THE MATERNAL AND INFANT HEALTH INITIATIVE CONTRACEPTIVE CARE - - PowerPoint PPT Presentation

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THE MATERNAL AND INFANT HEALTH INITIATIVE CONTRACEPTIVE CARE - - PowerPoint PPT Presentation

Feb 16, 2024 131 likes •527 views

THE MATERNAL AND INFANT HEALTH INITIATIVE CONTRACEPTIVE CARE MEASURES 2019 Update / Closeout Office of Population Affairs/Centers for Disease Control and Prevention Susannah Cohen, Ph.D., M.S. California Department of Health Care Services

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THE MATERNAL AND INFANT HEALTH INITIATIVE CONTRACEPTIVE CARE MEASURES 2019 Update / Closeout

Office of Population Affairs/Centers for Disease Control and Prevention Susannah Cohen, Ph.D., M.S. California Department of Health Care Services Information Management Division Office of Family Planning July 18, 2019

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  • Nearly 2/3 adult women enrolled in Medicaid are in their

reproductive years (ages 19-44)

  • Medicaid currently finances about 45% of all births in the

United States

  • The Centers for Medicare & Medicaid Services (CMS)

can play a major role in improving the quality of maternity care, birth outcomes and in measuring how care is delivered to pregnant and postpartum women.

  • New authorities for quality improvement and

measurement in the Affordable Care Act created

  • pportunity to improve perinatal outcomes and reduce

disparities

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Maternal and Infant Health Care Quality

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  • The initiative is designed to:

1) improve the rate and content of postpartum visits in Medicaid and the Children’s Health Insurance Program (CHIP) 2) increase the number of births that are intended

  • Promote the use of effective methods of

contraception in order to improve pregnancy timing and spacing and the health outcomes for both women and children.

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Maternal Infant Health Initiative

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  • Maternal Infant Health Initiative (MIHI)
  • 4 year grant program (9/2015-9/2019)
  • 14 states and 1 territory participating
  • Offered by the U.S. Department of Health

and Human Services, Centers for Medicare & Medicaid Services (CMS), and Children’s Health Insurance Program (CHIP)

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Adult Medicaid Quality Grants: Measuring and Improving the Quality

  • f Care in Medicaid
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  • Testing and evaluating methods for collection

and reporting of the Contraceptive Use (CCW) and Postpartum Contraceptive Use (CCP) measures

  • Developing staff capacity to report, analyze,

and use the data for monitoring and improving access and the quality of care in Medicaid

  • Improve health care quality for women of

childbearing age enrolled in Medicaid

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Goals

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  • Women Age: 15–44 (as of end of

measurement year) that:

– Adopted or continued use of the most effective or moderately effective FDA-approved methods of contraception. – Adopted or continued use of a long-acting reversible method of contraception (LARC).

  • Age Groups:

– 15–20 and 21–44

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CCW : Measure Specifications

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  • Intermediate outcome measure

– Measure designed to encourage providers to screen all women for pregnancy intention, and to counsel more fully about contraceptive options so that more women use the most and moderately effective methods of contraception

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CCW: Most/Moderately Effective Contraception Use

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  • Access measure
  • Designed to encourage

providers/service sites that are under performing (below the mean or median) to focus on removing unnecessary barriers to LARC access

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CCW: LARC Contraception Use

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  • Continuous enrollment:
  • Medi-Cal: Fee-for-Service & Managed Care
  • The measurement year
  • FPACT clients
  • Enrolled at some point during the measurement year
  • Allowable Gap:
  • Medi-Cal: No allowable gap during the continuous

enrollment period

  • FPACT: gap allowed, since only need to enroll once per

year

  • Anchor date: December 31st of measurement year
  • Benefit: Medical or Family Planning Only Services
  • Event / dx: Provision of contraception

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CCW: Eligible Population

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  • Most effective method of contraception

– female sterilization, contraceptive implants, or intrauterine devices or systems (IUD/IUS)

