title: Variations in practice guideline adherence for abnormal cervical cytology in a county healthcare system.
abstract: BACKGROUND
  Reduction in cervical cancer incidence and mortality is not only dependant on promoting cervical cancer screening but also on providing appropriate follow-up and treatment of abnormal cervical cytology.
  
  
  OBJECTIVE
  The objective of this study was to determine variations in guideline adherence for women requiring abnormal cervical cytology follow-up.
  
  
  METHODS
  Subjects of the study are women 18 years or older with an abnormal Pap test in 2000 within a large county healthcare system (n = 8,571).
  
  
  METHODS
  Guideline adherence was determined by the presence or absence of the appropriate follow-up procedure within an acceptable time interval for each degree of cytological abnormality. Patients with no follow-up studies were deemed to be lost to follow-up.
  
  
  RESULTS
  Of study subjects, 18.5% were lost to follow-up care. Of the remaining 6,987 women, 60.3% received optimal care, 9.4% received suboptimal care, and 30.3% received poor care. Follow-up rates were higher for patients with higher degree of cytological abnormality (OR, 1.29, 95% CI, 1.17-1.42), older patients (OR, 1.03, 95% CI, 1.02-1.030) and those receiving the index Pap test at a larger healthcare facility (OR, 1.13; 95% CI, 1.01-1.27). Receiving optimal care was positively correlated with higher degree of cytological abnormality (p < .0001) and larger facility size (p = .002). Regional variations in care demonstrated the largest cluster having the lowest lost to follow-up rate and the most optimal care.
  
  
  CONCLUSIONS
  A significant number of women with abnormal cervical cytology are receiving less than optimal care. Further studies are required to determine the specific healthcare delivery practices that need to be targeted to improve guideline adherence for follow-up of abnormal cytology.
authors.affiliation: Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA. risinghal@ph.lacounty.gov
authors.forename: Rita
authors.initials: R
authors.lastname: Singhal
authors.forename: Lisa V
authors.initials: LV
authors.lastname: Rubenstein
authors.forename: Mingming
authors.initials: M
authors.lastname: Wang
authors.forename: Martin L
authors.initials: ML
authors.lastname: Lee
authors.forename: Anwar
authors.initials: A
authors.lastname: Raza
authors.forename: Christine H
authors.initials: CH
authors.lastname: Holschneider
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D002983:Clinical Competence; D003153:Community Health Services / Q000592:standards* / Q000706:statistics & numerical data; D003695:Delivery of Health Care; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008403:Mass Screening; D008485:Medical Audit; D008507:Medically Underserved Area; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000628:therapy*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000628:therapy*