Increasing Contraception Documentation in an Academic Rheumatology Clinic: A Quality Improvement Approach

Abstract

Objective: This quality improvement initiative aimed to increase the rate of provider screening and documentation of contraception use for reproductive-aged women seen in an academic rheumatology fellows' clinic to >50% by 24 weeks, with sustained improvement at one year.

Methods: With a multidisciplinary team, we devised and implemented six interventional cycles over 24 weeks informed by key stakeholder survey responses. The primary outcome measure was the percentage of eligible visits with contraception information documented in the structured electronic health record field. The smoking status documentation rate was tracked as a balancing measure, and the percentage of contraception documenters who were non-medical doctor (MD) clinical staff, the target group for the intervention, was tracked as a process measure. Outcome, process, and balancing measures were assessed every two weeks over one year.

Results: Over 24 weeks, the rate of contraception documentation increased from 11% to 54% (median 30%), and the median smoking status documentation rate was 88% (68%-97% range); the median rate of non-MD clinical staff documenters was 92% (70%-100% range). Interventions included an introductory educational session with documentation instruction and scripts to guide screening, email reminders from nursing leadership, and interim educational sessions. At one year, the contraception documentation rate was sustained at 50%.

Conclusion: A multicycle educational intervention led to an increase in the contraception documentation rate from 11% to 54% for reproductive-aged women seen in an academic rheumatology fellows' clinic over 24 weeks, with sustained improvement at one year. Future interventions will focus on increasing contraception counseling and referrals for patients in rheumatology clinics who were high risk.

Figure 1

Pareto chart indicating barriers to contraception documentation elicited from stakeholder survey.

Figure 2

Run chart tracking primary outcome measure (contraception documentation rate) and balancing measure (smoking status documentation rate) every 2 weeks over a 52‐week period. PDSA, Plan–Do–Study–Act. Red dashed line: 80% cut‐off; orange solid line: cumulative percentage.