  • Moderately effective method of contraception

– Injectables, oral pills, patch, ring, or diaphragm

  • Long-acting reversible method of contraception

(LARC)

– Contraceptive implants, intrauterine devices or systems (IUD/IUS)

  • Measurement year: Calendar year

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Measure Definitions

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  • Excluded if:

– Infecund for non-contraceptive reasons – Pregnant and not at risk of unintended pregnancy – Gave birth in Nov or Dec of measurement year

  • ACOG guidance is certain contraception can be started

6 weeks after live birth

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Exclusions

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How Numerators Populations Relates to Eligible Population

LARC Eligible Women MM Effective

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CCW: CA State Eligible Women by Program & Age Group 2014-2017

Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: 01/09/2019

2014 2015 2016 2017 2014 2015 2016 2017 FFS

17,432 20,817 18,898 16,245 53,505 103,275 72,588 69,610

FPACT 231,214 191,851 188,691 184,448

1,337,285 1,046,242 987,718 949,701

MC

306,889 370,507 425,596 474,854 743,152 1,150,964 1,343,609 1,480,662

Total

555,535 583,175 633,185 675,547 2,133,942 2,300,481 2,403,915 2,499,973

15-20 Year olds 21-44 Year olds

15-20 Year

  • lds

21-44 Year

  • lds

FFS FPACT MC Total

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CCW: CA State Eligible Women by Program & Age Group 2014-2017

Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: 01/09/2019

500,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 2014 2015 2016 2017 2014 2015 2016 2017 15-20 Year olds 21-44 year olds # Eligible Women Program Type, Year, Age Group FFS FPACT MC

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CCW: CA State M/M & LARC Contraceptive Use 2014-2017

Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019

Age group Year # Eligible women # MM usage # LARC usage 15-20 2014 555,533 219,606 48,857 15-20 2015 583,175 163,860 28,319 15-20 2016 633,185 172,934 27,019 15-20 2017 675,547 151,678 39,078 Age group 2014 2,133,940 786,705 141,090 21-44 2015 2,300,481 776,030 178,661 21-44 2016 2,403,915 783,239 168,552 21-44 2017 2,499,973 699,257 208,994

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Rates of CA State M/M & LARC Contraceptive Use 2014-2017

16 Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019 8/15/2019

40% 9% 37% 7% 28% 5% 34% 8% 27% 4% 33% 7% 22% 6% 28% 8%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 15-20 years 15-20 years 21-44 years 21-44 years Most/Mod LARC Most/Mod LARC Rate of Contraceptive Use Contraceptive Use Type & Age Group 2014 2015 2016 2017

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Last Most / Moderately Effective Contraceptives Provided 2016 & 2017

Data Source: MIS/DSS data warehouse - Data Represented: 2016-2017 2017 Date Downloaded: 06/24/2019

14% 6% 52% 11% 4% 3% 2% 0% 8% 16% 12% 58% 2% 4% 4% 1% 0% 3%

0% 10% 20% 30% 40% 50% 60% 70% Contraceptive Type Percent of Total Last Contraceptive Provided 2016 2017

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CCW: CA State M/M & LARC Use by Program & Year Ages 15-20 Years

Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019

Program Year # Eligible women # MM usage # LARC usage FFS 2014 17,430 8,120 1,673 FFS 2015 20,817 2,688 550 FFS 2016 18,898 2,269 363 FFS 2017 16,245 1,907 495 FPACT 2014 231,214 62,950 14,739 FPACT 2015 191,851 108,128 18,454 FPACT 2016 188,691 110,594 17,344 FPACT 2017 184,448 84,955 23,830 MC 2014 306,889 148,536 32,445 MC 2015 370,507 53,044 9,315 MC 2016 425,596 60,071 9,312 MC 2017 474,854 64,816 14,753

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Rates of Contraceptive Use by Program & Contraceptive Type 15-20 years 2014-2017

Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019

47% 27% 48% 10% 6% 11% 13% 56% 14% 3% 10% 3% 12% 59% 14% 2% 9% 2% 12% 46% 14% 3% 13% 3%

0% 10% 20% 30% 40% 50% 60% 70% FFS FPACT MC FFS FPACT MC M/M LARC Rate of Contraceptive Use Program, Contraceptive Type, Year 2014 2015 2016 2017

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CCW: CA State M/M & LARC Use by Program & Year Ages 21-44 Years

Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019

Program Year # Eligible women # MM usage # LARC usage FFS 2014 53,503 26,989 4,645 FFS 2015 103,275 15,815 4,419 FFS 2016 72,588 9,519 2,292 FFS 2017 69,910 8,337 2,394 FPACT 2014 1,337,285 385,404 70,887 FPACT 2015 1,046,242 504,388 111,266 FPACT 2016 987,718 469,657 94,732 FPACT 2017 949,701 371,096 113,277 MC 2014 743,152 374,312 65,558 MC 2015 1,150,964 255,827 62,976 MC 2016 1,343,609 304,063 71,528 MC 2017 1,480,662 319,814 93,322

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Rates of Contraceptive Use by Program & Contraceptive Type 21-44 years 2014-2017

Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019

50% 29% 50% 9% 5% 9% 15% 48% 22% 4% 11% 5% 13% 48% 23% 3% 10% 5% 12% 39% 22% 3% 12% 6%

0% 10% 20% 30% 40% 50% 60% FFS FPACT MC FFS FPACT MC M/M LARC Rate of Contraceptive Use Program, Contraceptive Type, Year 2014 2015 2016 2017

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Contraceptive Use by Race/Ethnicity 2015-2017 15-20 years old

Data Source: MIS/DSS data warehouse - Data Represented: 2015-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019

Hispanic White Black Asian AN/AI OA/PI 2015 Eligible 241,722 70,749 33,494 74,390 2,813 124,734 Most / Mod 33,732 21,034 7,609 32,695 1,071 58,952 LARC 6,200 2,994 1,173 5,358 208 10,917 2016 Eligible 286,718 75,831 34,650 73,031 2,947 117,694 Most / Mod 39,381 22,351 7,630 28,974 1,061 55,963 LARC 6,644 2,998 1,058 4,787 201 9,704 2017 Eligible 327,121 76,202 35,427 70,263 2,965 116,435 Most / Mod 41,612 21,295 7,107 23,958 831 47,237 LARC 10,662 4,431 1,492 6,519 246 13,320

2015 2015 2016 2016 2017 2017

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Rates of Most/Moderately Effective Contraceptive Use by Race/Ethnicity 15-20 years 2015-2017

23 Data Source: MIS/DSS data warehouse - Data Represented: 2015-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019 2019

14% 30% 23% 44% 38% 47% 14% 29% 22% 40% 36% 48% 13% 28% 20% 34% 28% 41%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Hispanic White Black Asian AN/AI OA/PI

Rate of Contraceptive Use Race / Ethnicity 2015 2016 2017

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Rates of LARC Contraceptive Use by Race/Ethnicity 15-20 years 2015-2017

24 Data Source: MIS/DSS data warehouse - Data Represented: 2015-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019 019

3% 4% 4% 7% 7% 9% 2% 4% 3% 7% 7% 8% 3% 6% 4% 9% 8% 11%

0% 2% 4% 6% 8% 10% 12% 14% Hispanic White Black Asian AN/AI OA/PI Rate of Contraceptive Use Race / Ethnicity 2015 2016 2017

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Contraceptive Use by Race/Ethnicity 2015-2017 21-44 years old

Data Source: MIS/DSS data warehouse - Data Represented: 2015-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019

