Background Too-frequent screening for cervical cancer can increase costs, lead to unnecessary invasive procedures associated with overtreatment, and shift resources away from the one in five women who do not receive recommended routine screening.
Context A large, US-based integrated healthcare system with centralised evidence services and eight independent regions developed and implemented an evidence-based guideline for cervical cancer screening. Novel implementation strategies and performance monitoring in one region in Southern California led to significant improvements and are described below.
Description of Best Practice Graded evidence summaries were conducted by a centralised analytic unit, and recommendations developed by a guideline team with representation from each region. In one large region with more than 3 million patients, interventions aimed at the practitioner, patient and systems levels were implemented for routine Pap and HPV co-testing. Practitioner interventions included electronic distribution of guidelines, point-of-care electronic prompts, and workflow support. Patient-level interventions included point-of-care education, and in-reach/outreach activities. System-level interventions focused on centralised patient outreach letters and reminder calls, computerised decision support, and unscreened cancer lists for panel management. Monthly performance monitoring on a measure of “overpopulation” was reported at medical centre, department and provider levels. In a five-year period, over 100,000 fewer unnecessary Pap tests were performed, while screening rates increased by 7%.
Lessons for Guideline Developers, Adaptors, Implementers, and/or Users Centralised guideline development, coupled with coordinated implementation and performance monitoring, can reduce unnecessary screening and invasive procedures, focus resources on appropriate routine screening in underscreened populations, improve patient access and reduce costs.
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