Identifying and Addressing Opportunities in Primary Care to Improve Healthy Birth Intervals

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ABSTRACT Approximately 30% of pregnancies in the United States occur after a short interpregnancy interval (IPI) <18 months. Short IPI is associated with adverse maternal and infant outcomes, especially among women from high-risk populations. Primary care offers an opportunity to engage and educate reproductive age patients about birth spacing, provide preconception and contraceptive care between pregnancies (“interconception” care) and coordinate their acute and chronic care needs. Groups with higher risks of adverse pregnancy outcomes, such as low-income women, are more likely to receive their reproductive care from a primary care provider (PCP) than an obstetrician-gynecologist. Three quarters of reproductive age women in the United States have at least one physician visit each year, most commonly with their PCP; however, only 14% of office visits involve preconception or contraceptive care. Many PCPs already feel task-saturated when delivering primary care and face numerous barriers to providing high-quality interconception care. Although some interventions appear to be effective, attempts to improve preconception/interconception care, within primary care, have had limited success. We hypothesize that this may be due to inadequate design for sustainable implementation into clinical workflows. This developmental study will therefore gather key stakeholders (e.g. primary care clinicians, nurses, practice administrators and staff) and female reproductive age patients at three diverse primary practices to take part in a failure modes effects and criticality analysis (FMECA). This risk assessment engineering methodology will allow us to fully characterize and understand the failures/missed opportunities in the systems and processes of primary care to deliver interconception care. We will then apply an iterative user-centered design approach, building from existing interventions and from the FMECA results, to create a novel intervention for integrating effective, patient-centered interconception care into primary care. In future work, we intend to test this novel intervention using a type II hybrid implementation/effectiveness trial.