An eLearning series for staff working in Title X-funded settings: An effort to disseminate national family planning recommendations.

OBJECTIVES: A team of trainers and instructional designers who develop federally funded training for staff working in Title X-funded settings developed an eLearning series of seven modules to support dissemination of Providing Quality Family Planning Services: Recommendations from CDC and the US Office of Population Affairs. QFP outlines how to provide services related preventing and achieving pregnancy. STUDY DESIGN: We evaluated participant reactions and intention to apply what they learned from the eLearning modules. RESULTS: In 2021, 6132 unique individuals completed 12,102 modules, and of those, 5324 unique individuals completed 10,460 evaluations (86% evaluation response rate). Nearly all respondents agreed that the modules were useful (97%), that they would recommend the training to others (96%), and that they were confident in their ability to apply what they learned (97%). More than half (60%) of respondents intended to share information and tools with colleagues and with clients; one in ten (10%) intended to change program practices. CONCLUSIONS: eLearning modules can be an efficient way to disseminate recommendations.

What do Family Planning Staff Prioritize for Patient Experience Improvements? Findings From a Training Initiative in New York State.

It is especially important for providers of sexual and reproductive healthcare services to deliver positive patient experiences, given the personal, preference-driven, and sensitive nature of these services. We facilitated a patient experience training initiative with 8 teams representing family planning agencies in New York State. Teams participated in onsite assessment activities, 4 individualized coaching calls, and 5 group virtual sessions. Teams reported regularly on their progress and changes made. Seven teams (88%) improved clinic flow and 4 teams (50%) increased access to appointments. Five teams (63%) each addressed staff satisfaction and internal communication, and 2 teams (25%) improved their first impressions with patients. Four teams (50%) enhanced the physical environment and 3 teams (38%) improved their website and virtual presence. When engaged in a process to collect data, identify opportunities for improvement, implement changes, and reflect on the progress of those changes-both individually and with peer agencies-all 8 teams successfully implemented system-level changes.

Increasing access to single-visit contraception in urban health care settings: Findings from a multi-site learning collaborative.

OBJECTIVES: Multiple barriers limit access to the full range of contraceptive options. The purpose of this quality improvement initiative was to increase single-visit access to the full range of contraceptive methods in primary care, postabortion, and immediate postpartum settings in New York City (NYC). STUDY DESIGN: From 2015 to 2018 we convened 2 learning collaboratives, named the Quality Improvement Network for Contraceptive Access, with 17 teams (representing 40 sites) from New York City-based hospitals and health centers using an adaptation of the Institute for Healthcare Improvement's Breakthrough Series Learning Collaborative model. Participating teams sought to implement evidence-informed recommendations to increase access. The goal was to increase the patient-centeredness of services by reducing barriers. In the absence of a way to directly measure access, we measured progress toward implementation of the 4 recommendations and contraceptive care utilization measures as proxies for access, and asked teams to describe facilitating factors. RESULTS: Learning collaborative teams successfully implemented all 4 of the recommendations in 95% of the participating sites. Patients who chose and received a most or moderately effective method increased from 22% to 38% in primary care, and from 0% to 17% in the immediate postpartum period. Patients who chose and received a long-acting-reversible contraceptive increased from 5% to 11% in primary care, and from 0% to 3% in immediate postpartum. Facilitating factors included the involvement of interdisciplinary teams, consideration of costs, utilization of peers to demonstrate change, and champions to drive change. CONCLUSIONS: The application of evidence-informed recommendations using a structured quality improvement initiative increases contraceptive access. IMPLICATIONS: This paper identifies key facilitators and factors that influenced the successful implementation of evidence-based recommendations for access to the full range of contraceptive methods in primary care, postabortion, and immediate postpartum settings. Findings can inform future initiatives that seek to increase contraceptive access at the service delivery level, as a component of reproductive autonomy, and contraceptive equity.

Implementation of a Learning Collaborative Model Increases Chlamydia Screening at 37 Family Planning Clinics: Lessons Learned From 3 Cohorts.

