Quality Improvement Measures for Cervical Screening Guidelines in a Clinic for Uninsured Adults

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https://digitalcommons.unf.edu/etd/510; https://digitalcommons.unf.edu/cgi/viewcontent.cgi?article=1550&context=etd
Baker-Townsend, Julie Ann; Baker-Townsend, Julie, 1966-
University of North Florida; UNF; Dissertations; Academic -- UNF -- Doctor of Nursing Practice; Dissertations; Academic -- UNF -- Nursing; DNP; D.N.P.; Project; Pap smear; cervical cytology; clinical practice guidelines; University of North Florida; UNF; Dissertations, Academic -- UNF -- Doctor of Nursing Practice; Dissertations, Academic -- UNF -- Nursing; DNP; D.N.P.; Project; Pap smear; cervical cytology; clinical practice guidelines; Family Practice Nursing; Medicine and Health Sciences; Nursing
interview description
Cervical cancer, a completely curable disease with early detection and management, is an international concern. Early identification allows for treatment of the disease, which prevents or slows progression, ultimately reducing morbidity and mortality. Due to the regressive nature of most cervical lesions, the duration between cervical cytology has been lengthened to prevent over diagnosis and treatment. This was reflected in the 2012 United States Preventative Services Task Force (USPSTF) clinical practice guideline for cervical cancer screening.The purpose of this project was to determine the effectiveness of a quality improvement initiative to increase adherence to the 2012 USPSTF guideline at a volunteer medical clinic for the working uninsured. In this retrospective, time series observational evaluation, data were collected via chart review regarding adherence to the guideline. The intervention consisted of the placement of a visual algorithm educational tool for clinical decision-making for cervical cytology screening in each exam room. Data were collected during three time periods: (1) the 3 months prior to initial education of clinic staff regarding the guideline; (2) the 3months between initial education and introduction of the algorithm; and (3) the 3 months post introduction of the algorithm.A total of 335 charts were reviewed. There was a significant difference in the proportion of appropriate screening among the three groups (Χ2= 6.83 p=.03). There was also a significant difference in appropriate screening rates between the new and established patients’ group, controlling for group (p<.0001). The use of the interventional algorithm is recommended to improve adherence to evidence-based practice guideline related to cervical screening as it decreases harm(s) to the patient by reduction of fear, cost to the patient, and overtreatment of benign regressive lesions.