The Community Health Center - Reproductive Life Plan (CHC-RLP) Project - PROJECT SUMMARY/ABSTRACT
Background: A key strategy to the prevention of adverse maternal and child outcomes, like maternal and
infant mortality, is the delivery of high-quality health care before and after pregnancy (pre and inter-conception
care). In these encounters, the exploration of patients’ pregnancy desires allows for the provision of patient-
centered counseling and services based on those goals to support the health of future pregnancies and
prevent unintended ones. Primary Care Providers (PCPs), who care for most non-pregnant women of
reproductive age, are essential partners in this effort, yet studies show they are less likely than their obstetric
counterparts to provide preconception or contraceptive health care. Structured reproductive health
assessments, known as reproductive life plans (RLP), have been promoted as a strategy to routinely integrate
preconception care into clinical care, and one such tool, One Key Question® (OKQ), holds particular promise
for PCPs, as it allows for a meaningful, brief, assessment without the need to be a reproductive health expert.
Objectives: The Community Health Center-Reproductive Life Plan (CHC-RLP) Project, led by
AllianceChicago, a HRSA funded Health Center-controlled network with a shared data infrastructure including
OKQ® as a structured field, will assess the impact of OKQ® implementation on reproductive health metrics in
the community health, primary care, setting. In partnership with Friend Health, a CHC in the South Side of
Chicago, and a team of researchers, the CHC-RLP Project will achieve two specific aims: 1) conduct a
structured training for OKQ® implementation, harnessing the electronic health record (EHR) as a tool; and 2)
leverage EHR data and utilize an implementation science framework to determine whether OKQ®
implementation influences reproductive health (preconception and contraceptive care) metrics.
Methods: This randomized control trial will be guided by the Reach, Effectiveness, Adoption, Implementation
and Maintenance, (RE-AIM) framework. Randomization will occur at the level of the primary care provider, and
randomized providers will receive structured OKQ® training, including both clinical guidance as well as support
for incorporating OKQ® into clinic workflow and documentation in the EHR. After 12 months of implementation,
EHR data on service provision and outcomes will be explored to determine success of the implementation and
differences in reproductive health outcomes (contraceptive provision and folic acid supplementation) between
the patients who received care from the providers in the intervention group as compared to patients from the
providers in the control, usual-care, group.
Implications of expected findings: The results will inform a future large-scale efficacy trial, which has the
potential to lead the Centers for Medicare & Medicaid Services to endorse RLP as a quality metric, and further
validate the notion of health information technology as a tool to mitigate health disparities.
