Identification of birth control method users and improving provider awareness of birth control method (BCM) vs. emergency contraception (EC) usage in an urban, adolescent school-based health population

SBHCs bridge access to reproductive health care for adolescents[1].  Addressing electronic medical record (EMR) documentation and provider awareness of service utilization is critical to demonstrate effective delivery of reproductive health care, including BCM and EC. 

In summer 2014, the Montefiore School Health Program (MSHP) began quality improvement project around the documentation and coding of reproductive health visits. Analysis of system-wide EMR data, using an innovative data-mining tool, Clinical Looking Glass®, identified 3,519 females aged 13-19 accessing the MSHP network during fall 2014.

Utilizing improved coding, MSHP identified 872 adolescent females using a BCM, including LARCs, and 268 using EC with no documented BCM at our SBHCs. EC accounted for 23% of all contraception accessed and 51% of EC users without BCM used EC more than once.  At 5 SBHCs, EC use represented ≥ 25% of all contraception use and ≥ 55% of EC users without BCM used EC more than once.  The next phase targets provider awareness of both BCM and EC utilization. The interventions include site-specific population reporting, provider survey, and a provider report of repeat EC users. We predict an increase in documented BCM and a reduction in repeat EC utilization.

Identification of BCM vs. EC users and feedback to SBHC providers on contraceptive utilization in their population is critical to improving reproductive health services for at-risk adolescents.

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[1] Soleimanpour S, Geierstanger SP, Kaller S, McCarter V, Brindis CD. The role of school health centers in health care access and client outcomes. Am J Public Health. 2010; 100:1597–603.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
Describe effective techniques to improve documentation and coding of contraceptive visits Identify methods to use standard documentation and coding of contraceptive visits in electronic medical records to accurately identify birth control method users Evaluate 3 provider interventions targeting awareness of contraceptive utilization and their ability to reduce repeat emergency contraceptive use without uptake of birth control method

Keyword(s): Contraception, School-Based Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked in child, adolescent and women's reproductive health care for 10 years in both the United States and Latin America. I have extensive experience with EMR design, training, data utilization and reporting implementation in a variety of clinical settings. I have led several QI and evaluative projects aimed at improved health services provision through improved documentation and population utilization patterns at the Montefiore School Based Health program.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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