Implementation of a Cervical Cancer Screening Management Protocol to Improve Individual Provider Compliance Within a Practice

Background: The American Society for Colposcopy and Cervical Pathology (ASCCP) provides evidence-based guidelines for clinicians regarding follow-up screening and treatment for cervical cancer screening (CCS) results. Providers use these guidelines to counsel and advise patients regarding ongoing clinical management. Studies show that feedback and anticipatory guidance from providers improve patient compliance with recommended screening and treatment. It is incumbent upon clinicians to track their patients' results and attendance at follow-up appointments for the most optimal clinical outcomes and to ensure compliance with ASCCP clinical guidelines. Local Problem: The Birthcare Healthcare practice lost the graduate assistant (GA) who previously assisted providers with CCS tracking and follow-up. Providers were expected to assume responsibility for tracking CCS results and ensuring appropriate patient follow-up. The practice manager requested an evaluation of clinicians' performance with and adherence to the current CCS tracking protocol. Methods: A pre-intervention survey and individual interviews were used to assess the usability of and satisfaction with the current CCS tracking protocol. Current ASCCP guidelines were reviewed for updates to include in a revised CCS tracking protocol developed and implemented in this practice for 6 weeks. A post-intervention survey gathered feedback regarding the revised protocol and its sustainability. Pre- and post-intervention chart audits of CCS tracking were conducted to determine the efficacy of the revised CCS management protocol. Interventions: Responses from the pre-implementation survey and participant interviews informed creation of a revised CCS tracking protocol. Several PDSA cycles were used to make ongoing changes to the new protocol based on user feedback and experiences during implementation. Results: Pre-intervention survey results from providers (n=16) showed that members of the practice felt the current CCS tracking system helped reduce errors in managing abnormal CCS results. All members interviewed reported confidence in following the ASCCP guidelines and used the designated content expert at BCHC for assistance in managing abnormal CCS results. Post-implementation survey results (n=7) showed that providers were receptive to the revised CCS tracking protocol and agreed that it had potential to improve patients' clinical outcomes and follow-up compliance. However, all participants felt that having an individual designated at BCHC to track abnormal CCS results would be necessary to maintain effective CCS management within the practice. Comparison of data obtained from pre-intervention (n=698) and post-intervention (n=210) chart audits revealed no significant improvement in providers' compliance when using the revised protocol, even when providers reported they followed all steps. Conclusion: This quality improvement project evaluated the feasibility, usability, and satisfaction with a revised CCS tracking protocol for clinicians at BCHC. Providers' compliance with the new protocol was no better than their compliance with the practice's current protocol. Perceived individual clinical barriers and time constraints continue to be problematic for clinicians to manage their own CCS results and patient follow-up. Further study must be done to create a usable and sustainable protocol satisfactory to practice members.