Effect of a clinical practice improvement intervention on Chlamydial screening among adolescent girls.
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.
Shafer
Mary-Ann B
MA
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
Tebb
Kathleen P
KP
Pantell
Robert H
RH
Wibbelsman
Charles J
CJ
Neuhaus
John M
JM
Tipton
Ann C
AC
Kunin
Sharon Brown
SB
Ko
Timothy H
TH
Schweppe
David M
DM
Bergman
David A
DA
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