BACKGROUND: Chlamydia is the most commonly reported notifiable condition in the United States. Chlamydia disproportionately impacts young women and women of color. Annual screening of sexually active women 24 years and younger is recommended. METHODS: Between 2016 and 2019, we facilitated 3 learning collaboratives to increase chlamydia screening at a combined 37 family planning clinics funded by the Planned Parenthood Federation of America, the Office of Population Affairs in the Department of Health and Human Services, and the New York State Department of Health. We applied a consistent learning collaborative approach across the 3 cohorts. Participating clinics sought to improve the proportion of clients screened for chlamydia each month, implemented a standard set of recommended practices, attended virtual learning sessions, reported updates on quality improvement efforts and chlamydia screening data monthly, and provided qualitative feedback in an online final assessment. RESULTS: Median screening rates increased by 11%, 22%, and 24% in the 3 collaboratives (P values of <0.01, 0.05, and 0.02, respectively). Increases were sustained after the collaboratives ended though the changes did not reach statistical significance. At least 75% of clinics increased screening rates in each collaborative. Clinics reported that adopting normalizing and opt-out language when counseling clients about screening was both feasible and effective, as was reducing missed opportunities for screening. CONCLUSIONS: Learning collaboratives consistently resulted in improvement across 3 cohorts and shed light on barriers and facilitators to screening in family planning settings. Public health practitioners are encouraged to draw on our results and lessons learned to promote screening.

State Laws Related to Billing Third Parties for Health Care Services at Public Sexually Transmitted Disease Clinics in the United States.

BACKGROUND: Health departments (HDs) cite state laws as barriers to billing third parties for sexually transmitted disease (STD) services, but the association between legal/policy barriers and third-party HD billing has not been examined. This study investigates the relationship between laws that may limit HDs' ability to bill, clinic perceptions of billing barriers, and billing practices. METHODS: Two surveys, (1) clinic managers (n = 246), (2) STD program managers (n = 63), conducted via a multiregional needs assessment of federally funded HD clinics' capacity to bill for STD services, billing/reimbursement practices, and perceived barriers were combined with an analysis of state laws regarding third-party billing for STD services. Statistical analyses examined relationships between laws that may limit HDs' ability to bill, clinic perceptions, and billing practices. RESULTS: Clinic managers reported clinics were less likely to bill Medicaid and other third parties in jurisdictions with a state law limiting their ability to bill compared with respondents who billed neither or 1 payer (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.10-0.97) and cited practical concerns as a primary barrier to billing (OR, 2.83; 95% CI, 1.50-5.37). The STD program managers report that the staff believed that STD services should be free (OR, 0.34; 95% CI, 0.13-0.90) was associated with not billing (not sure versus no resistance to billing); confidentiality concerns was not a reported barrier to billing among either sample. CONCLUSIONS: Practical concerns and clinic staff beliefs that STD services should be free emerged as possible barriers to billing, as were laws to a lesser extent. Attempts to initiate HD billing for STD services may benefit from staff education as well as addressing perceived legal barriers and staff concerns.

From theory to application: using performance measures for contraceptive care in the Title X family planning program.

OBJECTIVE: The objective was to describe a Performance Measure Learning Collaborative (PMLC) designed to help Title X family planning grantees use new clinical performance measures for contraceptive care. STUDY DESIGN: Twelve Title X grantee-service site teams participated in an 8-month PMLC from November 2015 to June 2016; baseline was assessed in October 2015. Each team documented their selected best practices and strategies to improve performance, and calculated the contraceptive care performance measures at baseline and for each of the subsequent 8 months. RESULTS: PMLC sites implemented a mix of best practices: (a) ensuring access to a broad range of methods (n=7 sites), (b) supporting women through client-centered counseling and reproductive life planning (n=8 sites), (c) developing systems for same-day provision of all methods (n=10 sites) and (d) utilizing diverse payment options to reduce cost as a barrier (n=4 sites). Ten sites (83%) observed an increase in the clinical performance measures focused on most and moderately effective methods (MME), with a median percent change of 6% for MME (from a median of 73% at baseline to 77% post-PMLC). CONCLUSION: Evidence suggests that the PMLC model is an approach that can be used to improve the quality of contraceptive care offered to clients in some settings. Further replication of the PMLC among other groups and beyond the Title X network will help strengthen the current model through lessons learned. IMPLICATIONS: Using the performance measures in the context of a learning collaborative may be a useful strategy for other programs (e.g., Federally Qualified Health Centers, Medicaid, private health plans) that provide contraceptive care. Expanded use of the measures may help increase access to contraceptive care to achieve national goals for family planning.