Tracking abnormal cervical cancer screening: evaluation of an EMR-based intervention.
BACKGROUND
System level barriers have been associated with inadequate follow-up of abnormal cervical cytology.


OBJECTIVE
The aim of this study was to develop and evaluate an electronic tracking system to improve follow-up of abnormal Pap tests.


METHODS
We implemented an electronic medical record (EMR)-based Pap test tracking system at two clinical practices at an inner-city academic health center. The system generated a provider-specific monthly report of all abnormal Pap results, and provided a patient-specific Pap tracking table embedded in the EMR for each subject.


RESULTS
We compared abnormal Pap test follow-up rates for the 24 months pre-intervention with rates 12 months following its implementation (post-intervention). The evaluation followed all subjects for 12 months from the date of their abnormal Pap test, looking for diagnostic resolution.


RESULTS
Subjects were young women (mean age = 30.5) of primarily white (42%) and African American (37%) descent, who spoke English (88%). Forty-eight percent were insured through publicly subsidized insurance. Controlling for type of abnormality and practice location, the adjusted mean time to resolution decreased significantly from 108 days (confidence interval, CI 105-112 days) in the pre-intervention period to 86 days (CI 81-91 days).


CONCLUSIONS
Our study cannot demonstrate that with follow up, we directly avoided cases of invasive cervical cancer. However, we show that in an at-risk urban population, an automated, EMR-based tracking system reduced the time to resolution, and increased the number of women who achieved diagnostic resolution.
Dupuis
Elizabeth A
EA
Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, 801 Massachusetts Avenue, Suite 470, Boston, MA 02118, USA. Elizabeth.Dupuis@bmc.org
White
Hilary F
HF
Newman
Daniel
D
Sobieraj
Jerome E
JE
Gokhale
Manjusha
M
Freund
Karen M
KM
D000293:Adolescent; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000453:epidemiology; D003266:Continuity of Patient Care; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D055088:Early Detection of Cancer; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D017010:Reminder Systems; D014505:Urban Population; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology