Implementation of postpartum LARC in Georgia
Contraception
Awarded 2015
Complex Family Planning Fellowship Research
Lisa Hofler, MD, MPH
Emory University
$52,623

Study Overview: This project explored immediate postpartum long-acting reversible contraception (LARC) program implementation in the hospital setting. Hospital teams reported that implementing immediate postpartum LARC programs involves multiple hospital departments and a number of important steps to consider.
Background: There are many advantages to LARC provision in the immediate postpartum setting. Increased interest nationwide in immediate postpartum LARC is leading many states and healthcare systems to work toward its availability. However, there is little evidence to guide the implementation of immediate postpartum LARC programs. The complexities of the implementation process, the steps required for implementation, and the needs of healthcare institutions are not well characterized.
Statement of Purpose: We sought to understand immediate postpartum LARC program implementation in the hospital setting.
Methodology: We conducted semi-structured interviews with 32 key personnel from the 10 hospitals participating in the Georgia Perinatal Quality Collaborative’s postpartum LARC initiative. We used implementation science frameworks to guide data collection and analysis. We grouped participant-identified key steps for immediate postpartum LARC program implementation into a stage-based guide for implementing immediate postpartum LARC programs. We compared the implementation guide to the steps accomplished by each hospital at the time of the final interview.
Important Findings: Common themes for the implementation experience included team member identification and ongoing communication, payer preparedness challenges, interdependent department-specific tasks, and piloting with continuing improvements. Participants expressed a need for anticipatory guidance throughout the process. Key first steps to immediate postpartum LARC program implementation were identifying project champions, creating an implementation team that included all relevant departments, obtaining financial reassurance, and ensuring hospital administration awareness of the project. Potential barriers included lack of knowledge about immediate postpartum LARC, financial concerns, and competing clinical and administrative priorities. Hospitals that were successful at implementing immediate postpartum LARC programs did so by prioritizing clear communication and multidisciplinary teamwork. While the implementation guide reflects a comprehensive assessment of the steps to implementing immediate postpartum LARC programs, not all hospitals required every step to succeed.
Conclusion: Hospital teams report that implementing immediate postpartum LARC programs involves multiple departments and a number of important steps to consider. A stage-based approach to implementation, and a standardized guide detailing these steps, may provide the necessary structure for the complex process of implementing immediate postpartum LARC programs in the hospital setting.

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