Using “One Key Question” to Address Pregnancy Intention at the UPMC Shadyside Family Health Center
Hodan Ismail, MD; Lisa Schlar, MD
Women’s pregnancy intention can impact primary care decisions. For women hoping to become pregnant, preconception care is important, while those hoping to avoid pregnancy may need contraceptive counseling. Additionally, pregnancy intention screening is important when prescribing teratogenic medications. Our goal is to increase pregnancy intention screening at Shadyside Family Health Center (SFHC), using a validated EMR tool called “One Key Question (OKQ)” which asks patients “Would you like to be pregnant in the next year?”
Providers were asked to incorporate OKQ into all visits with reproductive-age women (ages 18-44) and document using a “Dotphrase” in Epic EMR. Multiple PDSA cycles included office huddle encouragement, distribution of provider report cards, and provider didactic sessions. Subsequent patient interventions differed by pregnancy intention. Data were analyzed monthly using an automated Epic report.
Baseline utilization of OKQ dotphrase was13%, and intervention data, collected from April 2018-March 2019, showed that providers used OKQ dotphrase in 1337/ 6405 of encounters (21%). Among those asked, 81% answered “No”, 16% answered “Yes” and 3% answered, “Not Sure.” Monthly OKQ screening rates improved to 18-20% with huddle reminders and improved again to 29% after implementing the 2nd PDSA cycle. Intervention outcomes analysis is underway.
We successfully raised provider awareness about the importance of screening for pregnancy intention and increased screening tool utilization. OKQ use was helpful for identifying patients at risk for adverse outcomes and guiding providers towards appropriate interventions for patient pregnancy intention. Barriers exist as a result of encounter logistics and time constraints.