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Performance of Implementing Guideline-Driven Cervical Cancer Screening Measures in an Inner-City Hospital System

Wieland, Daryl L. MD1,2; Reimers, Laura L. MPH2; Wu, Eijean MD, MPP2; Nathan, Lisa M. MD, MPH2; Gruenberg, Tammy MD1,2; Abadi, Maria MD2,3; Einstein, Mark H. MD, MS1,2,4

Journal of Lower Genital Tract Disease: October 2011 - Volume 15 - Issue 4 - pp 296-302
doi: 10.1097/LGT.0b013e3182112f22
Original Articles

Objective: In 2006, the American Society for Colposcopy and Cervical Pathology updated evidence-based guidelines recommending screening intervals for women with abnormal cervical cytology diagnosis. In our low-income inner-city population, we sought to improve performance by uniformly applying the guidelines to all patients. We report the prospective performance of a comprehensive tracking, evidence-based algorithmically driven call back, and appointment scheduling system for cervical cancer screening in a resource-limited inner-city population.

Materials and Methods: Outreach efforts were formalized with algorithm-based protocols for triage to colposcopy, with universal adherence to evidence-based guidelines. During implementation from August 2006 to July 2008, we prospectively tracked performance using the electronic medical record with administrative and pathology reports to determine performance variables such as the total number of Pap tests, colposcopy visits, and the distribution of abnormal cytology and histology results, including all cervical intraepithelial neoplasia 2, 3 diagnoses.

Results: A total of 86,257 gynecologic visits and 41,527 Pap tests were performed system-wide during this period of widespread and uniform implementation of standard cervical cancer screening guidelines. The number of Pap tests performed per month varied little. The incidence of CIN 1 significantly decreased from 117 (68.4%) of 171 during the first tracked month to 52 (54.7%) of 95 during the last tracked month (p = 0.04). The monthly incidence rate of CIN 2, 3, including incident cervical cancers, did not change. The total number of colposcopy visits declined, resulting in a 50% decrease in costs related to colposcopy services and approximately a 12% decrease in costs related to excisional biopsies.

Conclusions: Adherence to cervical cancer screening guidelines reduced the number of unnecessary colposcopies without increasing numbers of potentially missed CIN 2, 3 lesions, including cervical cancer. Uniform implementation of administrative-based performance initiatives for cervical cancer screening minimizes differences in provider practices and maximizes performance of screening while containing cervical cancer screening costs.

Strict adherence to cervical cancer screening guidelines and use of administrative algorithms for follow-up decreases the number of colposcopy procedures and costs.

1Department of Obstetrics and Gynecology, Jacobi Medical Center; 2Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine; 3Department of Pathology, Jacobi Medical Center; and 4Albert Einstein College of Medicine Cancer Center, Bronx, NY

Reprint requests to: Mark H. Einstein, MD, MS, Department of Obstetrics, Gynecology and Women's Health, 1695 Eastchester Rd, Suite 601, Bronx, NY 10461. E-mail: meinstei@montefiore.org

This project was funded, in part, by the Albert Einstein Cancer Center National Institutes of Health/National Cancer Institute (grant no. P30CA013330).

©2011The American Society for Colposcopy and Cervical Pathology