ORIGINAL RESEARCH
Christine Dehlendorf, Erin Wingo, Lindsey Gibson, Sonja Goetsch-Avila, Rebecca Kriz, Danielle Hessler
Corresponding Author: Erin Wingo; Department of Family and Community Medicine, School of Medicine, University of California, San Francisco
Email: erin.wingo@ucsf.edu
DOI: 10.3122/jabfm.2025.250073R1
Keywords: Community Health Centers, Contraceptives, Health Equity, Quality Improvement, Quality of Care, Reproductive Health
Dates: Submitted: 02-21-2025; Revised: 05-05-2025; Accepted: 05-19-2025
Status: In production.
OBJECTIVE: Expanding access to high-quality contraceptive care in primary care is key to achieving reproductive health equity. We assessed the impact of an equity-focused quality improvement learning collaborative (QILC) on contraceptive care at community health centers (CHCs) through innovative performance measurement.
METHODS: We developed a nine-month QILC including monthly learning sessions on reproductive health equity and person-centered contraceptive care, supporting resources, peer-learning opportunities, and technical assistance. We assessed QILC impact through three performance measures collected pre-post QILC: the Person-Centered Contraceptive Counseling (PCCC) measure that assesses contraceptive counseling; the Contraceptive Care Screening electronic clinical quality measure (eCQM) (CCS-SINC); and contraceptive use eCQM (CU-SINC). CHCs collected PCCC surveys from patients pre-post QILC, and we extracted electronic health record data to calculate eCQMs. To assess intervention impact, we compared pre-post PCCC scores and eCQM percentages.
RESULTS: Nine CHCs participated in the QILC. Assessing contraceptive care screening, median increase in CCS-SINC was 14.4% (Interquartile range [IQR]: 7.5% - 40.4%) between baseline and endline. CHCs realized an increase in CU-SINC (mdn relative Δ: 4.9%; IQR [3.7% - 22.3%). Compared to baseline, at endline, five of nine CHCs improved their PCCC score (Δ 2.1% to 26.2%) and three of those surpassed the 80% benchmark for high-quality care. Greater improvement in performance measure scores was noted among CHCs with leadership buy-in and lower staff turnover.
CONCLUSIONS: Participation in an equity-focused and measurement-driven QILC led to improvements in person-centered contraceptive care delivery.