title: Evaluating a Quality Improvement Program for Cervical Cancer Screening at an Urban Safety Net Clinic.
abstract: This article evaluates a quality improvement program for improving guideline-consistent cervical cancer screening practices in an urban safety net clinic. Quality improvement initiatives that combine policy with practice are particularly timely in light of the alignment of cervical cancer screening guidelines released in 2012 by the most influential national organizations. A descriptive comparison design was employed using the Healthy People 2020 target of 93% screened according to guidelines. Provider-, patient-, and workflow-based strategies included (1) addition of a clinical decision support system, (2) provider educational outreach, (3) patient reminder letters, and (4) development of a clinic procedure manual. Through the application of an established quality measurement tool, three quality indicators were measured: screened according to evidence-based guidelines, not screened, and screened more frequently than recommended. Data from the sample (N = 1,032) were collected at baseline and 12 months postimplementation. Each quality indicator category was significant at follow-up. Patients screened according to guidelines nearly doubled while the number of underscreened patients was reduced by nearly half. Similarly, there was a threefold decrease in patients screened more frequently than recommended. Clinical administrators, quality improvement specialists, and health care providers in primary care settings can use the strategies implemented in this study as a starting point for continuous quality improvement initiatives for cervical cancer screening.
authors.affiliation: University of Virginia School of Nursing, Charlottesville, VA, USA rhillsdnp@gmail.com.
authors.forename: Robin L
authors.initials: RL
authors.lastname: Hills
authors.affiliation: University of Virginia School of Nursing, Charlottesville, VA, USA.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Kulbok
authors.affiliation: University of Virginia School of Nursing, Charlottesville, VA, USA.
authors.forename: Myra
authors.initials: M
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D020000:Decision Support Systems, Clinical; D004501:Education, Medical; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D017057:Medically Uninsured; D008875:Middle Aged; D065006:Papanicolaou Test / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D017010:Reminder Systems; D064876:Safety-net Providers; D014505:Urban Population; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014768:Virginia; D016387:Women's Health; D055815:Young Adult
keywords: cervical cancer; health disparities; health promotion; implementation strategies; quality improvement; systems change; women’s health