The National Quality Forum has endorsed – for the first time – a set of quality measures related to the prescribing of contraception.
The three new measures are intended to help reduce unintended pregnancies by ensuring that women aged 15-44 years are offered effective birth control options.
“[We] felt strongly that we needed to take a broader look at reproductive health and think about care even before someone was pregnant,” Helen Burstin, MD , the National Quality Forum’s (NQF) chief scientific officer, said in an interview. “That logically led us to thinking about what could come forward that would be useful, specifically around contraception. [We were] pleased to see this wider array of measures coming forward this round that weren’t as focused specifically on pregnancy and perinatal outcomes.”
Measure 2903 assesses the percentage of women at risk for unintended pregnancy who are provided a method of contraception considered either “most effective,” such as sterilization, implants, or an intrauterine device (IUD), or “moderately effective,” including oral contraceptives, injectables, the patch, the ring, or a diaphragm. The goal of the new measure is not for physicians to achieve 100% prescribing of methods in these categories as women may choose other, less effective methods. The goal is improvement over time, according to the NQF report on the measures.
Measure 2904 assesses the percentage of women aged 15-44 years at risk of an unintended pregnancy who receive a long-acting reversible contraceptive (LARC). The measure is intended to identify situations in which women do not have access to LARCs. The availability of LARCs varies depending on insurance coverage and availability of trained providers, according to NQF. “The measure encourages health systems to look at reporting units with very low rates of provision of LARC to identify unnecessary barriers to LARCs,” the report states. The measure does not include a target percentage for access to LARCs.
Measure 2902 is related to the postpartum period and assesses the percentage of women aged 15-44 years who have had a live birth and are provided a “most effective” or “moderately effective” method of contraception within 3 and 60 days of delivery, and the percentage of those provided with a LARC in the same time period after giving birth. “Contraceptive care for postpartum women is important to facilitate birth spacing, and this measure identifies women more clearly at risk for pregnancy,” the report states.
At the end of 2016, the NQF endorsed a total of 18 perinatal and reproductive health measures that also included measures related to chlamydia screening, labor and delivery, care of premature neonates, and postpartum care. NQF-endorsed measures are frequently used in federal public reporting and performance-based payment programs, including by Medicaid. They are also used in the private sector by hospitals and health plans.
The measures are a good foundation for understanding how women are accessing and using contraception, said Nikki Zite, MD , a professor and director of the obstetrics and gynecology residency program at the University of Tennessee, Knoxville.
“I think it was done in a very careful and thoughtful way, that they are going to track the percent of women of childbearing age using highly effective and moderately effective contraceptive options and they are going to separately track the percent of contracepting women using long-acting reversible methods,” Dr. Zite said. “We hope that if we educate women about contraceptive options, if they are trying to prevent pregnancies, they will choose the option that works best for them, and therefore it will be the most effective.”
Another selling point for the new measures is that they are patient-centered, Dr. Zite added. “The emphasis is on giving access for women who want access, removing barriers, but then also there is no goal amount, so we are not trying to say we want every woman to have LARC because that is not the right option for every woman.” Dr. Zite is an unpaid trainer for Nexplanon and serves on an international IUD advisory board for Bayer.
The American College of Obstetricians and Gynecologists voiced its support for the new measures. “All of these measures will help us advance understanding across the health care system in order to reduce unintended pregnancy,” said Sean Currigan, quality and safety officer at ACOG. “Specifically, the LARC measure will help us understand the unnecessary variation in access to LARC across providers and systems, especially outside of the Title X system; and the postpartum contraception measure will help us understand continuing barriers to contraception like nonpayment/coverage of immediate postpartum LARC.”
In 2016, ACOG withheld its endorsement from quality measures issued by the Core Quality Measures Collaborative (a group led by the Centers for Medicare & Medicaid Services and America’s Health Insurance Plans, with input from NQF, medical societies, employer groups, and consumer groups), because contraception measures were not included in the ob.gyn. measure set.