Hispanic White Black Asian AN/AI OA/PI 2015 Eligible 549,845 373,309 141,211 270,999 12,028 790,616 Most / Mod 135,253 98,640 34,036 106,460 3,543 355,558 LARC 33,610 20,399 7,729 21,109 844 85,362 2016 Eligible 674,422 393,623 146,450 257,522 11,931 727,460 Most / Mod 167,049 104,068 34,634 92,999 3,210 318,969 LARC 39,918 20,705 7,558 19,201 733 69,279 2017 Eligible 755,861 403,863 158,778 250,135 12,367 697,666 Most / Mod 173,513 97,982 33,040 79,645 2,952 259,975 LARC 53,803 24,553 9,566 22,693 942 81,813

2015 2015 2016 2016 2017 2017

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Rates of Most/Moderately Effective Contraceptive Use by Race/Ethnicity 21-44 years 2015-2017

26 Data Source: MIS/DSS data warehouse - Data Represented: 2015-2017 2017 Date Downloaded: Denominator 12/12/2017, Numerator 4/2/2018 8/15/2019

25% 26% 24% 39% 29% 45% 25% 26% 24% 36% 27% 44% 23% 24% 21% 32% 24% 37%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Hispanic White Black Asian AN/AI OA/PI

Rate of Contraceptive Use Race / Ethnicity 2015 2016 2017

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Rates of LARC Contraceptive Use by Race/Ethnicity 21-44 years 2015-2017

27 Data Source: MIS/DSS data warehouse - Data Represented: 2015-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019 8/15/2019

6% 5% 5% 8% 7% 11% 6% 5% 5% 7% 6% 10% 7% 6% 6% 9% 8% 12%

0% 2% 4% 6% 8% 10% 12% 14%

Hispanic White Black Asian AN/AI OA/PI

Rate of Contraceptive Use Race / Ethnicity 2015 2016 2017

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Year Population On SSI Not on SSI 2014 Eligible 18,190 537,343 2014 M/M 9,044 210,562 2014 LARC 1,987 46,870 Year Population On SSI Not on SSI 2015 Eligible 17,140 566,193 2015 M/M 2,070 161,805 2015 LARC 247 28,071 Year Population On SSI Not on SSI 2016 Eligible 17,686 615,496 2016 M/M 2,215 162,678 2016 LARC 259 26,749 Year Population On SSI Not on SSI 2017 Eligible 17,484 658,067 2017 M/M 2,000 149,678 2017 LARC 295 38,783

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Contraceptive Use by Disability Status: 2014-2017 15-20 years

Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019

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Rates of Contraceptive Use by Disability Status 15-20 years 2014-2017

29 Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019 8/15/2019

50% 12% 13% 11% 11% 1% 1% 2% 39% 29% 26% 23% 9% 5% 4% 6%

0% 10% 20% 30% 40% 50% 60% 2014 2015 2016 2017 2014 2015 2016 2017 Most / Mod LARC Rate of Contraceptive Use Contraceptive Type & Year SSI No SSI

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Year Population On SSI Not on SSI 2014 Eligible 68,490 2,065,450 2014 M/M 47,496 739,209 2014 LARC 9,091 131,999 Year Population On SSI Not on SSI 2015 Eligible 69,150 2,231,731 2015 M/M 10,142 765,911 2015 LARC 1,697 176,969 Year Population On SSI Not on SSI 2016 Eligible 68,249 2,335,663 2016 M/M 10,899 758,600 2016 LARC 1,844 166,635 Year Population On SSI Not on SSI 2017 Eligible 69,112 2,430,897 2017 M/M 9,699 689,558 2017 LARC 1,985 207,009

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Contraceptive Use by Disability Status: 2014-2017 21-44 years

Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019

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Rates of Contraceptive Use by Disability Status 21-44 years 2014-2017

