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Chlamydia Screening Coverage Estimates Derived Using Healthcare Effectiveness Data and Information System Procedures and Indirect Estimation Vary Substantially

Broad, Jennifer M. MPH*; Manhart, Lisa E. PhD*; Kerani, Roxanne P. PhD; Scholes, Delia PhD; Hughes, James P. PhD*; Golden, Matthew R. MD, MPH*†

Sexually Transmitted Diseases: April 2013 - Volume 40 - Issue 4 - p 292–297
doi: 10.1097/OLQ.0b013e3182809776
Original Study

Background Screening coverage is an important determinant of chlamydial control program success.

Objectives The aim of this study was to compare chlamydial screening coverage estimates.

Methods We compared 9 estimates among women aged 15 to 25 years in Washington State, 2009. Four used Healthcare Effectiveness Data and Information System (HEDIS) procedures among Group Health enrollees. Separate HEDIS estimates assessed all enrollees and the subset of women who used services; for each group, separate estimates defined the sexually active population using HEDIS methods or National Survey of Family Growth (NSFG) data. Three indirect screening estimates used census and NSFG data to define the population’s size and derived the number of tests performed by dividing the number of reported cases by test positivity defined using data from different laboratories, adjusted for repeat testing. A fourth indirect estimate was adjusted for reason for testing. A direct-indirect estimate combined data on the number of tests performed in reporting laboratories and an indirect estimate of tests performed elsewhere.

Results Healthcare Effectiveness Data and Information System procedures and NSFG data yielded similar estimates of the percentage of women who were sexually active (60% vs. 61%). Screening coverage estimated by HEDIS was higher among Group Health users (43.6%) than among all enrollees (34.2%). Indirect screening coverage estimates varied from 46.4% to 68.7%. The direct-indirect estimate, which included a direct measure of the number of tests performed to identify 52% of reported cases, was 57.6%.

Conclusions Most sexually active women aged 15 to 25 years in Washington State were screened for chlamydia in 2009. Healthcare Effectiveness Data and Information System methods may underestimate screening coverage. Health departments can derive population-based coverage estimates using data from large laboratories.

Comparison of chlamydial screening coverage estimation techniques within Washington State suggest that the Healthcare Effectiveness Data and Information System measure may underestimate coverage and that indirect estimation may be more useful to obtain population-based estimates.

From the *University of Washington; †Public Health–Seattle and King County; and ‡Group Health Research Institute, Seattle, WA

Supported by Centers for Disease Control and Prevention Chlamydia Evaluation Initiative.

Correspondence: Matthew R. Golden, MD, MPH, PHSKC HIV/STD Program, UW Center for AIDS and STD, Harborview Medical Center, Box 359777325, Ninth Ave, Seattle, WA 98l04. E-mail:

Conflict of interest and sources of funding: Grant funding from Genprobe Diagnostics (to M.R.G.). All other authors declare no conflict of Interest.

Received for publication September 4, 2012, and accepted November 29, 2012.

© Copyright 2013 American Sexually Transmitted Diseases Association