This page includes publications on measurement and the Person-Centered Contraceptive Counseling (PCCC) measure, news articles and op-eds published on the PCCC, and additional readings that provide context on topics such as person-centeredness. If a publication linked or included on this page is not accessible, please contact us for access. 

Foundational Publications 

This commentary describes the PCCC pilot in 2018-2019 and how organizations have since expressed the value of using the PCCC measure as it provides the opportunity to leverage information for quality improvement and center patient voices in contraceptive care. The PCCC is a standalone patient-reported outcome performance measure that uses a 4-item survey to assess the three domains of person-centered contraceptive counseling (interpersonal connection, decision support, and adequate information). This measure was piloted by UCSF following NQF’s call to develop measures that focused on patient-centeredness. Claims-based measures, endorsed by the NQF in 2016, played an important role in prioritizing quality of contraceptive care at the state and federal level but also raised a few concerns. These measures could hinder patient centeredness by incentivizing counseling towards specific methods, and inadvertently neglect patient preferences related to reproduction and pregnancy prevention. The PCCC measure can be integrated into existing patient experience surveys to provide quality improvement insights.

This paper goes over the process of testing the validity and reliability of the PCCC measure as a performance measure, in preparation for application for endorsement from the National Quality Forum. We combined data from two research studies, a statewide quality improvement assessment, and a dedicated data collection effort at nine sites, all collected between 2009 and 2019 at 22 total sites in the United States, to evaluate the validity and reliability of the four-item PCCC measure aggregated at the provider and facility level. The development and use of the measures of patient experience, like the PCCC, is critical for prioritizing patient-centeredness in reproductive health care. The PCCC measure can facilitate the identification of gaps and disparities in patient-centered contraceptive counseling and enable quality improvement to promote quality, equitable contraceptive care.

The PCCC measure was developed from the 11-item Interpersonal Quality of Family Planning (IQFP) scale. This paper outlines the creation of the PCCC, a 4-item patient-reported outcome performance measure. To explore clarity and importance of each of the IQFP’s 11 items, we conducted English and Spanish cognitive interviews with patients who received contraceptive counseling at 3 publicly funded California clinics. The 11-item IQFP scale was reduced to a 4-item scale (the PCCC) that includes items evaluating provider performance regarding respect for patients, information provision, and eliciting and honoring patient preferences for birth control.

The objective of this paper was to describe the development of the Interpersonal Quality of Family Planning (IQFP) scale. We performed initial item selection based on qualitative work regarding patient preferences for contraceptive counseling and a review of patient-reported measures of communication. We then tested the scale with women receiving contraceptive counseling visits and coded the audio recordings with a focus on patient-centered communication. We determined the final scale based on interitem correlations and exploratory factor analysis. Content, construct, convergent and discriminant validity were all tested by investigating associations between the final scale and the satisfaction and audio-recording-derived measures using mixed effects logistic regression. We selected an 11-item, 1-factor IQFP scale, with a Cronbach's alpha of 0.95. This scale showed positive associations with measures of satisfaction with counseling and with the chosen method.

Performance measures for contraceptive care should prioritize quality of contraceptive care that is reflective of women’s needs and preferences. This commentary reflects on how standardized measures of contraceptive care seem to focus on the use and uptake of long-acting reversible contraception (LARCs). From a public health perspective, the increase of LARCS has the potential to reduce unintended pregnancy rates and has been suggested to decreasing pregnancy complications. However, there are inadvertent risks involved in measurement that associates uptake in LARCS with higher quality of care. Incentivizing counseling for LARC based methods is especially problematic among disadvantaged populations, considering the United States’ history of forced sterilization and coercive practices in these groups. These measures may lead to more directive counseling that neglects patients’ preferences and priorities regarding their reproductive health. A measure that centers patient experience and preferences of contraceptive counseling may yield better clinical outcomes and patient satisfaction. 

Measurement and the PCCC 

PCCC in the News 

 

Additional Readings