The Person-Centered Contraceptive Counseling (PCCC) measure is a tool to evaluate the person-centeredness of contraceptive counseling.
Person-centered measures such as the PCCC can help inform efforts to improve health care quality. Here we will share why defining quality in contraceptive care is uniquely complex and needed, as well as provide background on PCCC’s development, including its adaptation from the Interpersonal Quality of Family Planning (IQFP) Scale, its validation, and its endorsement as a performance measure by the National Quality Forum, and now the Partnership for Quality Measurement (PQM).
Patient-Centeredness in Quality Measurement
The Institute of Medicine (Now called the National Academy of Medicine) has stated that patient-centeredness – defined as care that focuses on patients’ own needs, values and preferences - is a key component of quality care. It is important for health systems to measure quality care to understand the performance of its physicians, health staff, and clinics. In 2016, The Office of Population Affairs (OPA) developed contraceptive care measures, endorsed by the National Quality Forum (NQF), that assess the provision of contraception. These contraceptive care measures were an important step towards prioritizing the quality of contraceptive care. However, their focus on prescription methods, and particularly Long-Acting Reversible Contraceptives (LARCs), as well as the lack of ability to exclude those who did not want contraception from the denominator, results in the potential to incentivize directive and non-patient centered counseling. Concerns about this potential undesired effect of these measures resulted in calls for a measure that centered patient experience, both as a measure that can be tracked alongside the contraceptive provision measures and to allow for evaluation of patient-centered contraceptive care as a goal in and of itself.
The Person-Centered Contraceptive Counseling (PCCC) measure is a patient-reported outcome performance measure (PRO-PM) that seeks to understand the experience of patients during their visit where they discussed contraceptive options. Derived from the Interpersonal Quality of Family Planning (IQFP), the PCCC went through validation and was endorsed by NQF, and now the Partnership for Quality Measurement (PQM).
The Interpersonal Quality of Family Planning (IQFP) Scale
The 11-item IQFP Scale was developed by PCRHP to capture the three domains of quality contraceptive counseling found to be important to patients in qualitative research, including interpersonal connection between provider and patient, adequate information, and decision support.
The IQFP Scale was shortened from 11- to a 4-item scale, the PCCC measure, to create a patient-reported outcome performance measure (PRO-PM) for quality improvement. PRO-PMs are measures of how patients feel about the care that they receive and the results from the measure can track the performance of providers and clinics.
The Patient-Centered Contraceptive Counseling (PCCC) Measure
The development of the PCCC began by identifying which items to retain from the 11-item IQFP to create a shorter, but still valid and reliable, measure. This was done using iterative and triangulated qualitative and quantitative methods, including factor analysis and cognitive interviewing (see graphic below). Factor analysis is a statistical method to find any potential patterns and describe variability among observed, correlated variables. Cognitive interviewing is a method to evaluate and improve questionnaire design. We then tested the face validity of those remaining items, a process to ensure that the measure aligned with patient, provider and clinic administrator perspectives on quality. A pilot test of the PCCC then took place throughout the United States to evaluate the validity and reliability of the PCCC as a PRO-PM when aggregated at the provider and clinic level. Throughout the development of the PCCC, a patient stakeholder group based in the Bay Area met with the research team to provide feedback and guidance.
If you’re interested in learning more about the development of the PCCC, please see the publications page.
Endorsement of the PCCC
PCRHP prioritized seeking endorsement for the PCCC because health care organizations, insurance payers, and government agencies look to NQF (now PQM) as a source of rigorously tested and vetted performance measures for use in accountability programs. In 2020, the Person-Centered Contraceptive Counseling Measure was approved for endorsement.
