title: Practice-Based Quality Improvement Collaborative to Increase Chlamydia Screening in Young Women.
abstract: Chlamydia trachomatis infections are common among sexually active young women. We developed a practice-based quality improvement (QI) collaborative to increase Chlamydia screening in at-risk young women.
  
  
  
  Structured data fields were integrated into the electronic record for practices affiliated with Boston Children's Hospital. A learning community (LC) was developed. Content included the adolescent well visit, assessment of sexual/risk behaviors, epidemiology of sexually transmitted diseases, and screening methods. The QI initiative effectiveness was assessed by comparing preintervention and postintervention rates of Chlamydia screening by using statistical process control analyses and logistic regressions.
  
  
  
  LC participants demonstrated significant increases in recommended Chlamydia screening, as illustrated by using Healthcare Effectiveness Data and Information Set (HEDIS) screening rates (LC1: 52.8% preintervention vs 66.7% postintervention [P < .0001]; LC2: 57.8% preintervention vs 69.3% postintervention [P < .0001]). Participating practices reported total improvements larger than nonparticipating practices (13.9% LC1, 11.5% LC2, and 7.8% nonparticipants). QI and LC efforts also led to increased documentation of sexual activity status in the record (LC1: 61.2% preintervention to 91.2% postintervention [P < .0001]; LC2: 43.3% preintervention to 61.2% postintervention [P < .0001]). Nonparticipating practices were more likely to perform indiscriminate screening.
  
  
  
  Through our QI and LC efforts, statistically and clinically meaningful improvements in Chlamydia screening rates were attained. Differences in rates of improvement indicate that LC participation likely had effects beyond electronic medical record changes alone. During the project time frame, national HEDIS screening rates remained unchanged, suggesting that the observed improvements were related to the interventions and not to a national trend. As a result of QI tools provided through the LCs, HEDIS screening goals were achieved in a primary care setting.
authors.affiliation: Divisions of Adolescent Medicine and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and amy.divasta@childrens.harvard.edu.
authors.forename: Amy D
authors.initials: AD
authors.lastname: DiVasta
authors.affiliation: Pediatric Physicians' Organization at Children's, Brookline, Massachusetts.
authors.forename: Emily K
authors.initials: EK
authors.lastname: Trudell
authors.affiliation: Pediatric Physicians' Organization at Children's, Brookline, Massachusetts.
authors.forename: Mary
authors.initials: M
authors.lastname: Francis
authors.affiliation: Pediatric Physicians' Organization at Children's, Brookline, Massachusetts.
authors.forename: Glenn
authors.initials: G
authors.lastname: Focht
authors.affiliation: Pediatric Physicians' Organization at Children's, Brookline, Massachusetts.
authors.forename: Farah
authors.initials: F
authors.lastname: Jooma
authors.affiliation: Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and Pediatric Physicians' Organization at Children's, Brookline, Massachusetts Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts;
authors.forename: Louis
authors.initials: L
authors.lastname: Vernacchio
authors.affiliation: Divisions of Adolescent Medicine and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Sara F
authors.initials: SF
authors.lastname: Forman
mesh_terms: D000293:Adolescent; D001900:Boston; D002690:Chlamydia Infections / Q000175:diagnosis*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D000070516:Intersectoral Collaboration; D008403:Mass Screening / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D011320:Primary Health Care; D058996:Quality Improvement; D012309:Risk-Taking; D012725:Sexual Behavior; D055815:Young Adult