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- Title
Using a Frontline Staff Intervention to Improve Cervical Cancer Screening in a Large Academic Internal Medicine Clinic.
- Authors
Heidemann, Danielle L; Adhami, Angie; Nair, Anupama; Haftka-George, Alexis; Zaidan, Mariam; Seshadri, Vaidehi; Tang, Amy; Willens, David E.
- Abstract
<bold>Background: </bold>Cervical cancer is the third most common malignancy affecting women. Screening with Papanicolaou (Pap) tests effectively identifies precancerous lesions and early-stage cervical cancer. While the nationwide rate of cervical cancer screening (CCS) is 84%, our urban general internal medicine (GIM) clinic population had a CCS rate of 70% in 2016.<bold>Objective: </bold>To improve our clinic's CCS rate to match or exceed the national average within 18 months by identifying barriers and testing solutions.<bold>Design: </bold>A quality improvement project led by a multidisciplinary group of healthcare providers.<bold>Participants: </bold>Our GIM clinic includes 16 attending physicians, 116 resident physicians, and 20 medical assistants (MAs) with an insured and underserved patient population.<bold>Intervention: </bold>Phase 1 lasted 9 months and implemented CCS patient outreach, patient financial incentives, and clinic staff education. Phase 2 lasted 9 months and involved a workflow change in which MAs identified candidates for CCS during patient check-in. Feedback spanned the entire study period.<bold>Main Measures: </bold>Our primary outcome was the number of Pap tests completed per month during the 2 study phases. Our secondary outcome was the clinic population's CCS rate for all eligible clinic patients.<bold>Key Results: </bold>After interventions, the average number of monthly Pap tests increased from 35 to 56 in phase 1 and to 75 in phase 2. Of 385 patients contacted in phase 1, 283 scheduled a Pap test and 115 (41%) completed it. Compared to baseline, both interventions improved cervical cancer screening (phase 1 relative risk, 1.86; 95% CI, 1.64-2.10; P < 0.001; phase 2 relative risk, 2.70; 95% CI, 2.40-3.02; P < 0.001). Our clinic's CCS rate improved from 70% to 75% after the 18-month intervention.<bold>Conclusions: </bold>The rate of CCS increased by 5% after a systematic 2-phase organizational intervention that empowered MAs to remind, identify, and prepare candidates during check-in for CCS.
- Subjects
MEDICAL assistants; CERVICAL cancer; EARLY detection of cancer; INTERNAL medicine; PHYSICIANS; MEDICAL personnel; HEALTH care reminder systems
- Publication
JGIM: Journal of General Internal Medicine, 2021, Vol 36, Issue 9, p2608
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-021-06865-8