Date Updated:  

eCQM Title: Post-partum follow up for contraception

eCQM Identifier if already designated: N/A

eCQM Version Number: v0

NQF Number:

MAT GUID:

Measurement Period: 12 months

Lookback Period: 90 days

Measure Steward: CDC

Measure Developer: NACHC

Endorsed By:

Description: This measure is intended to evaluate how many women with a recent pregnancy ending in delivery received post-partum follow up care, contraceptive counseling in the peri- or post-partum period and what contraceptive method, if any, they selected.

Intent: The measure is designed to enable a quality improvement workflow to support closing care gaps around opportunities to identify women at the end of a pregnancy episode that concluded in delivery.

Copyright:

Disclaimer:

Measure Scoring: Composite, proportion

Measure Type: Composite, process and outcome

Stratification: None

Risk Adjustment: None

Rate Aggregation: Describes how to combine information calculated based on logic in each of several populations into one summarized result. It can also serve to describe how to risk adjust the data based on supplemental data elements described in the eCQM.

Rationale: Supports patient-centered decision-making, allowing multiple methods to determine which patients fall out of the measure based on early termination of the pregnancy episode.  

Clinical Recommendation Statement: MEC/SPR guidelines

Improvement Notation: Higher score indicates better performance on post-partum visit and contraceptive counseling, higher score indicates higher level of access to contraceptive methods.

Reference(s):

Bernard, Caitlin, et al. “Comparison of an Additional Early Visit to Routine Postpartum Care on Initiation of Long-

Acting Reversible Contraception: a Randomized Trial.” Contraception, 2018,

doi:10.1016/j.contraception.2018.05.010.


Brunner Huber, LR, et al. Factors Associated with Pregnancy Intention among Women Who Have Experienced a

Short Birth Interval: Findings from the 2009 to 2011 Mississippi and 2009 Tennessee Pregnancy Risk Assessment

Monitoring System. Annals of Epidemiology, 29 Mar. 2018.


Lopez, Laureen M, et al. “Education for Contraceptive Use by Women after Childbirth.” Cochrane Database of

Systematic Reviews, 2012, doi:10.1002/14651858.cd001863.pub3.


Lopez, LM, et al. “Strategies for Improving Postpartum Contraceptive Use: Evidence from Non-Randomized Studies.”

The Cochrane Database of Systematic Reviews, 27 Nov. 2014, doi:10.1002/14651858.CD011298.pub2.


Sothornwit, Jen, et al. “Immediate versus Delayed Postpartum Insertion of Contraceptive Implant for

Contraception.” Cochrane Database of Systematic Reviews, 2017, doi:10.1002/14651858.cd011913.pub2.


Trussell, J. Contraceptive Technology. Vol. 20, Ardent Media, Inc., 2011.


Definition: Long-acting contraception (LARC): Intrauterine devices and contraceptive implants.

Estimated Delivery Date (EDD): 40 weeks from LMP or calculated delivery date by gestational age as estimated by ultrasound.


Guidance: Use estimated delivery date (EDD) to determine the approximate delivery date and assume that pregnancy continued to delivery by 42 weeks if no confirmed delivery date is entered into record. Look for 6 week post-partum visit by 8 weeks post-EDD if delivery date is not available. If pregnancy episode started but was either closed by event other than delivery or if record contains termination of pregnancy via method other than delivery then episode should be excluded from criteria. Patients may qualify for contraceptive counseling as early as 34 weeks of pregnancy given that pre-delivery counseling provides option to maximize methods available immediately after delivery including sterilization or IUD.

 

Transmission Format:

Proportion or Ratio eCQMs: The following sections are found in the header of a Proportion or Ratio measure:

  • Initial Population: All women with a pregnancy episode ending in delivery, age 15-44.
  • Denominator: Women at risk for pregnancy who were pregnancy with EDD ending within 8 weeks of measurement period.
  • Denominator Exclusions: Women who have pregnancy loss prior to delivery. Women who were transferred to another source of care, women who did not survive post-natal period or were incapacitated within 6 weeks after delivery.
  • Numerator1: Contraceptive counseling was provided to patient within 8 weeks before EDD or 6 weeks after actual delivery date. If no delivery date was recorded in structured data, counseling within 8 weeks after EDD is allowed.
  • Numerator1 Exclusions: Patient had hysterectomy within 7 days of delivery.
  • Numerator2: A post-partum visit was recorded for patient within 6 weeks after actual delivery date. If no delivery date was recorded in structured data, post-partum visit within 8 weeks after EDD is allowed.
  • Numerator3: A contraceptive method was selected by the patient and provided.
  • Numerator3 Exclusions: Patient had hysterectomy within 7 days of delivery.
  • Measure Population: Women with a pregnancy episode ending in delivery.
  • Measure Observations: Pregnancy ending within 90 days before the start of the measurement period through 8 weeks before the end of the measurement period with a delivery.


Supplemental Data Elements: CMS defines four required Supplemental Data Elements (payer, ethnicity, race, and sex), which are variables used to aggregate data into various subgroups. Comparison of results across strata can serve to show places disparities exist or areas in which exposing differences in results is necessary. Additional supplemental data elements required for risk adjustment or other purposes of data aggregation can be included in the Supplemental Data Element section. For this measure sex is not relevant because it excludes male patients.


Measure Flow


  

Electronic Measure Specification


Population Criteria: CQL development not yet defined

  • Reporting Stratification: This is variable groupings on which the measure is designed to report, such as diagnosis or age.
  • Definitions: These are additional CQL definitions (expression logic) that the population definitions might reference. A CQL definition is the basic unit of logic within the CQL library.
  • Functions: This is a CQL expression that performs a calculation frequently found in eCQMs and is designed to return a value. Age calculations, for example, are expressed as functions.
  • Terminology: Refer to Women’s Health Contraception NACHC Data Dictionary.
  • Data Criteria (QDM Data Elements): This is a list that contains the QDM datatypes and value set name or direct reference code description used in the measure. These are the building blocks used to assemble the population criteria of an eCQM.

• Supplemental Data Elements: This is specific information to be retrieved for each patient reported in the eCQM, such as race, ethnicity, payer, and sex. Supplemental data elements might be used for risk adjustment or population health analytics. For this measure sex is not relevant because it excludes male patients