Background:
Kaiser Permanente is the oldest and largest HMO in the US caring for over 8 million members, and over 6 million in California. Promotion of preconception care within a large health plan requires integrated population management approaches based on evidence. Through clinician driven research conducted with the Kaiser Permanente Northern California (KPNC) population by the Women's Health Research Institute, transference of evidence to clinical practice changes has been more rapid.

Objectives:
Share relevant research conducted by the Women's Health Research Institute within KPNC focusing on strategies that promote preconception care.
Share integrated approaches towards improving preconception care based on evidence from research conducted with the KPNC population.


Methods:
Share highlights of results of 3 research studies conducted by WHRI/KPNC about teratogen exposure, preconception care of women with diabetes, and the self report of unintended pregnancy.
Share integrated Population Management Approaches used by KPNC to improve preconception care.
Share KPNCs clinical tool: Prevention Recommendations for Women of Reproductive Age

Results:
Study results show that one in every 6 reproductive age women was prescribed a D or X category medication. 51% have no evidence of contraception use compared to 48% of women prescribed A or B category medications.
About 70% of diabetic women at KPNC planned their pregnancy. Seventy-five percent of women were contracepting during the 12 months prior to pregnancy but 54% of women reporting unintended pregnancies using least effective or no contraception. During preconception, the mean HgbA1c was 7.65 for the intended group and 8.65 for the unintended group.
Thirty-eight percent of all KPNC pregnancies are either mistimed or unwanted but there was no statistcal difference in pregnancy outcomes (PTL, LBW, Lenth of stay, NICU scores). Pregnancies that were unintended were more likely to indicate substance abuse.

Conclusion and implications for practice:
Dissemination of preconception care research conducted within KPNC has enabled operational and clinical practice changes to progress more rapidly and with greater participation from our primary care colleagues.