Single Health System Adherence to 2012 Cervical Cancer Screening Guidelines at Extremes of Age and Posthysterectomy.
To estimate the proportion of guideline nonadherent Pap tests in women aged younger than 21 years and older than 65 years and posthysterectomy in a single large health system. Secondary objectives were to describe temporal trends and patient and health care provider characteristics associated with screening in these groups.



A retrospective cross-sectional chart review was performed at Fairview Health Services and University of Minnesota Physicians. Reasons for testing and patient and health care provider information were collected. Tests were designated as indicated or nonindicated per the 2012 cervical cancer screening guidelines. Point estimates and descriptive statistics were calculated. Patient and health care provider characteristics were compared between indicated and nonindicated groups using χ and Wilcoxon rank-sum tests.



A total of 3,920 Pap tests were performed between September 9, 2012, and August 31, 2014. A total of 257 (51%; 95% confidence interval [CI] 46.1-54.9%) of tests in the younger than 21 years group, 536 (40%; 95% CI 37.7-43.1%) in the older than 65 years group, and 605 (29%; 95% CI 27.1-31.0%) in the posthysterectomy group were not indicated. White race in the older than 65 years group was the only patient characteristic associated with receipt of a nonindicated Pap test (P=.007). Health care provider characteristics associated with nonindicated Pap tests varied by screening group. Temporal trends showed a decrease in the proportion of nonindicated tests in the younger than 21 years group but an increase in the posthysterectomy group.



For women aged younger than 21 years and older than 65 years and posthysterectomy, 35% of Pap tests performed in our health system were not guideline-adherent. There were no patient or health care provider characteristics associated with guideline nonadherent screening across all groups.
Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Biostatistics & Bioinformatics, Masonic Cancer Center, the Institute for Health Informatics, the School of Public Health, Division of Biostatistics, the Department of Surgery, Division of Colon & Rectal Surgery, and the Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.
Deanna
D
Teoh
Rachel
R
Isaksson Vogel
Gretchen
G
Hultman
Minnu
M
Monu
Levi
L
Downs
Melissa A
MA
Geller
Chap
C
Le
Genevieve
G
Melton-Meaux
Shalini
S
Kulasingam
D000328:Adult; D000367:Age Factors; D000368:Aged; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy; D008297:Male; D008875:Middle Aged; D008880:Midwifery / Q000706:statistics & numerical data; D009722:Nurse Practitioners / Q000706:statistics & numerical data; D065006:Papanicolaou Test / Q000592:standards / Q000706:statistics & numerical data*; D010823:Physician Assistants / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000706:statistics & numerical data* / Q000639:trends; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult