Evaluating a Lower-Cost Family Planning Improvement Model
Special Projects Fund
Many studies link births from unintended pregnancies to adverse maternal and child health outcomes.
If current trends continue, more than half of all U.S. women will experience an unintended pregnancy by the time they reach the age of 45. Of the 1.5 million unplanned births documented in 2011, 68% were covered by public insurance programs, costing federal and state governments $21 billion in public expenditures. Many women—especially those who are uninsured or on Medicaid—rely on federally qualified health centers (FQHCs) for a range of health care services, including family planning. Some FQHCs receive federal Title X funding, whereas others do not, leading to inconsistencies in the quality of care. Compared with their Title X-funded counterparts, non-Title X FQHC staff tend not to provide family planning services proactively, addressing it only when raised as a primary care issue by patients. In 2013, NYSHealth awarded Public Health Solutions a grant to pilot the Quality Improvement Learning Collaborative model to improve family planning at four non-Title X-funded FQHCs in New York City. In 2018, NYSHealth awarded Public Health Solutions another grant to evaluate a low-cost version of this model to improve contraceptive services for women receiving care at federally qualified health centers.
Under this grant, Public Health Solutions piloted a redesigned model based on the 2013 version, which yielded a 77% increase in screenings and a 53% increase in contraception use. Despite its success, the model had proven difficult to widely replicate because of the cost of sustaining health educators with special training. To address this issue, Public Health Solutions secured a $350,000 grant from the Ira W. DeCamp Foundation to pilot a redesigned model that could be scaled up and sustained in more settings. The new model is similar to the original model but less costly, given that the health educator component is not included. Funding from NYSHealth supported an evaluation of this streamlined, lower-cost model. Key metrics included pregnancy intention screening rate; uptake of effective contraceptive methods among women of reproductive age; the impact on health center practices and care; and patient experience receiving care from each site, before and after the implementation of the redesigned model. This redesigned model achieved positive results while being more cost-effective, and Public Health Solutions promoted its use statewide.