학술논문
Impact of Patient Reminders on Papanicolaou Test Completion for High-Risk Patients Identified by a Clinical Decision Support System.
Document Type
Academic Journal
Author
MacLaughlin KL; 1 Department of Family Medicine, Mayo Clinic , Rochester, Minnesota.; Kessler ME; 2 Division of Primary Care Internal Medicine, Mayo Clinic , Rochester, Minnesota.; Komandur Elayavilli R; 3 Division of Biomedical Statistics and Informatics, Mayo Clinic , Rochester, Minnesota.; Hickey BC; 4 Knowledge and Delivery Center, Mayo Clinic , Rochester, Minnesota.; Scheitel MR; 4 Knowledge and Delivery Center, Mayo Clinic , Rochester, Minnesota.; Wagholikar KB; 5 Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts.; Liu H; 3 Division of Biomedical Statistics and Informatics, Mayo Clinic , Rochester, Minnesota.; Kremers WK; 3 Division of Biomedical Statistics and Informatics, Mayo Clinic , Rochester, Minnesota.; Chaudhry R; 2 Division of Primary Care Internal Medicine, Mayo Clinic , Rochester, Minnesota.
Source
Publisher: Mary Ann Liebert, Inc Country of Publication: United States NLM ID: 101159262 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1931-843X (Electronic) Linking ISSN: 15409996 NLM ISO Abbreviation: J Womens Health (Larchmt) Subsets: MEDLINE
Subject
Language
English
Abstract
Background: A clinical decision support system (CDSS) for cervical cancer screening identifies patients due for routine cervical cancer screening. Yet, high-risk patients who require more frequent screening or earlier follow-up to address past abnormal results are not identified. We aimed to assess the effect of a complex CDSS, incorporating national guidelines for high-risk patient screening and abnormal result management, its implementation to identify patients overdue for testing, and the outcome of sending a targeted recommendation for follow-up.
Materials and Methods: At three primary care clinics affiliated with an academic medical center, a reminder recommending an appointment for Papanicolaou (Pap) testing or Pap and human papillomavirus cotesting was sent to high-risk women aged 18 through 65 years (intervention group) identified by CDSS as overdue for testing. Historical control patients, who did not receive a reminder, were identified by CDSS 1 year before the date when reminders were sent to the intervention group. Test completion rates were compared between the intervention and control groups through a generalized estimating equation extension.
Results: Across the three sites, the average completion rate of recommended follow-up testing was significantly higher in the intervention group at 23.7% (61/257) than the completion rate at 3.3% (17/516) in the control group (p < 0.001).
Conclusions: A CDSS with enhanced capabilities to identify high-risk women due for cervical cancer testing beyond routine screening intervals, with subsequent patient notification, has the potential to decrease cervical precancer and cancer by improving adherence to guideline-compliant follow-up and needed treatment.
Materials and Methods: At three primary care clinics affiliated with an academic medical center, a reminder recommending an appointment for Papanicolaou (Pap) testing or Pap and human papillomavirus cotesting was sent to high-risk women aged 18 through 65 years (intervention group) identified by CDSS as overdue for testing. Historical control patients, who did not receive a reminder, were identified by CDSS 1 year before the date when reminders were sent to the intervention group. Test completion rates were compared between the intervention and control groups through a generalized estimating equation extension.
Results: Across the three sites, the average completion rate of recommended follow-up testing was significantly higher in the intervention group at 23.7% (61/257) than the completion rate at 3.3% (17/516) in the control group (p < 0.001).
Conclusions: A CDSS with enhanced capabilities to identify high-risk women due for cervical cancer testing beyond routine screening intervals, with subsequent patient notification, has the potential to decrease cervical precancer and cancer by improving adherence to guideline-compliant follow-up and needed treatment.