title: Implementing Immediate Postpartum Long-Acting Reversible Contraception Programs.
abstract: To understand the most important steps required to implement immediate postpartum long-acting reversible contraception (LARC) programs in different Georgia hospitals and the barriers to implementing such a program.
  
  
  
  This was a qualitative study. We interviewed 32 key personnel from 10 Georgia hospitals working to establish immediate postpartum LARC programs. Data were analyzed using directed qualitative content analysis principles. We used the Stages of Implementation to organize participant-identified key steps for immediate postpartum LARC into an implementation guide. We compared this guide to hospitals' implementation experiences.
  
  
  
  At the completion of the study, LARC was available for immediate postpartum placement at 7 of 10 study hospitals. Participants identified common themes for the implementation experience: team member identification and ongoing communication, payer preparedness challenges, interdependent department-specific tasks, and piloting with continuing improvements. Participants expressed a need for anticipatory guidance throughout the process. Key first steps to immediate postpartum LARC program implementation were identifying project champions, creating an implementation team that included all relevant departments, obtaining financial reassurance, and ensuring hospital administration awareness of the project. Potential barriers included lack of knowledge about immediate postpartum LARC, financial concerns, and competing clinical and administrative priorities. Hospitals that were successful at implementing immediate postpartum LARC programs did so by prioritizing clear communication and multidisciplinary teamwork. Although the implementation guide reflects a comprehensive assessment of the steps to implementing immediate postpartum LARC programs, not all hospitals required every step to succeed.
  
  
  
  Hospital teams report that implementing immediate postpartum LARC programs involves multiple departments and a number of important steps to consider. A stage-based approach to implementation, and a standardized guide detailing these steps, may provide the necessary structure for the complex process of implementing immediate postpartum LARC programs in the hospital setting.
authors.affiliation: Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Hofler
authors.forename: Sarah
authors.initials: S
authors.lastname: Cordes
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Cwiak
authors.forename: Peggy
authors.initials: P
authors.lastname: Goedken
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.forename: Melissa
authors.initials: M
authors.lastname: Kottke
mesh_terms: D003142:Communication; D003267:Contraception / Q000191:economics; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D004343:Drug Implants; D057286:Electronic Health Records; D005260:Female; D005377:Financial Management, Hospital; D005845:Georgia; D006284:Health Plan Implementation / Q000458:organization & administration*; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D007434:Intrauterine Devices; D024802:Nurse's Role; D010607:Pharmacy Service, Hospital; D010819:Physician's Role; D049590:Postpartum Period; D016730:Program Development / Q000379:methods*; D012051:Reimbursement Mechanisms
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants