135. Piloting a Quality Improvement Package for Adolescent Sexual and Reproductive Health Care in Community Health Centers: Getting to Quality for Teens (Q4T)

Equitable provision of quality adolescent sexual and reproductive health (ASRH) services (e.g., contraceptive and sexually transmitted infections [STI] services) can reduce rates of unintended pregnancies, HIV, and other STIs and disparities in these outcomes. Despite ASRH practice recommendations from national organizations, including the Society for Adolescent Health and Medicine, gaps in implementation persist. To support scale-up of ASRH-related quality improvement (QI) efforts, the Centers for Disease Control and Prevention (CDC) collaborated with the National Association of Community Health Centers and Cicatelli Associates, Inc. to support the Quality and Access for Reproductive Health Equity for Teens (QARE, pronounced ‘care’) for Teens project. This initiative included the development of an ASRH QI package (Quality for Teens or Q4T) that collates rapid cycle, actionable change strategies and implementation resources. Following our presentation on the development of Q4T at SAHM 2022, here we summarize results from pilot testing and subject matter expert review. Q4T was piloted from January to May 2022 with four health centers from diverse settings with varying experience in ASRH service delivery and QI. The pilot aimed to gather feedback on the extent to which the package helps health centers identify gaps in current ASRH service delivery, select ASRH improvement goals, and implement change strategies to reach those goals. During monthly virtual meetings, collaborators gathered feedback on the utility of the package and suggestions for strengthening the content and format. Successes and challenges, implementation barriers and facilitators, and additional implementation tips were also collected from the four health centers via online surveys. Additionally, we queried subject matter experts (SMEs) at CDC, the Office of Population Affairs, and the Health Resources and Services Administration via email to elicit feedback on the package. Overall, pilot sites and SMEs provided positive feedback on the package, indicating the content was comprehensive and well-organized and supportive of providers with a range of experience. The majority of tools/resources were seen as helpful and implementation tips were highly valued. We also received numerous suggestions to strengthen the content and format of package. Suggestions included integrating content on organizing a QI implementation team and engaging senior leadership, including performance measures, and clarifying health equity elements. Participants provided over 40 additional implementation tips, as well as feedback to enhance the trauma-informed approach section. Regarding format, suggestions involved incorporating interactive components: a needs assessment with clear direction for next steps based on findings; an action plan; and a QI implementation structure (e.g., interactive timelines and flowcharts). The pilot sites recommended establishing learning collaboratives to support QI implementation using the package and linking newly engaged health centers with experienced Q4T health centers to support sharing of lessons learned. Pilot and SME feedback suggest Q4T has the potential to support implementation of ASRH QI in health centers. Findings will inform revisions to the package. Building interactive components and supporting future implementation of learning collaboratives are being explored.