Cervical Cancer Prevention: Improving Abnormal Pap Follow-Up

Background: Cervical cancer continues to be a pervasive disease despite effective screening (Pap test) and treatment options available to reduce morbidity and mortality of cancer progression. Studies suggest that nearly half of cervical cancer diagnoses result from a lack of follow-up after an abnormal Pap result. Practice and provider-related barriers contribute to this lack of follow-up and are targets identified for quality improvement (QI). To improve and standardize abnormal Pap follow-up, the American Society for Colposcopy and Cervical Pathology (ASCCP) provides national guidelines and risk-based algorithms for abnormal result management and treatment. However, due to the increasing complexity of these algorithms, many practices are not in compliance with ASCCP management guidelines, contributing to inaccurate abnormal Pap follow-up. Advancements in Electronic Health Record (EHR) functionalities and application of information technologies are identified by ASCCP authors as measures to improve abnormal Pap management. Methods: A QI project was implemented to reduce practice and provider-related barriers to abnormal Pap follow-up and increase compliance with ASCCP management guidelines. An improved EHR tracking and reminder system was developed and implemented within a large midwifery and women's health practice in Utah. Post-intervention Likert-scale surveys were used to determine the acceptability and appropriateness of this project for increasing ASCCP compliance, and the feasibility of implementing this project at other practices. Individual qualitative interviews were administered to evaluate provider experience and satisfaction with this project in reducing barriers to follow-up. Results: Post-intervention, all providers (100%, n=18) reported that the improved Pap tracking system reduced difficulty in managing abnormal Pap follow-up and ensured patients got follow- up when they may otherwise have been lost to care. Nearly 95% of providers (n=17) reported that the system helped reduce errors in abnormal Pap management and reduced time spent managing abnormal results. All providers (100%, n=18) agreed that this system met their approval and was applicable for improving ASCCP compliance. Nearly 95% of providers (n=17) reported that this project would be implementable for other practices. Conclusions: This QI project demonstrated a reduction in practice and provider-related barriers to abnormal Pap follow-up, and an increase in compliance with ASCCP management guidelines through the use of this improved EHR tracking and reminder system. Due to a high level of provider support and satisfaction with this project, this tracking system remains in use and is a well-established part of the practice workflow. Results from this project indicate it is feasible and easily implementable. Suggested next steps include initiating EHR tracking functionalities within other practices performing cervical cancer screening.