Strengthening the Capacity of Family Planning Agencies to Improve the Quality of Family Planning Ser

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Strengthening the Capacity of Family Planning
Agencies to Improve the Quality of Family
Planning Services Cooperative Agreement for
Research to Improve the Delivery of Family
Planning Services

• Presentation for the Office of Family Planning
• National Title X Grantee Meeting
• September 20, 2006

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Family Planning Service Delivery Improvement
Research

• Developed collaboratively by
• Johns Hopkins Bloomberg School of Public Health
• Office of Family Planning, DHHS
• Title X Family Planning Program Grantees,
  including
• California Family Health Council
• Family Planning Council, Inc.
• Georgia Department of Human Resources
• Maryland Department of Health and Mental Hygiene
• Medical and Health Research Association of NYC,
  Inc.

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Johns Hopkins Bloomberg School of Public Health
Team

• Freya Sonenstein, Investigator
• Young Mi Kim, Investigator
• Michael Koenig, Investigator
• Kathleen Cardona, Project Coordinator
• Davida Becker, Research Assistant

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Project History
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(No Transcript)
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Background

• Measuring and understanding the quality of health
  services within the U.S. is a national priority.
• Limited research on the quality family planning
  services in U.S., more work done on family
  planning services in developing countries.
• Need to understand
• dimensions of quality of care
• implications for contraceptive adoption, method
  continuation, method use and use-effectiveness,
  satisfaction, compliance with clinical
  recommendations, and avoidance of unintended
  pregnancy.

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Project Objectives

• To develop feasible and practical approaches to
  measuring the quality of family service delivery
  in Title X clinics.
• Focus on all points of contact, particularly
  client-provider service interactions.
• To develop research infrastructure to test
  approaches to improve the quality of family
  planning service delivery.
• Form a network of research-oriented Title X
  grantee agencies.
• To enhance the dissemination of information about
  science-based practices to practitioners.

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Conceptual Framework
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Research Aims

• To assess and define the quality of services
  provided in Title X Clinics.
• To assess client satisfaction with both access to
  and quality of services provided at their family
  planning visit.
• To assess the relationship between quality care
  and client outcomes, such as
• Method adoption continuation
• Return to the clinic as recommended and
• Follow-through on referrals and therapies.

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Intervention Aims

• In response to research findings Design, test
  and evaluate pilot service improvement
  interventions.
• To develop a tool box of assessment instruments,
  easily self-administered by individual clinics,
  to help all family planning clinics achieve their
  goal of providing high-quality care to their
  clients.

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Evaluation Phase
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Study Components

• Main Study
• Client baseline self-administered pre- and
  post-visit survey.
• Client telephone interviews at 2 and 7 months.
• Client billing data reviewed at 7 months.
• Facility survey completed by clinic manager.

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Study Components

• Observational sub-study
• Audio- or videotaped observations of
  client-provider counseling interactions.
• Clients are included in main study sample.
• Focus group held in each metropolitan area for
  providers involved in observational subsample.

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Research Project Sample

• 30 clinics across four metropolitan areas.
• San Francisco, New York City, Philadelphia,
  Atlanta
• Eligible clinics gt200 new clients/year and 2
  clinicians.
• N1500 clients in main study (50 per clinic).
• N80 clients in observational sub-study (10
  client-clinician pairs at two clinics in each
  metropolitan area).
• Pre-testing and pilot data collection at two
  clinics in Baltimore.

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Client Eligibility

• Inclusions
• Female family planning clients aged 18-35.
• New clients only (no visit to this clinic
  location within past 5 years).
• Speaks English or Spanish as primary language.
• Exclusions
• Women who are sterilized, currently pregnant or
  seeking pregnancy.
• Clients requesting and receiving pregnancy test
  or emergency contraception services without a
  full clinical visit.

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Data Collection

• Research Assistants (RAs) will be recruited and
  hired in each metropolitan area, and trained
  on-site by Johns Hopkins staff.
• Local RAs will be responsible for all day-to-day
  research activities during clinic-based data
  collection as well as telephone follow-up.

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Research Benefits

• Direct benefits to Title X program
• Document high quality services delivered by Title
  X clinics
• Complement to quality assurance programs that
  focus on more technical aspects of patient care.
• Ability to define what are quality family
  planning services, based on client perceptions.
• Tool box of assessment instruments to be made
  available to clinics.

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Research Benefits

• Direct benefits to participating clinics
• Possibility of receiving pilot intervention
  resources.
• Funds available for staff in-service/training
  activity.
• Computer for sites where A-CASI is used.
• Development of an ongoing research network of
  family planning providers.

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Expected Products

• Literature review of aspects of service quality
  in U.S.
• Assessment/Improvement toolkit for use in the
  family planning clinic setting (SDIR in-a-box).
• Clinic self-assessment materials.
• Information on best practices.
• Computer-based counseling training tool.

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Collaborative Process

• Active collaboration between JHU, OPA, and Title
  X Grantee Partners.
• Development of research protocol, instruments,
  and other study materials.
• Dissemination of results.
• Use of Implementing Best Practices
  website/network to facilitate collaboration as
  project develops.

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Implementing Best Practices Website
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http//www.ibpinitiative.org
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• For more information, please contact
• Kathleen M. Cardona, DrPH
• Project Research Coordinator
• kcardona_at_jhsph.edu