Electronic Reminders Can Improve Cervical Cancer Screening Rates

According to an AHRQ-funded study in the Journal of Women’s Health, a clinical decision support system that identified high-risk patients, generated patient lists for clinician review and provided subsequent patient reminders led to a 24 percent increase in cervical cancer testing for patients at high risk for the disease. The study group consisted of women at high risk between the ages of 18 and 65 at three primary care clinics affiliated with the Mayo Clinic. Researchers concluded that a clinical decision support system that identifies women at high risk for cervical cancer and can send patient reminders when they are due for testing might be able to decrease cervical cancer rates by improving adherence to follow-up testing and treatment. Access the abstract.

2018 May;27(5):569-574. doi: 10.1089/jwh.2017.6667. Epub 2018 Jan 3.

Impact of Patient Reminders on Papanicolaou Test Completion for High-Risk Patients Identified by a Clinical Decision Support System.

MacLaughlin KL1, Kessler ME2, Komandur Elayavilli R3, Hickey BC4, Scheitel MR4, Wagholikar KB5, Liu H3, Kremers WK3, Chaudhry R2.

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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.