A QUALITY IMPROVEMENT INITIATIVE AIMED AT INCREASING THE NUMBER OF ADOLESCENTS SCREENED FOR CONTRACEPTIVE NEEDS IN AN OUTPATIENT PRIMARY CARE SETTING

ABSTRACT Emily Butler: A Quality Improvement Initiative Aimed at Increasing the Number of Adolescents Screened for Contraceptive Needs in an Outpatient Primary Care Setting(Under the direction of Amanda Brinson) Background: Unintended pregnancy rates among young adults in the US are decreasing but remain seven times higher than those in other high-income countries. Research shows that adolescents often do not use their preferred contraceptive method, which can lead to early discontinuation and result in a higher risk of unwanted pregnancies.Objective: This quality improvement project aimed to address this disparity by implementing universal screening for contraceptive needs in the primary care setting. Methods: This quality improvement initiative aimed to enhance contraceptive needs screening in a pediatric primary care clinic by utilizing the validated Self-Identified Need for Contraception (SINC) question to assess adolescents' contraceptive needs. The SINC question was added to clinic documentation within the sexual and reproductive health section of the teen confidentiality note. Providers received education on the initiative and were encouraged to participate when they saw eligible patients (i.e., 13-21 years old, female sex). Implementation spanned 18 weeks and included four PDSA cycles. Results: Of the 107 patients who met the inclusion criteria during the 18-week implementation period, 61 received SINC screening, meaning 57% of eligible patients were reached. Over the last six weeks of implementation, screening rates exceeded the 50% median, indicating a significant shift in process performance. In the initial weeks of implementation, providers’ lack of easy access to the SINC question in the EHR acted as a barrier to patient screening. Conclusion: Achieving the goal of screening at least 50% of eligible patients for contraceptive needs marks an improvement from the baseline data, where there was no universal screening for contraceptive needs. The project's findings confirm the importance of implementing a standardized universal screening process for contraceptive needs within primary care settings. Due to the novelty of this research, further studies are needed to evaluate the effectiveness of contraceptive screening tools on adolescent health outcomes. This shift represents a non-random improvement in screening rates, consistent with special cause variation observed on the run chart. These findings suggest that embedding a standardized screening tool within the EHR can improve consistency of contraceptive needs assessment in adolescent primary care.