Implementation of One Key Question® at an Urban Teaching Hospital: Challenges and Lessons Learned

Abstract

Introduction: One Key Question® is a patient-centered tool that seeks to understand patient pregnancy intention and counseling. This pilot study aimed to assess implementation of OKQ at an urban healthcare facility and improve understanding of short interpregnancy intervals (IPI). Methods: We describe the implementation of OKQ in our setting using the Diffusion of Innovation Theory as a framework. We broke this up into two phases – the first to assess provider acceptance of the OKQ integration into the clinic workflow and the second to assess how well documentation of OKQ answers occurred in our EMR. Results: Most providers in the first phase reported awareness of the inclusion of OKQ in the EHR, yet most physician providers reported only using OKQ at “some visits” (n=5) compared to the MAs, who reported using OKQ at “every visit” (n=8). Most providers felt that OKQ was an effective method of providing preconception and contraception care for women of reproductive age (n=10). Sixty-four patients completed a survey on OKQ after their visit who identified as young (mean age 28.7), either Black (46.9%) or Hispanic (51.6%) and pregnant (61%). Of those, 83% reported that they were not asked OKQ and 42% reported receiving counseling on optimal IPI. In those patients, 78% had documentation of usage of OKQ in the medical record. Discussion: The implementation of OKQ provided an opportunity to provide standardized preconception and contraception care to our patient population and improve information regarding short IPI. However, challenges existed in implementation which much be overcome to benefit from OKQ. Significance: OKQ has been used successfully in primary care and other settings to assess pregnancy intentions. This article adds to the literature by investigating the implementation of OKQ in a low-resource setting during prenatal and gynecology care. It shares struggles of implementing OKQ in an electronic medical record and how to roll out this program in a setting where pregnancy intention already is including in various forms by our providers.