ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Given that cervical cancer screening (CCS) rates have declined during the COVID-19 pandemic, and the extent to which logistical barriers contribute to delayed CCS, this quality improvement project aims to improve CCS rates in our clinic through dedicated, convenient clinical sessions for Pap tests. DESCRIPTION OF PROGRAM/INTERVENTION: The UPMC General Internal Medicine-Oakland (GIMO) Clinic held “Pap Days,” clinic sessions dedicated for CCS and conducted by women's health-trained GIM faculty. Eligible patients were those who: 1) see PCPs at GIMO, 2) were eligible for CCS based on age and pelvic organ status (i.e. had not had hysterectomy for benign reasons), and 3) were overdue for CCS. Bulk EMR-generated messaging was used to invite eligible patients to schedule an appointment. PCPs could also directly refer patients. MEASURES OF SUCCESS: We will analyze the administrative burden involved in scheduling the sessions and the return on that investment, e.g. the number of invitations sent, the number of appointments made, and the number of appointments completed. As the goal of CCS is to identify and treat precancerous lesions before they become cancerous, we will quantify the abnormal results that are detected and any recommended follow-up testing. We will also analyze patient characteristics, to guide future Pap Days. FINDINGS TO DATE: 70 appointment slots were scheduled over 4 days in November and December 2021. 1086 patients were contacted through a secure messaging portal. 67 appointments were scheduled for 63 unique patients;38 visits were completed (57%), 5 were no-shows (7.5%), 22 cancelled (33%), 2 were not for CCS (3.3%). 57 of 63 patients (90%) were insured by the health system's affiliated health plan;39 (62%) had employer-sponsored plans, 5 had Affordable Care Act plans (8%), 16 had Medicaid (25%), and 3 had Medicare (5%). 12/63 (19%) patients had no prior CCS records in our EMR. Of the 38 Paps that were performed, 30 (79%) were normal, 2 (5.3%) were ASCUS/ HPV-, 2 (5.3%) were ASCUS/HPV+, and 4 (11%) were unsatisfactory. Evaluation of how long patients were overdue is ongoing. KEY LESSONS FOR DISSEMINATION: This project demonstrates the feasibility and success of a quality improvement intervention-dedicated CCS sessions-to improve rates of CCS. Recruiting patients and scheduling appointments was relatively easy to implement, and anecdotal feedback from the patients and physicians was very positive. We recruited a wide array of patients from our clinic panel. Challenges were encountered because our EMR often defaults to 3-year CCS intervals and requires that providers manually update the interval to 5 years where appropriate, so outreach lists included patients who were wrongly identified as overdue. Nevertheless, the results of this program suggest that it is scalable to more patients and would be easy to implement in outpatient clinics of any size and geographical area.