Evaluating a Quality Improvement Program for Cervical Cancer Screening at an Urban Safety Net Clinic

Abstract

This article evaluates a quality improvement program for improving guideline-consistent cervical cancer screening practices in an urban safety net clinic. Quality improvement initiatives that combine policy with practice are particularly timely in light of the alignment of cervical cancer screening guidelines released in 2012 by the most influential national organizations. A descriptive comparison design was employed using the Healthy People 2020 target of 93% screened according to guidelines. Provider-, patient-, and workflow-based strategies included (1) addition of a clinical decision support system, (2) provider educational outreach, (3) patient reminder letters, and (4) development of a clinic procedure manual. Through the application of an established quality measurement tool, three quality indicators were measured: screened according to evidence-based guidelines, not screened, and screened more frequently than recommended. Data from the sample (N = 1,032) were collected at baseline and 12 months postimplementation. Each quality indicator category was significant at follow-up. Patients screened according to guidelines nearly doubled while the number of underscreened patients was reduced by nearly half. Similarly, there was a threefold decrease in patients screened more frequently than recommended. Clinical administrators, quality improvement specialists, and health care providers in primary care settings can use the strategies implemented in this study as a starting point for continuous quality improvement initiatives for cervical cancer screening.

‘I’m a bit of a champion for it actually’: qualitative insights into practitioner-supported self-collection cervical screening among early adopting Victorian practitioners in Australia

“…Another important finding from this study was that, while practitioners considered themselves as champions of self-collection, their ability to adopt a ‘ whole of practice’ approach to the implementation of the restricted self-collection cervical screening pathway remained resource dependent. Both practice champions and utilising a ‘whole of practice’ approach have been found to been characteristics of successful interventions in improving cancer screening participation within primary practice (Shaw et al., 2013 ; Hills et al., 2015 ; Weiner et al., 2017 ; Bakhai et al., 2018 ). This point is pertinent as considerations are given to how the Australia health system can foster greater adoption of self-collection cervical screening by primary care.…”

Primary care practice-based interventions and their effect on participation in population-based cancer screening programs: a systematic narrative review

“…Twenty-two studies from the US (n = 18), Canada (n = 3) and Australia (n = 1) were multi-component non-randomized trials (Potter et al, 2011;Kaczorowski et al, 2013;Dorrington et al, 2015;Harris et al, 2015;Hills et al, 2015;Mader et al, 2016;Marx et al, 2016;Wu et al, 2016;Baxter et al, 2017;Green et al, 2017;Hountz et al, 2017;Weiner et al, 2017;Bakhai et al, 2018;Nguyen et al, 2020;Desai et al, 2021;Funes et al, 2021;Frissora et al, 2021;Hussain et al, 2021;Jones et al, 2022;Ruggeri et al, 2020;Walker-Smith and Baldwin, 2020;Willemse et al, 2022) (Table 3).…”

Technology-Enabled and Artificial Intelligence Support for Pre-Visit Planning in Ambulatory Care: Findings From an Environmental Scan

“…Less common were activities on the day of an appointment, though key informants indicated that they thought huddling was likely more common than reported in studies, suggesting that some PVP practices may be routine and not described as part of an innovative practice change. Pre-visit planning practices identified in the literature mostly encompassed 2-3 16,[18][19][20][21][22]24,25,[28][29][30][31][32][33] of the AMA's 10 steps while 5 studies reported just 1 activity (though these were substantive efforts to prepare the patient for a productive visit), 15,26,[34][35][36][37] and 9 studies reported 4 or more steps, 5,17,23,27,38,[39][40][41][42] with 8 being the most steps reported in 1 article. 5 Pre-visit planning seems to be used primarily to ensure that health maintenance is up to date, current laboratory data are available, and patients have set priorities for their visit.…”

“…Both the literature and the interviews revealed a focus on a high-risk group (eg, patients with diabetes or those taking opioids), 5,23,28,30,[33][34][35][36] and/or quality metrics (eg, pneumococcal vaccination rates) as common strategies for implementing PVP. 5,[15][16][17][18][19][20][21][22][23][24] Most efforts with an evaluative element (14 of 24) described in the literature were implemented within a process improvement setting and utilized quality improvement, plan-do-study-act, or Lean methods. Such approaches seemed to be a facilitating factor for implementation as multiple improvement cycles were often utilized to develop a sustainable workflow.…”