NEW DATA: What happens when patients are asked about their goals during every visit?

Everything can change when women are given the opportunity to reflect on their pregnancy or reproductive health goals as a standard part of every visit with their healthcare provider:

“Do you want to become pregnant in the next year?” or “Are you planning a pregnancy?”

It’s remarkable how infrequently this type of question is asked in the primary care setting, which can deny women the chance for a dialogue about their plans and their options for birth control. In Delaware, asking a Pregnancy Intention Screening Question (PISQ) is now standard practice across Upstream-trained healthcare centers. If the answer to this question is yes, it creates the moment for providers to discuss preconception care and pregnancy planning to support a healthy pregnancy. If the answer is no, it creates the opportunity to provide excellent, patient-centered birth control counseling and the option to choose and receive the birth control method of her choice during that same visit, rather than being asked to come back again. If the answer is not as simple as yes or no, this question allows the patient and provider to have a conversation about her reproductive health goals.

This should be considered standard care. Before working with Upstream, providers shared stories with us about patients who came in for their annual check up and did not have this conversation, only to return several months later with an unplanned, sometimes even high risk pregnancy.

This practice change is so innovative and unusual that the New York Times opened their story about us with it. Before Upstream in Delaware, very few women at health centers had a PISQ response documented in their electronic health record. That has changed dramatically.

GRAPH: % of Women of Reproductive Age With an EHR-Documented Response to a PISQ (12 Months Before and After)
Percentage of unduplicated patients age 15-44 with a PISQ response documented in a dedicated EHR field over a 12-month period prior to and following Upstream engagement. Because reporting varied slightly by agency, results are not comparable across agencies.


What does this practice transformation mean for patients? Here’s a powerful, 90 second interview with Dr. Janice Tildon-Burton, a Delaware-based OB-GYN who is also the former head of the state section of the American College of OB-GYNs. Prior to our work together, her team was not regularly asking patients a PISQ. Dr. Tildon-Burton tells a moving story about the transformative power of having the conversation: “[It] just sums up the reason why I’m here and why I do what I do.”

Helping women achieve their own goals of becoming pregnant only if and when they want to is now standard care at practices across Delaware – a simple but radical notion that will have a profound impact for generations of Delawareans.

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