Klinger, Dr. Susan
University of Northern Colorado
Type of Resources
Place of Publication
University of Northern Colorado
Cervical cancer screening has evolved throughout the years into the current, very effective, algorithms for screening and management. The success of improved early detection of cervical cancer has saved many lives (Lees, Erickson, & Huh, 2016). The addition of human papillomavirus testing and genotyping has allowed for more efficient, and less invasive, management of cervical cancer screening (Cox, 2009). While there are significant advantages to these new guidelines, there are barriers to applying them in practice. The clinical site for the project was identified to be in need of a quality improvement project aimed at creating an improved patient notification, tracking and reminder system as well as improving provider adherence with the evidence-based guidelines. There were 48 total eligible providers that were included in the project. After identification of the problem, a review of the literature was undertaken to identify an evidence-based strategy for addressing practice gaps. This literature review focused on provider guideline adherence with cervical cancer screening guidelines and patient notification, tracking and reminder systems. Current literature demonstrates a gap in provider guideline adherence nationwide as well as strategies aimed at improving both provider and patient adherence with the reccomendations. These include use of consistent patient notification processes, implementation of an electronic tracking and reminder system, and provider educational sessions aimed at improving guideline compliance. Donabedian’s (2005) quality improvement framework was utilized to divide the literature findings into those interventions that effect outcomes, structure, and process of care in order to form the project plan and methods. Following this in-depth look at the background and existing literature, the project plan was established. The plan consisted of two phases: the first focusing on creation of project materials and preparation for project implementation, and the second focusing on the roll out of the new process and data collection for project analysis. Two objectives were identified for this project: improve provider adherence to the 2012 American Society of Colposcopy and Cervical Pathology Guidelines and implementation of an electronic patient notification, tracking and reminder system. A plan for data collection and analysis through pre- and post-implementation provider surveys and chart audits was established. After project implementation, data collection and analysis occurred. Objective One was evaluated in order to determine if the project implementation correlated with an increase in provider guideline adherence. The quality improvement project did find an improvement in guideline adherence in recommending appropriate follow-up for patients following receipt of cervical cancer screening results. For their survey responses on a series of patient vignettes, as well as whether patients were actually screened at an appropriate interval according to the recommendations, the providers were not found to show a statistical improvement following implementation of the project. In evaluating Objective Two, there was found to be moderate compliance on the part of the providers with the new process in the weeks following project implementation. Nursing participants in the new process were found to be 100% compliant with following the process. No statistical difference was found in provider beliefs regarding the practice’s tracking and reminder system pre- and post-intervention. Limitations existed in this study that limit the ability of the researcher to make assumptions based on the findings. Regardless, this project served to address the need for a robust notification tracking and reminder system. This system helps to ensure that patients receive timely, clear, and concise communication regarding their cervical cancer screening results and what these results mean for them. Additionally, they are notified and reminded to follow-up as needed. This is all done in an attempt to continue to drive down cervical cancer rates while also reducing unnecessary, and costly, procedures and testing.
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