:
acknowledging historical and ongoing reproductive mistreatment of people of color and other marginalized individuals whose reproductive desires have been devalued;
recognizing that counselor bias, unconscious or otherwise, can affect care and working to minimize the effect of bias on counseling and care provision; and
prioritizing patients' values, preferences, and lived experiences in the selection or discontinuation of a contraceptive method.

Ob-gyns should adhere to the recommended ethical approach of shared decision making through patient-centered contraceptive counseling.

Increased score indicates improvement

Reference Type: Citation

Reference Text: 'American College of Obstetricians and Gynecologists’ Committee on Health Care for Underserved Women, Contraceptive Equity Expert Work Group, and Committee on Ethics (2022). Patient-Centered Contraceptive Counseling: ACOG Committee Statement Number 1. Obstetrics and gynecology, 139(2), 350–353. https://doi.org/10.1097/AOG.0000000000004659'

Reference Type: Citation

Reference Text: 'Dehlendorf, C., Perry, J. C., Borrero, S., Callegari, L., Fuentes, L., & Perritt, J. (2024). Meeting people's pregnancy prevention needs: Let's not force people to state an "Intention". Contraception, 135, 110400. https://doi.org/10.1016/j.contraception.2024.110400'

Reference Type: Citation

Reference Text: 'Health Resources and Services Administration (2019). Women’s Preventive Services Guidelines. U.S. Department of Health and Human Services. https://www.hrsa.gov/womens-guidelines-2019'

Reference Type: Citation

Reference Text: 'Wingo, E., & Dehlendorf, C. (2024). Lack of pregnancy intention or interest in pregnancy prevention now? How best to screen for desire for contraceptive care. Contraception, 135, 110303. https://doi.org/10.1016/j.contraception.2023.110303'

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Any patient who is asked SINC and whose response to SINC is documented is included in the numerator.  

The postpartum population are not included in this measure in order to allow for measurement of distinct care pathways between those receiving prenatal care and those not receiving prenatal care. This requires excluding those who receive prenatal care at the specified facility, do not experience a pregnancy loss, and have a live birth date or EDD that would make them eligible for postpartum contraception during the measurement period. Patients who have undergone female sterilization are also excluded because they are using permanent contraception. 

The phrasing and format of the SINC Screening question utilized in this eCQM was developed with attention to the long history of reproductive oppression in the United States. From the forced sterilization of Black and Indigenous people of color, to the fervor and explicit promotion of long-acting reversible contraception (LARC) as a “solution” to poverty by public health professionals, we know patients’ desires and wellbeing have not always been at the center of healthcare (Wingo & Dehlendorf, 2024).  Patients have been pressured into making reproductive health decisions that don’t reflect their own desires, particularly for Black, Indigenous, and people of color (BIPOC). Every day, patients bring this history and their lived experiences of reproductive oppression into the exam room.

In developing this question, UCSF PCRHP was intentional in having the explicit goal to center patients’ desires and meet their needs. To meet this goal, our team collaborated with reproductive justice experts to ensure this screening tool centers patients’ autonomy and reproductive health needs and does not replicate systems of oppression.

The SINC Screening question is also a component of the endorsed SINC-Based Contraceptive Care eCQMs for Non-Postpartum and Postpartum populations (CBE #3699e and #3682e) to help providers understand how often they are providing contraception to patients, postpartum and not postpartum, who are interested in talking about contraception at their visits. 

This Contraceptive Care Screening eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

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Patients assigned female at birth aged 15-44 who had a qualifying encounter during the measurement period

Initial Population

1) Had a live birth making them eligible for postpartum contraception: Those who had a prenatal visit in the year prior to the measurement period through the first 9 months of the measurement period (i.e., 1/1/XX-1 through 9/30/XX) with a documented live birth delivery date, or a documented estimated delivery date (EDD) between 3 months prior to the measurement period and 9 months into the measurement period (i.e., 10/1/XX-1 through 9/30/XX), provided that those with EDD only did not have a documented ectopic pregnancy, intrauterine fetal demise, early pregnancy loss, or abortion 
2) Are anatomically infecund: those with documentation of anatomical infecundity due to removal of uterus and/or bilateral ovaries during the year prior to measurement period and through the measurement period (i.e., 1/1/XX-1 through 12/31/XX)
3) Have had female sterilization (e.g., bilateral tubal ligation or bilateral salpingectomy) those with documentation of a bilateral tubal ligation or bilateral salpingectomy for female sterilization in year prior to measurement period and through the measurement period (i.e., 1/1/XX-1 through 12/31/XX)

Of eligible women, those who were asked the SINC question during the measurement period and had at least one documented response

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For every patient evaluated by this measure, supplemental data elements (SDE) are also included: payer, race, ethnicity, and sex. These SDEs are available, but not required for eCQM calculation.