31 Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019 8/15/201 9

69% 15% 16% 14% 13% 2% 3% 3% 36% 34% 32% 28% 6% 8% 7% 9%

0% 10% 20% 30% 40% 50% 60% 70% 80%

2014 2015 2016 2017 2014 2015 2016 2017 M/M LARC

Rate of Contraceptive Use Contraceptive Type & Year SSI No SSI

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Year Population English Spanish Other/Unk 2014 Eligible 186,129 118,272 251,132 2014 M/M 87,718 58,403 73,485 2014 LARC 19,039 12,702 17,116 Year Population English Spanish Other/Unk 2015 Eligible 228,034 140,689 214,452 2015 M/M 42,714 11,995 109,151 2015 LARC 7,834 1,930 18,555 Year Population English Spanish Other/Unk 2016 Eligible 250,707 169,160 213,318 2016 M/M 46,015 15,173 111,746 2016 LARC 7,330 2,236 17,453 Year Population English Spanish Other/Unk 2017 Eligible 265,140 200,128 210,283 2017 M/M 47,475 17,634 86,566 2017 LARC 10,879 4,096 24,103

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Contraceptive Use by Language: 2014-2017 15-20 years

Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019

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Contraceptive Use by Language: 2014-2017 15-20 years

Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019

47% 19% 18% 18% 10% 3% 3% 4% 49% 7% 9% 9% 11% 1% 1% 2% 29% 51% 52% 41% 7% 9% 8% 11%

0% 10% 20% 30% 40% 50% 60% 2014 2015 2016 2017 2014 2015 2016 2017 Most/Mod LARC

Rate of Contraceptive Use Contraceptive Type & Year

English Spanish Other/Unknown

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Year Population English Spanish Other/Unk 2014 Eligible 655,564 101,311 1,377,065 2014 M/M 338,066 38,668 409,971 2014 LARC 59,049 6,089 75,952 Year Population English Spanish Other/Unk 2015 Eligible 1,037,928 155,727 1,106,826 2015 M/M 232,991 32,312 510,727 2015 LARC 57,372 8,140 113,149 Year Population English Spanish Other/Unk 2016 Eligible 1,161,235 187,481 1,055,199 2016 M/M 265,716 40,598 476,925 2016 LARC 61,704 9,861 96,987 Year Population English Spanish Other/Unk 2017 Eligible 1,262,301 209,355 1,028,353 2017 M/M 275,296 42,708 381,253 2017 LARC 79,528 13,359 116,107

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Contraceptive Use by Language: 2014-2017 21-44 years

Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019

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Contraceptive Use by Language: 2014-2017 21-44 years

Data Source: MIS/DSS data warehouse - Data Represented: 2014-2017 2017 Date Downloaded: Denominator 01/09/2019, Numerator 06/24/2019

52% 22% 23% 22% 9% 6% 5% 6% 39% 20% 21% 20% 6% 5% 5% 6% 30% 46% 44% 37% 6% 10% 9% 11%

0% 10% 20% 30% 40% 50% 60% 2014 2015 2016 2017 2014 2015 2016 2017 Most/Mod LARC

Rate of Contraceptive Use Contraceptive Type & Year

English Spanish Other/Unknown

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Lessons learned

  • Data can be messy at many different points in the

reporting stream

  • OFP enrollment process can create multiple id’s

for same individual

– OFP has extensive linkage and deduplication procedure to consolidate the id’s into a single CA_id

  • Deduped id table only available at OFP, not in MIS/DSS
  • Hasn’t been updated beyond 2015

– Larger scale record reconciliation project linking multiple data sets across California’s Health and Human Services Agency

  • Centralized into MIS/DSS
  • Pilot completed, refresh underway, expansion

anticipated

  • http://www.datanetwork.org/research/chhs-annual-

record-reconciliation/

  • Always a good idea to cross validate methods

36 8/15/2019

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  • Family PACT providers now required to have ability

to administer LARC

  • Collaborations:

– LARC Focus Study

  • Medical Managed Care Quality Monitoring Division

(MCQMD)and EQRO, Health Services Advisory Group (HSAG)

  • Working with plans to study LARC utilization and

policies

– LA County Department of Public Health

  • PRA for LA specific M/M and LARC Contraceptive Use
  • Workgroup:

– ASTHO Increasing Access to Contraception Learning Community

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How has data affected policy?

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How can we improve contraceptive use in California? What stratifications would you like to see?

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