Effectiveness of clinical decision support to enhance delivery of family planning services in primary care settings.

PURPOSE: There is a need to improve delivery of family planning services, including preconception and contraception services, in primary care. We assessed whether a clinician-facing clinical decision support implemented in a family medicine staffed primary care network improved provision of family planning services for reproductive-aged female patients, and differed in effect for certain patients or clinical settings. METHODS: We conducted a pragmatic study with difference-in-differences design to estimate, at the visit-level, the clinical decision support's effect on documenting the provision of family planning services 52 weeks prior to and after implementation. We also used logistic regression with a sample subset to evaluate intervention effect on the patient-level. RESULTS: 27,817 eligible patients made 91,185 visits during the study period. Overall, unadjusted documentation of family planning services increased by 2.7 percentage points (55.7% pre-intervention to 58.4% intervention). In the adjusted analysis, documentation increased by 3.4 percentage points (95% CI: 2.24, 4.63). The intervention effect varied across sites at the visit-level, ranging from a -1.2 to +6.5 percentage point change. Modification of effect by race, insurance, and site were substantial, but not by age group nor ethnicity. Additionally, patient-level subset analysis showed that those exposed to the intervention had 1.26 times the odds of having family planning services documented after implementation compared to controls (95% CI: 1.17, 1.36). CONCLUSIONS: This clinical decision support modestly improved documentation of family planning services in our primary care network; effect varied across sites. IMPLICATIONS: Integrating a family planning services clinical decision support into the electronic medical record at primary care sites may increase the provision of preconception and/or contraception services for women of reproductive age. Further study should explore intervention effect at sites with lower initial provision of family planning services.

Feasibility study of family planning services screening as clinical decision support at an urban Federally Qualified Health Center network.

OBJECTIVE: The objective was to assess the feasibility of an intervention introducing family planning services screening clinical decision support to improve provision of contraception and/or preconception services for women of reproductive age in our primary care Federally Qualified Health Center (FQHC) network. STUDY DESIGN: We implemented a family planning services screening prompt for support staff to ask women 13-44 years at nonobstetric visits at specified time intervals. The response was displayed in the electronic medical record for the provider to review, linked to a documentation tool. We evaluated staff comfort with the screening before and after rollout at all seven FQHC sites. At the pilot site, we examined implementation feasibility by assessing screening rate and the outcome measure of family planning (contraception and/or preconception) documentation during visits by women 13-44 years before and during the intervention's first year. RESULTS: At baseline, support staff reported high level of comfort (60% very, 25% somewhat) in asking the family planning services screening question; this increased to 80% reporting they were "very comfortable" in the postsurvey (p = <.01). From mid-December 2016-mid-January 2018, the screening question was displayed for 1503 visits at the pilot site, of which 96% had a documented response. Family planning documentation rate at the pilot site showed a 6% increase from 64% during the preintervention period to 70% during the 13-month intervention period (p<.01). Time series analysis demonstrated more positive upward trend attributed to the intervention period (intervention R2=0.15 vs. preintervention R2=0.01). CONCLUSION: Our study demonstrated high staff acceptability of the intervention at all sites and a high screening rate with a significant increase in family planning documentation rate at the pilot site during the intervention period. This suggests that this family planning services screening decision support intervention is feasible in an FQHC setting. IMPLICATIONS: Implementation of a family planning services screening decision support intervention is feasible in an FQHC setting. Further evaluation of performance at multiple sites, accounting for variable site characteristics, is needed.