Evaluating a Quality Improvement Program for Cervical Cancer Screening Guideline Compliance

The unprecedented 2012 alignment of national cervical cancer screening recommendations indicates that the time is right for implementing strategies to improve screening guideline compliance in the primary care practice setting. The aim of this project was to evaluate a systematic quality improvement program for cervical cancer screening designed to improve compliance with national recommendations in an urban free clinic setting. The Theory of Diffusion of Innovations and the Awareness-to-Adherence Conceptual Model were integrated to provide a framework to improve program outcomes. With a focus on changing practice policies, the question guiding this study was: What are the outcomes of the implementation of a systematic, guideline-based quality improvement program for cervical cancer screening in terms of compliance with national clinical practice guidelines for screening in an urban free clinic setting? The provider- and workflow-based strategies implemented in the quality improvement program included 1) the addition of a clinical decision support system, 2) provider educational outreach, 3) patient reminder letters, and 4) the development of a procedures manual. An established quality measure guided the selection of the quality indicators, specifically patients screened according to evidence-based guidelines, patients who were not screened, and patients screened more frequently than recommended. A chi-square test of independence indicated that the proportions in each quality indicator category at baseline were significantly different from those at 12-months’ post-programmatic implementation. The first quality indicator -- the number of patients screened according to guidelines – nearly doubled. Conversely, the number of unscreened patients as well as the number of patients screened more frequently than recommended significantly decreased.