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Dissemination of Lean Methods to Improve Pap Testing Quality and Patient Safety

Raab, Stephen S. MD1; Andrew-Jaja, Carey MD2; Grzybicki, Dana M. MD, PhD3; Vrbin, Colleen M. BS1; Chesin, Carole M. MD2; Fisch, John M. MD2; Dabbs, David J. MD1; Sommer, Deborah L. MD2; Blaser, Sandra M. CNM2

Journal of Lower Genital Tract Disease:
doi: 10.1097/LGT.0b013e31815ae9a1
Original Articles
Spanish Translation
Abstract

Objective. To determine if the implementation of Lean methods resulted in improved Pap test quality and diagnostic accuracy in 5 clinician practices.

Materials and Methods. We performed a 1-year case-control study that included 5,384 control (preintervention) and 5,442 case (postintervention) women who had a Pap test procured by 1 of 5 clinicians. Using Lean methods, the clinicians increased their focus of Pap test procurement by creating a "one-by-one" workflow and recorded process completion using a Lean checklist. We compared the case and control Pap test quality and accuracy measures using the proportion of Pap tests lacking a transformation zone component, proportion of unsatisfactory Pap tests, frequency of newly detected cervical intraepithelial neoplasia following a previous benign Pap test, and proportion of Pap tests with a diagnosis of atypical squamous cells of unknown significance.

Results. After the intervention, there was a statistically significant decrease in the mean proportion of Pap tests lacking a transformation zone component, p =.011. Two of 5 clinicians showed a statistically significant decrease in their unsatisfactory Pap test frequency, although the overall Pap test unsatisfactory frequency for the case group was not statistically significant lower, p =.087. The case group showed a 114% increase in newly detected cervical intraepithelial neoplasia following a previous benign Pap test, p =.004. There was no statistically significant difference for the proportion of Pap tests with a diagnosis of atypical squamous cells of unknown significance, p =.908.

Conclusions. Disseminating Lean methods across a group of clinicians resulted in improved Pap test quality and diagnostic accuracy.

In Brief

Dissemination of Lean process redesign within a group of clinicians who procure Pap tests with improved sampling and significantly lowered cervical cancer screening errors.

Author Information

1Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 2Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, PA, and 3Department of Biomedical Informatics, University of Pittsburgh Medical Center, Pittsburgh, PA

Reprint requests to: Stephen S. Raab, MD, UPMC Cancer Pavilion 2nd Floor, Department of Pathology, 5150 Centre Ave, Pittsburgh, PA 15232. E-mail: raabss@upmc.edu

This study was supported by a grant from the Jewish Healthcare Foundation and grant HS13321-01 from the Agency for Healthcare Research and Quality.

©2008The American Society for Colposcopy and Cervical Pathology