Balancing enhanced contraceptive access with risk of reproductive injustice: A United States comparative case study.

Objective: We aimed to examine how peripartum contraceptive care quality improvement efforts address or perpetuate reproductive health injustices.

Study Design: We conducted a comparative case study of inpatient postpartum contraceptive care implementation in 2017 to 2018, using key informant interviews at 11 United States hospitals. After our primary analysis revealed tensions between enhancing access to contraceptive care and patient-centeredness, we conducted the current inductive content analysis guided by 4 questions developed post-hoc: (1) What are healthcare workers' aspirations for contraceptive quality improvement programs? (2) What are healthcare workers' biases regarding peripartum contraceptive care delivery? (3) Do care delivery processes center patients' needs? (4) Do healthcare workers recognize and engage with structural inequities?

Results: Seventy-eight key informants (i.

Feasibility and acceptability of a toolkit-based process to implement patient-centered, immediate postpartum long-acting reversible contraception services.

Background: National guidelines recommend that maternity systems provide patient-centered access to immediate postpartum long-acting reversible contraception (ie, insertion of an intrauterine device or implant during the delivery hospitalization). Hospitals face significant barriers to offering these services, and efforts to improve peripartum contraception care quality have met with mixed success. Implementation toolkits-packages of resources and strategies to facilitate the implementation of new services-are a promising approach for guiding clinical practice change.

Implementing immediate postpartum contraception: a comparative case study at 11 hospitals.

Background: Immediate postpartum long-acting reversible contraception (LARC) is an evidence-based practice, but hospitals face significant barriers to its adoption. Our objective was to examine how organizational context (e.g.

Cost sharing, postpartum contraceptive use, and short interpregnancy interval rates among commercially insured women.

Background: Increasing access to effective birth control after childbirth may meet many women's preferences and reduce short interpregnancy interval rates. Eliminating out-of-pocket costs for contraception has been reported to increase the use of the most effective methods among women with employer-based insurance, but the prevalence and effects of patient cost sharing for contraception have not been studied during the postpartum period.

Objective: This study aimed to examine the association between cost sharing for long-acting reversible contraception and postpartum contraception use patterns and pregnancies in the 12 months after delivery.

Champions in context: which attributes matter for change efforts in healthcare?

Background: Research to date has focused on strategies and resources used by effective champions of healthcare change efforts, rather than personal characteristics that contribute to their success. We sought to identify and describe champion attributes influencing outcomes of healthcare change efforts. To examine attributes of champions, we used postpartum contraceptive care as a case study, because recommended services are largely unavailable, and implementation requires significant effort.

Breakdown in the expedited partner therapy treatment cascade: from reproductive healthcare provider to the pharmacist.

Background: The rising incidence rates of sexually transmitted infections in the United States highlight the need for concurrent treatment of patients and their sexual partners. Expedited partner therapy allows healthcare providers to offer antibiotic prescriptions or medications to an index patient for distribution to their sexual partner(s) without evaluating the partner. We hypothesized that there was a gap between expedited partner therapy policy at the state level and its downstream implementation by community pharmacists.

Designing Tailored Displays for Clinical Practice Feedback: Developing Requirements with User Stories.

Improving visualizations in clinical quality reports and dashboards may improve the visualization influence on clinical practice. Tailored displays could accommodate individual and situational differences, but these diplays introduce complex requirements across healthcare professionals and teams. We applied user stories, a method for managing complex software requirements, to a user-centered design process for tailored visual displays about postpartum contraception care.