title: Feasibility and economic impact of a clinical pathway for pap test utilization in Gynecologic Oncology practice.
abstract: OBJECTIVE
  To evaluate the feasibility and impact on cost to the U.S. healthcare system of implementing a clinical pathway for Pap test utilization in screening and surveillance of gynecologic cancers in a university-based gynecologic oncology practice.
  
  
  METHODS
  Baseline data were collected for Pap test utilization between 1/1/04 and 6/30/05 and prospectively compared to Pap test utilization following the implementation of a clinical pathway (7/1/05 to 5/30/06). The clinical pathway: 1) employed ACOG guidelines for asymptomatic screening of non-cancer patients, 2) allowed testing at 4 months intervals for cervical/vaginal cancer surveillance, 3) limited testing for endometrial cancer surveillance to 2 tests/60 months, and 4) eliminated testing as part of ovarian cancer surveillance. Relevant costs were calculated using Medicare charge-to-cost ratios and adjusted to 2006 USD. For statistical analysis, differences in Pap test utilization and cost were evaluated using student's t-test.
  
  
  RESULTS
  During the baseline period, 1725 Pap tests were collected from 5605 ambulatory encounters, for a Pap test rate of 30.8% and an annualized cost of $93,759. After implementation of the clinical pathway, 4209 ambulatory encounters yielded an annual Pap test rate of 11% and an annual cost of $35,728 (p<0.0001), a savings of $58,031. In addition, clinical pathway implementation also registered an opportunity cost savings of 180.3 nursing personnel work hours ($4,162).
  
  
  CONCLUSIONS
  Reduction in the unnecessary use of Pap testing for asymptomatic screening and surveillance for gynecologic cancers through a straightforward clinical pathway is feasible and offers an opportunity for significant cost savings in gynecologic oncology healthcare expenditure.
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. antonio.santillan@ttuhsc.edu
authors.forename: Antonio
authors.initials: A
authors.lastname: Santillan
authors.forename: Linda
authors.initials: L
authors.lastname: Govan
authors.forename: Marianna L
authors.initials: ML
authors.lastname: Zahurak
authors.forename: Teresa P
authors.initials: TP
authors.lastname: Diaz-Montes
authors.forename: Robert L
authors.initials: RL
authors.lastname: Giuntoli
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
mesh_terms: D019091:Critical Pathways / Q000191:economics*; D005240:Feasibility Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000175:diagnosis / Q000191:economics / Q000473:pathology; D006176:Gynecology / Q000191:economics / Q000379:methods / Q000592:standards; D017048:Health Care Costs; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D008495:Medical Oncology / Q000191:economics / Q000379:methods / Q000592:standards; D014626:Vaginal Smears / Q000191:economics* / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*