1. Spartanburg Family Medicine Residency
Cervical Cancer Screening Compliance at a Family Medicine Residency Office
Christopher Shelby, M.D.
Julie Kinsman, M.D.
Spartanburg Family Medicine Residency
April 29, 2006

2. Background
Quality of care is becoming increasingly important in the care of patients and for physician reimbursement
Managed care plans grade physicians based on their performance of adhering to guidelines
Physician documentation of adherence to guidelines is a necessity

3. NCQA HEDIS
National Committee for Quality Assurance (NCQA) Health Plan Employer Data and Information Set (HEDIS) Criteria is used at Spartanburg Regional to evaluate physician adherence to quality of care measures
These measures were designed to allow comparison of managed health care plans performance and adherence to standardized criteria

4. HEDIS Criteria for Cervical Cancer Screening
HEDIS requires pap smear screening for every female ages 21 to 64 at least once in the previous two years, unless a hysterectomy is noted in the chart
HEDIS goals are set at 80 % compliance as of year 2000 guidelines

5. Why We Do Pap Smears
Half of all women newly diagnosed with cervical cancer have not had a Pap test in the past 5 years
Fifteen percent of women with cervical cancer develop it before the age of 30
The cervical cancer rate for all U.S. women is about 8 per 100,000, highest in Vietnamese, Hispanic, Korean, and Alaskan Americans

6. Why We Do Pap Smears
An average 20 year old woman can reduce her lifetime risk of cervical cancer from 2.5% to 0.7% through regular screening
The cervical cancer cure rate approaches 100% if the patient is treated when the cancer is in an early stage

7. Objective
Demonstrate that educational intervention and a reminder system can improve physician performance in adhering to HEDIS criteria regarding cervical cancer screening

8. Methods
Selected population at Spartanburg Regional FMC of 21 to 64 year old females seen during a six month period from June to December 2004 and then again from July 2005 to January 2006
Using a random number generator, 291 and 292 charts respectively were selected to review

9. Abstracted Chart Data Reviewed charts for : Medical record number
Date of birth
Race
Pap done in clinic or by different provider
Pap offered
Hysterectomy (excluded)
Number of visits if two or less (excluded)

10. Intervention
Group discussion at Resident’s Conference regarding guidelines for cervical cancer screening and reminder regarding proper documentation
Implementation of reminder system in Centricity Electronic Medical Records
Index card reminder placed on each resident work station

11. Total Number of Charts Prior to Intervention

12. Total Number of Charts After Intervention

13. Paps Performed by Age Prior to Intervention

14. Paps Performed by Age After Intervention

15. Paps Performed by Race Prior to Intervention
Of charts reviewed, FMC residents were in compliance with more African American (59%) and others (83%) than with Caucasian (46%) patients.

16. Paps Performed by Race After Intervention
Caucasians who received a pap 71%, African –Americans 72%, Hispanic/other 33%.

17. Location of Paps Done Prior to Intervention

18. Location of Paps After Intervention

19. Results After Intervention
Intervention improved screening in all age groups, (66% to 82% < age 40 and 46% to 61% > or = age 40)
Intervention improved screening in Caucasian population (45% vs. 71%) and African American population (59% vs. 72%)
More people were screened in our clinic (51% vs. 61%), more paps were documented as done elsewhere (6% vs. 10%) and more refused paps were documented (7% vs. 14%)

20. Comparison Chart

21. Results After Intervention
Intervention improved overall compliance from 57% to 71%
Counting those patients who were offered cervical screening, but was refused or not yet performed, this increased to 85%

22. Conclusion
Educational intervention and a reminder system improved compliance for cervical cancer screening in this setting