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Show CERVICAL CANCER PREVENTION: IMPROVING ABNORMAL PAP FOLLOW-UP Dana M. Fuqua, BSN, DNP Student Lisa J. Taylor-Swanson, PhD, MAcOM, LAc Key Findings: This EHR tracking and reminder system effectively reduced practice and provider-related barriers to abnormal Pap follow-up and increased compliance with ASCCP management guidelines within BirthCare HealthCare, a large midwifery and women’s health practice in Salt Lake City, Utah. Background Results Cervical cancer is the fourth most common cancer in women, with nearly 4,000 deaths each year in the U.S. Eighteen providers (100%) completed post-surveys. There are highly effective screenings (Pap test), yet loss to follow-up after an abnormal result is 30-50 percent. Practice-related barriers to follow-up include: lack of time to follow each result, limited capability to track patients, inaccuracies in follow-up recommendations and lack of consistency between providers. ASCCP guidelines standardize abnormal Pap management, but due to their increasing complexity, many practices are not compliant with this follow-up. This quality improvement project aimed to reduce barriers to follow-up and improve compliance with ASCCP management of abnormal Pap results. Methods A practice-specific EHR tracking and reminder system was implemented based on updated ASCCP riskmanagement recommendations, and provider education was provided at the time of intervention. Post-intervention surveys were sent to providers (n=18) to determine the acceptability, appropriateness and feasibility of the improved tracking system. Brief individual interviews (n= 8) gathered qualitative data on patient experience, provider experience and satisfaction with this quality improvement project. 100% (n=18) reported that this system helped reduce the difficulty of abnormal Pap management 94.4% (n=17) reported that this system reduced errors and amount of time spent managing abnormal results 100% (n=18) felt that this system helped ensure patients get follow-up who may otherwise have been lost to care Project meets approval for abnormal management: 100% (n=18) completely agreed or agreed Project suitable for increasing ASCCP compliance: 100% (n=18) completely agreed Conclusions Use of this EHR tracking and reminder system reduced practice and provider-related barriers to abnormal Pap follow-up. Provider comfort and compliance with ASCCP management guidelines was increased. Qualitative data indicated high level of provider satisfaction with and value of this project. This system remains in use within BirthCare HealthCare. Provider feedback suggests that this project is feasible for other practices aiming to improve abnormal Pap follow-up and increase ASCCPcompliant management. COLLEGE OF NURSING |
