Strengthening the Capacity of Family Planning Agencies to Improve the Quality of Family Planning Services: Cooperative

1. 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

2. 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.

3. 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

4. Project History

6. 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.

7. 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.

8. Conceptual Framework

9. 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.

10. 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.

11. Evaluation Phase

12. 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.

13. 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.

14. Research Project Sample 30 clinics across four metropolitan areas. San Francisco, New York City, Philadelphia, Atlanta Eligible clinics: >200 new clients/year and =2 clinicians. N=1500 clients in main study (50 per clinic). N=80 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. Implementing Best Practices Website

22. http://www.ibpinitiative.org

23. For more information, please contact: Kathleen M. Cardona, DrPH Project Research Coordinator kcardona@jhsph.edu