Contraceptive Care Screening eCQM | Person Centered Reproductive Health Program

Contraceptive care services support individuals to achieve their reproductive goals, including delaying or preventing pregnancy when desired. Integrating and optimizing contraceptive care into routine healthcare supports patient preferences, reinforces reproductive health care as part of whole-person care, and can result in increased provision of contraception to those who want the service. However, competing priorities can make it challenging to identify and address patients’ contraceptive needs, especially in primary care settings.

The Contraceptive Care Screening electronic clinical quality measure (eCQM; CCS-SINC) measures the percent of female-identified patients asked whether they want to discuss contraception at least once in a calendar year. This performance measure serves to motivate and enable efficient and patient-centered contraceptive need screening and is optimized for use in primary care settings.

CCS-SINC utilizes the Self-Identified Need for Contraception (SINC) screening question, which is a simple, patient-centered screening tool that helps providers quickly assess contraceptive need while supporting reproductive autonomy, as its measure of contraceptive need screening. For more on SINC development and implementation support, refer to our SINC webpage. Following the development and pilot implementation of the SINC screening question, our team created an eCQM to enhance the monitoring of SINC screening practices and workflow integration.

CCS-SINC was endorsed by the federally accredited, consensus-based entity, the Partnership for Quality Measurement (PQM), in the spring of 2025. More information on this process is available on PQM’s website, including our CCS-SINC application materials.

Self-Identified Need for Contraception Screening Question

Measure Specifications

CCS-SINC Measure Description: the percentage of patients with documented “female” sex in the electronic health record (EHR) and ages 15-44 years who were asked if they wanted to talk about contraception or pregnancy prevention and had their response recorded during the measurement period (which is a calendar year), among patients with a qualifying encounter (QE). The SINC question and its response options are specified in the LOINC code system and published online as a value set named “Self-Identified Need for Contraception (SINC)” (OID: 2.16.840.1.113762.1.4.1166.115) in the National Library of Medicine (NLM) Value Set Authority Center (VSAC, https://vsac.nlm.nih.gov/ - registration required).

Measurement period: The measurement period is a single calendar year.

Level of analysis: The measure is calculated at the facility level .

Inclusion criteria: All patients with documented “female” sex in the EHR, ages 15-44 years who had a QE at the specified facility during the measurement period

Exclusion criteria

Pregnant and postpartum patients
- This measure excludes individuals who receive prenatal care for a pregnancy that would make them eligible for postpartum contraception during the measurement period. Individuals who receive peripartum care have reproductive health needs that are distinct and bound to the timing of their pregnancy and delivery (e.g., most pregnant individuals receive contraceptive counseling at visits occurring during the third trimester of pregnancy ). Screening for contraceptive need during and directly following pregnancy is already well-incorporated into workflows and systems of care.
Patients who are anatomically infecund or have undergone sterilization procedures

Measure Flow Diagram

Inclusion Flow Diagram Contraceptive Care Screening eCQM

Denominator

The measure denominator includes patients with documented “female” sex in the EHR aged 15-44 who had a QE during the measurement period. Age is calculated with the start of the measurement period as an anchor date.

Denominator exclusions:

Patients are excluded from the denominator if:
- they had a live birth and are eligible for postpartum contraception during the measurement period (i.e., had a prenatal care visit plus a documented live birth delivery date or documented estimated delivery date without a non-live birth event between 3 months prior to the measurement period and 9 months into the measurement period),
- are anatomically infecund (i.e., due to removal of uterus and/or both ovaries), or
- have had female sterilization (i.e., use permanent contraception)

Numerator

The numerator includes patients in the denominator who were asked the SINC question during the measurement period and had at least one documented response.

Numerator exclusions:

Patients who were not asked the SINC screening question in the measurement period

Measure Calculation

How to calculate CCS-SINC

Step 1. Identify all patients with documented “female” sex in the EHR, ages 15-44 years who had a QE at the specified facility during the measurement period (calendar year)

Step 2. Define the denominator by excluding patients who:

Had a live birth making them eligible for postpartum contraception in the measurement period: Those who had a prenatal care visit in the year prior to the measurement period through the first 9 months of the measurement period (i.e., 1/1/XX-1 through 9/30/XX) with a documented live birth delivery date, or a documented estimated delivery date (EDD) between 3 months prior to the measurement period and 9 months into the measurement period (i.e., 10/1/XX-1 through 9/30/XX), provided that those with EDD only did not have a documented ectopic pregnancy, intrauterine fetal demise, early pregnancy loss, or abortionAre anatomically infecund: those with documentation of anatomical infecundity due to removal of uterus and/or bilateral ovaries during year prior to the measurement period and through the measurement period (i.e., 1/1/XX-1 through 12/31/XX)
Have had female sterilization (e.g., bilateral tubal ligation, or bilateral salpingectomy): Those with documentation of a bilateral tubal ligation or bilateral salpingectomy for female sterilization during the year prior to the measurement period and through the measurement period (i.e., 1/1/XX-1 through 12/31/XX)

Step 3. Define the numerator by identifying patients in the denominator who were asked the Self-Identified Need for Contraception (SINC) question and had at least one documented response during the measurement period

Step 4: Calculate the measure rate by dividing the numerator by the denominator, which gives the percentage who were asked the SINC question

Interpretation and Use

CCS-SINC scores are represented as a percentage, with 100% representing the highest level of care. This would indicate that all eligible patients were asked SINC in the calendar year, which is the goal of the quality metric. While SINC can be used in diverse health care settings l settings, this eCQM is generally recommended for analysis in primary care settings.

Note: In interpreting scores, health systems should consider what SINC workflows are in place (e.g. are there mechanisms in place to flag /remove from workflow patients who do not want to be asked SINC?). Depending on how SINC is implemented, best possible CCS-SINC score may be less than 100%.

Approaches to improving performance. Improving performance on this score entails optimizing integration of SINC into clinical workflows and electronic health records to ensure routine annual SINC screening of patients. For information on optimizing SINC in healthcare settings, see our SINC implementation guide.