title: Effect of a clinical practice improvement intervention on Chlamydial screening among adolescent girls.
abstract: BACKGROUND
  Chlamydia trachomatis infection is a serious public health concern that disproportionately affects adolescent girls. Although annual C trachomatis screening of sexually active adolescent girls is recommended by health professional organizations and is a Health Employer Data and Information Set (HEDIS) performance measure, this goal is not being met.
  
  
  OBJECTIVE
  To test the effectiveness of a system-level, clinical practice improvement intervention designed to increase C trachomatis screening by using urine-based tests for sexually active adolescent girls identified during their routine checkups at a pediatric clinic.
  
  
  METHODS
  A randomized cluster of 10 pediatric clinics in the Kaiser Permanente of Northern California health maintenance organization, where adolescent girls aged 14 to 18 years had a total of 7920 routine checkup visits from April 2000 through March 2002.
  
  
  METHODS
  Five clinics were randomly assigned to provide usual care and 5 to provide the intervention, which required that leadership be engaged by showing the gap between best practice and current practice; a team be assembled to champion the project; barriers be identified and solutions developed through monthly meetings; and progress be monitored with site-specific screening proportions.
  
  
  METHODS
  Chlamydia trachomatis screening rate for sexually active 14- to 18-year-old girls during routine checkups at each participating clinic.
  
  
  RESULTS
  The population of adolescents was ethnically diverse with an average age of 15.4 years. Twenty-four percent of girls in the experimental clinics and 23% in the control clinics were sexually active. Of the 1017 patients eligible for screening in the intervention clinic, 478 (47%) were screened; of 1194 eligible for screening in the control clinic, 203 (17%) were screened. At baseline, the proportion screened was 0.05 (95% confidence interval [CI], 0.00-0.17) in the intervention and 0.14 (95% CI, 0.01-0.26) in the control clinics. By months 16 to 18, screening rates were 0.65 (95% CI, 0.53-0.77) in the intervention and 0.21 (95% CI, 0.09-0.33) in the control clinics (time period by study group interaction, F(6,60) = 5.33; P<.001). The average infection rate for the experimental clinics was 5.8% (23 positive test results out of 393 total urine tests and a total of 3986 clinic visits) vs 7.6% in controls (12 positive test results out of 157 tests and 3934 clinic visits).
  
  
  CONCLUSIONS
  Implementation of this clinical practice intervention in a large health maintenance organization system is feasible, and it significantly increased the C trachomatis screening rates for sexually active adolescent girls during routine checkups.
authors.affiliation: University of California, San Francisco, School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Box 0503, San Francisco, CA 94143-0503, USA. shafer@itsa.ucsf.edu
authors.forename: Mary-Ann B
authors.initials: MA
authors.lastname: Shafer
authors.forename: Kathleen P
authors.initials: KP
authors.lastname: Tebb
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pantell
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Wibbelsman
authors.forename: John M
authors.initials: JM
authors.lastname: Neuhaus
authors.forename: Ann C
authors.initials: AC
authors.lastname: Tipton
authors.forename: Sharon Brown
authors.initials: SB
authors.lastname: Kunin
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Ko
authors.forename: David M
authors.initials: DM
authors.lastname: Schweppe
authors.forename: David A
authors.initials: DA
authors.lastname: Bergman
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000592:standards*; D002140:California; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000652:urine; D002985:Clinical Protocols; D003955:Diagnostic Tests, Routine; D005260:Female; D006279:Health Maintenance Organizations / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D008137:Longitudinal Studies; D008403:Mass Screening / Q000592:standards*; D010372:Pediatrics / Q000592:standards; D010808:Physical Examination; D011785:Quality Assurance, Health Care; D016482:Urinalysis