Effectiveness of clinical decision support to enhance delivery of family planning services in primary care settings

Silpa Srinivasulu, Seema D. Shah, Clyde B. Schechter, Linda Prine, Susan E. Rubin

Research output: Contribution to journalArticle

Abstract

Purpose: There is a need to improve delivery of family planning services, including preconception and contraception services, in primary care. We assessed whether a clinician-facing clinical decision support implemented in a family medicine staffed primary care network improved provision of family planning services for reproductive-aged female patients, and differed in effect for certain patients or clinical settings. Methods: We conducted a pragmatic study with difference-in-differences design to estimate, at the visit-level, the clinical decision support's effect on documenting the provision of family planning services 52 weeks prior to and after implementation. We also used logistic regression with a sample subset to evaluate intervention effect on the patient-level. Results: 27,817 eligible patients made 91,185 visits during the study period. Overall, unadjusted documentation of family planning services increased by 2.7 percentage points (55.7% pre-intervention to 58.4% intervention). In the adjusted analysis, documentation increased by 3.4 percentage points (95% CI: 2.24, 4.63). The intervention effect varied across sites at the visit-level, ranging from a −1.2 to +6.5 percentage point change. Modification of effect by race, insurance, and site were substantial, but not by age group nor ethnicity. Additionally, patient-level subset analysis showed that those exposed to the intervention had 1.26 times the odds of having family planning services documented after implementation compared to controls (95% CI: 1.17, 1.36). Conclusions: This clinical decision support modestly improved documentation of family planning services in our primary care network; effect varied across sites. Implications: Integrating a family planning services clinical decision support into the electronic medical record at primary care sites may increase the provision of preconception and/or contraception services for women of reproductive age. Further study should explore intervention effect at sites with lower initial provision of family planning services.

Original languageEnglish (US)
JournalContraception
DOIs
StateAccepted/In press - Jan 1 2020

Fingerprint

Clinical Decision Support Systems
Family Planning Services
Primary Health Care
Documentation
Contraception
Electronic Health Records
Insurance
Age Groups
Logistic Models
Medicine

Keywords

  • Clinical decision support
  • Family medicine
  • Family planning services
  • Federally qualified health center
  • Primary care
  • Screening

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

Effectiveness of clinical decision support to enhance delivery of family planning services in primary care settings. / Srinivasulu, Silpa; Shah, Seema D.; Schechter, Clyde B.; Prine, Linda; Rubin, Susan E.

In: Contraception, 01.01.2020.

Research output: Contribution to journalArticle

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abstract = "Purpose: There is a need to improve delivery of family planning services, including preconception and contraception services, in primary care. We assessed whether a clinician-facing clinical decision support implemented in a family medicine staffed primary care network improved provision of family planning services for reproductive-aged female patients, and differed in effect for certain patients or clinical settings. Methods: We conducted a pragmatic study with difference-in-differences design to estimate, at the visit-level, the clinical decision support's effect on documenting the provision of family planning services 52 weeks prior to and after implementation. We also used logistic regression with a sample subset to evaluate intervention effect on the patient-level. Results: 27,817 eligible patients made 91,185 visits during the study period. Overall, unadjusted documentation of family planning services increased by 2.7 percentage points (55.7{\%} pre-intervention to 58.4{\%} intervention). In the adjusted analysis, documentation increased by 3.4 percentage points (95{\%} CI: 2.24, 4.63). The intervention effect varied across sites at the visit-level, ranging from a −1.2 to +6.5 percentage point change. Modification of effect by race, insurance, and site were substantial, but not by age group nor ethnicity. Additionally, patient-level subset analysis showed that those exposed to the intervention had 1.26 times the odds of having family planning services documented after implementation compared to controls (95{\%} CI: 1.17, 1.36). Conclusions: This clinical decision support modestly improved documentation of family planning services in our primary care network; effect varied across sites. Implications: Integrating a family planning services clinical decision support into the electronic medical record at primary care sites may increase the provision of preconception and/or contraception services for women of reproductive age. Further study should explore intervention effect at sites with lower initial provision of family planning services.",
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