Tracking Abnormal Cervical Cancer Screening: Evaluation of an EMR-Based Intervention

• Published in: Journal of general internal medicine : JGIM Vol. 25; no. 6; pp. 575 - 580
• Main Authors: Dupuis, Elizabeth A., White, Hilary F., Newman, Daniel, Sobieraj, Jerome E., Gokhale, Manjusha, Freund, Karen M.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.06.2010; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Biological and medical sciences; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - epidemiology; Cervical cancer; Cervical Intraepithelial Neoplasia - diagnosis; Cervical Intraepithelial Neoplasia - epidemiology; Continuity of Patient Care; Delivery of Health Care - statistics & numerical data; Early Detection of Cancer; Electronic Health Records; Female; Female genital diseases; General aspects; Gynecology. Andrology. Obstetrics; Humans; Internal Medicine; Medical sciences; Medical screening; Medicine; Medicine & Public Health; Original; Original Article; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Reminder Systems; Tumors; Urban Population; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - epidemiology; Vaginal Smears; Young Adult; pap smear; papillomavirus; cervical cancer; Evaluation; Cervical smear; Papovaviridae; Malignant tumor; Medical screening; Female genital diseases; Infection; Papillomavirus; Virus; Medicine; Human papillomavirus; Viral disease; Papanicolaou smear test; Uterine cervix diseases; Cervical cancer; Cancer
• ISSN: 0884-8734; 1525-1497; 1525-1497
• DOI: 10.1007/s11606-010-1287-z

INTRODUCTION System level barriers have been associated with inadequate follow-up of abnormal cervical cytology. OBJECTIVE The aim of this study was to develop and evaluate an electronic tracking system to improve follow-up of abnormal Pap tests. PROGRAM DESCRIPTION We implemented an electronic medical record (EMR)-based Pap test tracking system at two clinical practices at an inner-city academic health center. The system generated a provider-specific monthly report of all abnormal Pap results, and provided a patient-specific Pap tracking table embedded in the EMR for each subject. EVALUATION We compared abnormal Pap test follow-up rates for the 24 months pre-intervention with rates 12 months following its implementation (post-intervention). The evaluation followed all subjects for 12 months from the date of their abnormal Pap test, looking for diagnostic resolution. RESULTS Subjects were young women (mean age = 30.5) of primarily white (42%) and African American (37%) descent, who spoke English (88%). Forty-eight percent were insured through publicly subsidized insurance. Controlling for type of abnormality and practice location, the adjusted mean time to resolution decreased significantly from 108 days (confidence interval, CI 105–112 days) in the pre-intervention period to 86 days (CI 81–91 days). CONCLUSION Our study cannot demonstrate that with follow up, we directly avoided cases of invasive cervical cancer. However, we show that in an at-risk urban population, an automated, EMR-based tracking system reduced the time to resolution, and increased the number of women who achieved diagnostic resolution.