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Kiyomi Goto DO

  • Graduate 2017
Scholarly Research Project

Using “One Key Question” to Address Pregnancy Intention in the UPMC Shadyside Family Health Center

Kiyomi K. Goto, DO; Jessica Brubach; Lisa Schlar, MD
University of Pittsburgh Medical Center Shadyside Family Medicine Residency, Pittsburgh, Pennsylvania


The rate of unintended pregnancy in the U.S. is 49%, which is associated with detrimental prenatal behaviors and adverse pregnancy outcomes. From 2014-2016, the unintended pregnancy rate was 42% among prenatal patients at the UPMC Shadyside Family Health Center (SHY FHC). Although providers do not routinely inquire about reproductive intentions, preconception health care is increasingly recognized as an important component of reproductive care. One Key Question (OKQ), a practice developed in Oregon and endorsed by many professional organizations, was chosen as a model for guiding provider inquiry about reproductive intentions to improve care.


A smart phrase to document reproductive intention was created with EPIC programmers at UPMC Shadyside. We asked providers to incorporate OKQ into all visits with women of reproductive age (ages 18-45), excluding adolescents. An automated report was built to determine the number of times the smart phrase was used. Data from monthly reports were reviewed starting in March 2017.


We will report rates of OKQ provider inquiry among reproductive-age women at the SHY FHC. We will report rates of contraception use among women not desiring pregnancy, and rates of multivitamin with folate use in women desiring pregnancy and how often providers made referrals for care based on pregnancy intention.


There are no published studies regarding OKQ effectiveness. Despite the barriers to OKQ smart phrase use among providers in a busy practice setting, we expect that using OKQ will enable providers to better address patients’ reproductive needs and potentially reduce rates of unintended pregnancy.