The visit-specific Person-Centered Contraceptive counseling (PCCC) measure has been used primarily to assess the person-centeredness of care directly after a patient’s visit. When sites implement the visit-specific PCCC survey, patients are given a survey on the care they received during a particular visit. Surveying after a clinic visit allows sites to understand the quality of the care patients receive at the clinic- and provider-level. While the visit-specific measure is optimized for quality improvement, it is not ideal for population-level sampling at a health plan or state level.
PCRHP has adapted the visit-specific PCCC for retrospective data collection on patient experience of contraceptive counseling to enhance measurement of and attention to patient-centered contraceptive care. Insurance plans, health systems, and MCOs routinely send out surveys to patients to gather information on their healthcare experiences looking back on a certain time period. These retrospective surveys provide opportunities to include patient voices to improve the quality of care. The retrospective PCCC measure (PCCC-RS) allows for population-level sampling at the level of health care plans and states and can be adapted for use in any patient experience survey.
PCCC-RS Survey
Think about your appointments when you talked about contraception or pregnancy prevention in the last 6 months.
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Overall, how do you think the member(s) of the healthcare team(s) (including any doctor, nurse, medical assistant, etc.) did? Please rate them on each of the following. |
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Respecting me as a person |
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5 |
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Letting me say what mattered to me about my birth control method |
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5 |
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Taking my preferences about my birth control seriously |
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5 |
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Giving me enough information to make the best decision about my birth control method |
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5 |
Adapting the PCCC Measure for Retrospective Use
The PCRHP team adapted the PCCC measure for retrospective use through a modified Delphi process with an expert workgroup and patient stakeholder group. This included modifying the question stem and measure instructions for use in retrospective surveys. No modifications were made to the survey items or response categories. See the figure below for more information on our modified Delphi process to adapt the PCCC measure for retrospective use.
Figure 1 Modified Delphi Process
Measure Validation and Endorsement
Following adaption, the PCCC-RS measure was piloted with 12 Planned Parenthood Federation of America affiliates and with Family Planning Only waiver recipients at Washington State Health Care Authority. The PCCC-RS measure is currently undergoing validation and will be submitted for endorsement to the Partnership for Quality Management.
Implementing the PCCC-RS Measure
The Survey
The PCCC-RS has been translated for usein Spanish. Our team is interested in adapting to other languages in the future and welcomes inquiries or sharing of translated versions.
Identifying Eligible Patients
The target population for the PCCC-RS is patients aged 15-45 years who were assigned female at birth, who are not currently pregnant nor have given birth in the past 6 months, and who received contraceptive counseling as part of their visits in the last 6 months prior to being surveyed.
Determining Eligibility
Surveys should be distributed to all patients who received services in the measurement time period of the last 6 months, as determined by administrative data. In order to ensure eligiblity for whom the survey has been distributed, a screening question can be used to identify patients eligible to take the survey:
"In the last 6 months, did you talk about contraception or pregnancy prevention with a member of the healthcare team (including any doctor, nurse, medical assistant, etc.)?"
This question serves to identify those within the target population who had any encounters relevant to the PCCC-RS (individuals who received contraceptive counseling the past six months).
Patients who are currently pregnant or given birth in the last 6 months are not eligible to complete the PCCC-RS survey. To identify those patients, implementors may want to ask two separate questions asking patients to self-report their current pregnancy status and whether they gave birth in the preceding six months.
Surveying Patients
PCCC-RS can be incorporated in your current patient surveying efforts as a standalone patient survey. Implementation of the PCCC-RS measure can be flexible to the context of your network. While the measure items should not be changed, small changes to the measure introduction or question stem can be made to describe in more detail the care settings at which respondents may have received care.
For example, when the PCCC-RS was implemented at Planned Parenthood Federation of America, the measure introduction was changed to reflect the care they were surveying:
"Think about your appointments at Planned Parenthood when you talked about contraception or pregnancy prevention in the last 6 months"
How to Analyze and Interpret PCCC-RS Measure Results
PCCC-RS responses are aggregated and reported as a percentage of patients who marked “excellent” on all four items. The items and response categories for the PCCC-RS remains the same as the visit specific and calculation is as follows:
Calculating the PCCC-RS Measure Result
The PCCC-RS measure result is calculated as the percentage of patients who gave a top score ("5") on all four items on the PCCC-RS scale.
The recommended minimum panel size is 150 patient responses at the state- and plan-level.
Interpreting the PCCC-RS Measure Result
Initial testing is underway to understand what a suitable benchmark score is for the PCCC-RS measure.
Stratifying PCCC-RS scores
While including patient characteristic questions as part of the PCCC-RS measure is not required, being able to stratify by certain patient characteristics (for example race/ethnicity or age) can identify inequities requiring attention.
PCRHP strongly advises that scores should only be reported for categories with at least 5 respondents to protect participant anonymity and ensure some level of relability of reported results.
Click here for more information on best practices for stratifying PCCC scores.