The Community Health Center - Reproductive Life Plan (CHC-RLP) Project

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PROJECT SUMMARY/ABSTRACT Background: A key strategy to the prevention of adverse maternal and child outcomes, like maternal and infant mortality, is the delivery of high-quality health care before and after pregnancy (pre and inter-conception care). In these encounters, the exploration of patients’ pregnancy desires allows for the provision of patient- centered counseling and services based on those goals to support the health of future pregnancies and prevent unintended ones. Primary Care Providers (PCPs), who care for most non-pregnant women of reproductive age, are essential partners in this effort, yet studies show they are less likely than their obstetric counterparts to provide preconception or contraceptive health care. Structured reproductive health assessments, known as reproductive life plans (RLP), have been promoted as a strategy to routinely integrate preconception care into clinical care, and one such tool, One Key Question® (OKQ), holds particular promise for PCPs, as it allows for a meaningful, brief, assessment without the need to be a reproductive health expert. Objectives: The Community Health Center-Reproductive Life Plan (CHC-RLP) Project, led by AllianceChicago, a HRSA funded Health Center-controlled network with a shared data infrastructure including OKQ® as a structured field, will assess the impact of OKQ® implementation on reproductive health metrics in the community health, primary care, setting. In partnership with Friend Health, a CHC in the South Side of Chicago, and a team of researchers, the CHC-RLP Project will achieve two specific aims: 1) conduct a structured training for OKQ® implementation, harnessing the electronic health record (EHR) as a tool; and 2) leverage EHR data and utilize an implementation science framework to determine whether OKQ® implementation influences reproductive health (preconception and contraceptive care) metrics. Methods: This randomized control trial will be guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance, (RE-AIM) framework. Randomization will occur at the level of the primary care provider, and randomized providers will receive structured OKQ® training, including both clinical guidance as well as support for incorporating OKQ® into clinic workflow and documentation in the EHR. After 12 months of implementation, EHR data on service provision and outcomes will be explored to determine success of the implementation and differences in reproductive health outcomes (contraceptive provision and folic acid supplementation) between the patients who received care from the providers in the intervention group as compared to patients from the providers in the control, usual-care, group. Implications of expected findings: The results will inform a future large-scale efficacy trial, which has the potential to lead the Centers for Medicare & Medicaid Services to endorse RLP as a quality metric, and further validate the notion of health information technology as a tool to mitigate health disparities.