Use of clinical performance measures for contraceptive care in Iowa, 2013

Abstract

Objectives: To assess feasibility of calculating clinical performance measures for contraceptive care for National Quality Forum submission: the percentage of women aged 15-44 years provided the following: (1) a most or moderately effective contraceptive method (MME) and (2) a long-acting reversible contraceptive (LARC) method.

Methods: We used 2013 Iowa Department of Public Health (IDPH) Title X and Iowa Medicaid data. We stratified Title X data by age and Medicaid data by age and benefit type (family planning waiver (FPW) vs. general Medicaid), and examined variation by residence, public health region and health plan based on program interest.

Findings: Among women attending IDPH Title X clinics in 2013 (N=11,584), 86% of women aged 15-20years and 83% of women aged 21-44years were provided MME; and 20% of women aged 15-20years and 20% of women aged 21-44years were provided LARC. Estimates varied across Title X subrecipient agencies, which receive federal funds from IDPH. Among Medicaid FPW clients (N=30,013), 79% of women aged 15-20years and 73% of women aged 21-44years were provided MME; and 12% of women aged 15-20years and 11% of women aged 21-44years were provided LARC. Among general Medicaid clients (N=14,737), 40% of women aged 15-20years and 28% of women aged 21-44years were provided MME; and 5% of women aged 15-20years and 5% of women aged 21-44years were provided LARC.

Conclusion: A high percentage of IDPH Title X and FPW clients were provided an MME method. No reporting entity had a LARC percentage less than 1%-2%.

Implications: Measure calculation using Title X and Medicaid data is feasible and can potentially be used to identify ways to increase access to contraceptive methods.

Keywords: Birth spacing; Contraception; Family planning; LARC; Performance measures; Unintended pregnancies.