How to Interpret and Use Contraceptive Use eCQM Results

Primary measure interpretation. CU-SINC, Postpartum and Non-Postpartum are reported as percentages. Unlike many quality measures, there is no target score or “benchmark” for the CU-SINC measures. Some patients will make informed decisions to use a non-prescription method, even when offered the full range of methods, or choose not to use a method at all. While the use of SINC excludes those who indicate they do not want to discuss contraception, even those who want to discuss contraception may not be interested in a prescription method. This means that the measure score is not expected to reach 100% and there is no specific identified threshold. As a general guideline, building on results from initial pilot testing, we consider a CU-SINC percentage of 20% low, suggesting the need for increased access, and 80% high, suggesting the need to ensure that contraceptive care is conducted in a patient-centered manner. 

The goal of providing contraception should never be to promote any one method or class of methods over a patient’s individual choices. As there is increased use of this measure over time, we will have an increased understanding of the range of scores and can publish additional guidance for interpretation. Individual facilities and clinics can use their scores over time to document changes in response to clinical or health systems interventions.

LARC-SINC interpretation. The LARC-SINC submeasure assesses whether LARC methods are available to those who want them. This submeasure is a “floor” measure, used to identify patients who have very limited or no access to LARC methods, which are more commonly inaccessible than other methods. For this reason, and aligned with the guidance for the claims-based Contraceptive Care measures, the target of the LARC-SINC submeasure is to reach a provision threshold of 2%. The LARC-SINC submeasure should not be used to encourage high rates of use, as this could lead to coercive practices related to contraception, especially practices targeting racial/ethnic minorities and low-income individuals. For this same reason, it is not appropriate to use the LARC-SINC submeasure in a pay-for-performance context.

While there are currently no benchmarks for the CU-SINC primary measures, they can still be used as a source of information on contraceptive access and used to inform targets for quality improvement. CU-SINC measures are designed to capture an estimate of contraceptive access on an annual basis. Measures should be tracked over time and monitored for change, with a focus on identifying and addressing low scores that may represent emergent barriers to access. Additionally, these scores, when tracked over time, can be used to evaluate quality improvement efforts seeking to advance access to contraceptive care. 

Two specific areas that agencies may want to examine for quality improvement opportunities include: 

1. Range of scores between facilities. If CU-SINC percentages differ substantially between different health care facilities, this may indicate opportunities to investigate and optimize access to methods within facilities with comparably lower scores. 
2. Method mix. Agencies may also want to look at percentages of use by each type of contraceptive method to ensure access to a full range of methods. If, for example, upon examination, percentage of patients reporting injectable contraception is around 1% while other short-acting methods are around 15%, agencies may want to investigate whether injectables are being stocked or other barriers exist to that method. We note that in assessing method mix it is important to consider the possibility that percentages may truly be reflective of patient preferences and lower percentages should not result in overpromotion of any particular method but rather be used as a signal of investigation to ensure that no barriers exist should a patient prefer that method. 

Development of the CU-SINC measures, formerly known as “SINC-based eCQMs”, began in 2019 and was partially funded by the Office of Population Affairs (OPA). To ensure the measures could be utilized in federal accountability programs and other larger-scale quality measurement initiatives, our team sought endorsement from the federally accredited, Centers for Medicare and Medicaid Services’ Consensus-Based Entity, which at that time was the National Quality Forum (NQF). This endorsement represents the national standard for evaluating and promoting quality measures. We received trial use endorsement from NQF in 2022, with the understanding that a full endorsement application would be submitted within a three-year period. “Trial Use” status allowed the measure to be used in healthcare facilities, while we continued to collect sufficient data to conduct validity and reliability analyses.  

Our team spent two years piloting, socializing, and supporting implementation of SINC. We then worked with two data partners to extract EHR data to analyze the validity and reliability of the measures. After rigorous testing and application preparation, we applied for endorsement in spring 2025 to the current Consensus-Based Entity, Partners for Quality Measurement. CU-SINC measures were fully endorsed by the PQM Recommendations Committee in fall 2025. 

Please visit the PQM’s webpages on CU-SINC (CU-SINC, Postpartum | CU-SINC, Non-postpartum) for information on measure background and specifications.

Non-prescription methods. The specifications of CU-SINC measure only capture the use of most or moderately effective contraceptive methods, including contraceptive pills, patches, injectables, and LARC methods (i.e. intrauterine device [IUD], implant). While other methods, like condoms, are important tools widely used by patients, our research into the feasibility of capturing necessary data elements showed that these methods are inconsistently captured in structured fields within electronic health records. As EHR documentation improves, we hope to expand the numerator definition of these measures to include non-prescription methods.

Use of a balancing measure. While the use of SINC to refine the denominator of CU-SINC focuses the measure only on those who express interest in contraceptive counseling, there is still a risk that use of these performance measures alone may not fully protect against coercive counseling practices. Providers may see low CU-SINC scores and feel pressure to have patients use contraception. Given the history and modern-day execution of coercive counseling practices, attention to the potential of access measures to incentivize coercion in contraceptive care is important. For this reason, we recommend using CU-SINC alongside a measure of patient experience to ensure that care is provided in a person-centered manner (see below). 

CU-SINC was designed to be used to monitor changes in score over time, as well as to be analyzed alongside balancing measures that can help identify suboptimal contraceptive counseling. Using CU-SINC simultaneously with other contraceptive care quality measures may offer a deeper understanding of measure scores and the relationship between contraceptive use and provision and person-centered care. Specifically, patient experience measures can be used as balancing measures to CU-SINC to identify potential areas for quality improvement initiatives, as many factors contribute to quality. 

Our team at PCRHP created the Person-Centered Contraceptive Counseling (PCCC) measure, which is recommended to be used alongside CU-SINC to deepen the assessment of contraceptive care quality. For more information on PCCC, visit our website on PCCC implementation. 

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