606 - Closing the Gap: Improving Inpatient Contraception Screening for Adolescents Through a Confidential Digital Tool

Publication Number: 2591.606

Aashka Dalal, Washington University in St. Louis, Saint Louis, MO, United States; Jane Alyce Hunt, Washington University in St. Louis School of Med, Saint Louis, MO, United States; Alice Jiang, Washington University School of Medicine, St louis, MO, United States; Alexandra Sprouse, Washington University in St. Louis School of Medicine, St Louis, MO, United States; Abigail Strege, St Louis Children’s Hospital, Saint Louis, MO, United States; Jinli Wang, Washington University in St. Louis School of Medicine, chesterfield, MO, United States

Background: Adolescent pregnancies are associated with adverse maternal and fetal outcomes, yet many adolescents face barriers to receiving sexual and reproductive healthcare. Hospitalization offers an opportunity to address these unmet needs. However, pediatric hospitalists report challenges to providing this care including limited knowledge, time constraints, confidentiality, and consent concerns.

Objective: Our aim was to address these barriers and increase contraception screening and provision using a novel, patient-centered, confidential contraception questionnaire with built-in clinical decision support.

Design/Methods: Patients aged ≥ 14 admitted to a general medicine service at St. Louis Children's Hospital (February 2025 - September 2025) completed a sexual health questionnaire assessing relevant medical, menstrual, and sexual history; interest in contraception; and contraception preferences. The tool automatically generated a 'Physician's Report' summarizing key survey responses, appropriate contraception options, and steps for contraception initiation for primary team review. Primary outcomes included screening for interest in contraception counseling and provision prior to discharge. Secondary outcomes included sexual history documentation (SHD); STI and pregnancy testing; and demographic factors associated with screening. Continuous and categorical variables were compared using t-tests and Chi-square tests, respectively.

Results: Of 310 post-intervention encounters, 66% (206/310) of eligible patients were screened for interest in contraception counseling; 16% (34/206) expressed interest, 79% (27/34) received counseling, and 55% (15/27) initiated contraception before discharge. Compared to 193 pre-intervention encounters (November 2024 - February 2025), there was a statistically significant increase in contraception screening (22.8% to 66.5%), SHD (53.4% to 62.6%), and pregnancy testing (48.2% to 62.9%). No significant differences were seen in contraception provision or STI testing between the two groups. Within the post-intervention group, longer length of stay was associated with higher screening rates, while age and insurance showed no significant association.

Conclusion(s): Implementation of a novel confidential contraception questionnaire with clinical decision support significantly improved contraception screening and sexual history documentation among hospitalized adolescents. Future efforts should explore factors influencing contraception provision among interested patients and reasons for declining contraception screening to further enhance reproductive health care delivery in the inpatient setting.

Types of Contraception Prescribed Inpatient