Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Chase Brexton Health Care, Baltimore, USA.
Matern Child Health J. 2024 Dec;28(12):2006-2012. doi: 10.1007/s10995-024-04002-5. Epub 2024 Oct 3.
Long-acting reversible contraceptives (LARCs) are the most effective forms of contraception available and therefore play a critical role in supporting patients to exercise bodily autonomy and achieve reproductive goals. A comprehensive set of quality improvement (QI) interventions were implemented between March and June 2019 to improve LARC access at a federally qualified health center (FQHC) in (US State).
An evaluation study was conducted to assess the impact of the QI initiative considering the number of LARCS delivered as a proxy for access. The Wilcoxon-rank test was applied to test for significance, given a non-parametric sample of LARCs delivered by 13 providers (matched to themselves) pre- and post-intervention. Reimbursement for LARC procedures pre- and post-intervention was also examined to determine economic impact and sustainability of incorporating a new device, the Liletta™, in the floor stock.
There was a statistically significant increase in LARC delivery between July 2019-March 2020 compared to July 2018-March 2019. Approximately $1,000 per month increased reimbursement for LARC services occurred post-intervention. The evaluation study concluded success of the QI intervention, with need for further study needed to determine equitable delivery of contraceptive services between different subpopulations and by insurance status.
The study provides a blueprint for QI initiatives to improve access to LARCs while also increasing revenue for LARC services in an FQHC setting.
长效可逆避孕措施（LARC）是目前可用的最有效的避孕方法，因此在支持患者行使身体自主权和实现生殖目标方面发挥着关键作用。2019 年 3 月至 6 月期间，在一家联邦合格的健康中心（FQHC）实施了一套全面的质量改进（QI）干预措施，以改善 LARC 的获取途径。
进行了一项评估研究，以评估 QI 计划的影响，将 LARC 的数量作为获取途径的替代指标。考虑到 13 名提供者（与自己匹配）在干预前后提供的 LARC 的非参数样本，应用 Wilcoxon-rank 检验来检验显著性。还检查了干预前后 LARC 程序的报销情况，以确定在库存中增加新设备（Liletta™）的经济影响和可持续性。
与 2018 年 7 月至 2019 年 3 月相比，2019 年 7 月至 2020 年 3 月 LARC 的使用量有统计学意义的增加。干预后，LARC 服务的报销每月增加约 1000 美元。评估研究得出结论认为 QI 干预是成功的，需要进一步研究以确定不同亚人群和不同保险状况之间避孕服务的公平提供。
该研究为改善 LARC 获得途径的 QI 计划提供了蓝图，同时也增加了 FQHC 环境中 LARC 服务的收入。
