Using Provider Incentives and an Opt-Out Strategy in a Successful Quality Initiative to Increase Chlamydia Screening

Elattma, Ahmed; Laves, Ellen; Taber, Bret; Karvonen, Kayla L.; Herrera, Maria Christina; Bakken, Eliza Hayes

doi:10.1016/j.jcjq.2020.03.003

Cited by 4 publications

(1 citation statement)

References 26 publications

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“… 14 , 16 Opt-out testing may consequently lead to more equitable care. However, to date most studies evaluating opt-out testing approaches have been restricted to females 15 , 17 - 20 and have only occurred in selective clinical environments including adolescent specialty clinics, 18 STI and family planning clinics, children’s hospitals, 17 detention centers, and emergency departments. 21 , 22 Given that most adolescents and young adults receive medical care in community-based primary care clinics, 16 understanding if opt-out testing is effective in improving testing rates and providing more equitable care in these settings is essential.…”

Section: Introductionmentioning

confidence: 99%

Closing the Equity Gap: An Intervention to Improve Chlamydia and Gonorrhea Testing for Adolescents and Young Adults in Primary Care

Tomcho

Lou

O’Leary

et al. 2022

J Prim Care Community Health

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Background: Chlamydia trachomatis and Neisseria gonorrhea are the most reported sexually transmitted infections in the United States. Testing rates remain suboptimal and may be subject to implicit bias. We evaluated the effectiveness of an opt-out chlamydia and gonorrhea testing program for adolescents and young adults in improving testing rates and promoting equity. Methods: An opt-out testing program that standardized testing to once annually for 14 to 24-year-old patients was implemented across 28 federally qualified health centers spanning 4 specialties. A quasi-experimental design using interrupted time series analyses evaluated testing and infection rates between baseline, intervention, and pandemic-associated test shortage periods. Reduction in testing inequities based on sex, race, ethnicity, insurance, and language preference were also examined. Results: A total of 57 452 encounters during the baseline, 17 320 during the intervention, and 26 993 during the test supply shortage periods were included. Testing increased from 66.8% to 81.0% (14.2% absolute increase) between baseline and intervention periods. Pediatric clinics demonstrated the largest improvement compared to other settings (absolute increase 30.9%). We found significant reductions in testing inequities for language preference ( P < .001), and un-insured and public insured individuals ( P < .001). More cases of chlamydia and gonorrhea were detected in the intervention period (chlamydia-29.7; gonorrhea-7.4 per 1000 patients) than in the baseline period (chlamydia-20.7; gonorrhea-4.4 per 1000 patients; P < .001). Conclusions: An opt-out approach increased testing, reduced inequities between some groups and detected more infections than a risk-based approach. Opt-out testing should be considered as an approach to increase detection of chlamydia and gonorrhea and promote equity.

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Section: Introductionmentioning

confidence: 99%

Closing the Equity Gap: An Intervention to Improve Chlamydia and Gonorrhea Testing for Adolescents and Young Adults in Primary Care

Tomcho

Lou

O’Leary

et al. 2022

J Prim Care Community Health

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Adolescent Chlamydia Screening in Pediatric Primary Care: A Quality Improvement Project

Foppert,

Bowles,

Belardo

et al. 2024

Journal of Advanced Nursing

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AimTo increase Chlamydia trachomatis screening in adolescents 15–19 years of age from 7.8% to 15% following a 6‐week implementation of universal chlamydia screening at three paediatric primary care (PPC) sites.MethodsPre‐implementation (1 January 2022–19 October 2022) and post‐implementation (20 October 2022–1 June 2023) screening rates were tracked through run charts and compared via Chi‐square testing. Universal opt‐out chlamydia screening with universal urine collection for 15‐ to 19‐year‐old was implemented at well visits, along with patient and staff education, and sexually transmitted infection treatment protocols.ResultsChlamydia trachomatis screening increased from 7.8% to 34.1% with implementation of universal opt‐out chlamydia screening. Proportions of patients screened increased significantly among White individuals, males and privately insured individuals.ConclusionsA universal C. trachomatis screening project can be feasibly implemented in pediatric primary care and successfully increase adolescent chlamydia screening rates.Implications for the ProfessionImplementing a universal opt‐out C. trachomatis screening project is feasible in PPC and can help achieve the public health goal of chlamydia identification and treatment.ImpactThese findings will be impactful for both paediatric primary care and adolescent patients. The universal, opt‐out C. trachomatis screening approach facilitated screening increases, improved equity in screening and led to increased case detection and treatment which has vast significance for those patients.Reporting MethodThis manuscript is submitted using the SQUIRE 2.0 guidelines for quality improvement reporting.Patient ContributionPatient contribution included de‐identified data collection of chlamydia screening rates of eligible adolescents 15–19 years old who attended routine well visits at the three PPC locations. The data were reviewed on a dashboard, then stratified by race, ethnicity, payor and sex assigned at birth.

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An Intervention to Improve Chlamydia and Gonorrhea Testing Among Adolescents in Primary Care

Tomcho¹,

Lou

O’Leary³

et al. 2021

Pediatrics

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BACKGROUND AND OBJECTIVES Rates of chlamydia and gonorrhea among adolescents continue to rise. We aimed to evaluate if a universal testing program for chlamydia and gonorrhea improved testing rates in an urban general pediatric clinic and an urban family medicine clinic within a system of federally qualified health care centers and evaluated the feasibility, cost, and logistic challenges of expanding implementation across 28 primary care clinics within a federally qualified health care centers system. METHODS A universal testing quality improvement program for male and female patient 14 to 18 years old was implemented in a general pediatrics and family medicine clinic in Denver, Colorado. The intervention was evaluated by using a controlled pre-post quasi-experimental design. The difference in testing rates due to the intervention was assessed by using a difference-in-differences regression model weighted with the inverse probability of treatment. RESULTS In total, 15 541 pediatric encounters and 5420 family medicine encounters were included in the analyses. In pediatrics, the unadjusted testing rates increased from 32.0% to 66.7% in the intervention group and from 20.9% to 28.9% in the comparison group. For family medicine, the rates increased from 38.5% to 49.9% in the intervention group and decreased from 26.3% to 24.8% in the comparison group. The intervention resulted in an adjusted increase in screening rates of 25.2% (P < .01) in pediatrics and 11.8% (P < .01) in family medicine. The intervention was well received and cost neutral to the clinic. CONCLUSIONS Universal testing for chlamydia and gonorrhea in primary care pediatrics and family medicine is a feasible approach to improving testing rates .

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Using Provider Incentives and an Opt-Out Strategy in a Successful Quality Initiative to Increase Chlamydia Screening

Cited by 4 publications

References 26 publications

Closing the Equity Gap: An Intervention to Improve Chlamydia and Gonorrhea Testing for Adolescents and Young Adults in Primary Care

Closing the Equity Gap: An Intervention to Improve Chlamydia and Gonorrhea Testing for Adolescents and Young Adults in Primary Care

Adolescent Chlamydia Screening in Pediatric Primary Care: A Quality Improvement Project

An Intervention to Improve Chlamydia and Gonorrhea Testing Among Adolescents in Primary Care

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