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Tom Garvey, BS, M2 Ann Evensen, MD Helen Luce, DO.

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Presentation on theme: "Tom Garvey, BS, M2 Ann Evensen, MD Helen Luce, DO."— Presentation transcript:

1 Tom Garvey, BS, M2 Ann Evensen, MD Helen Luce, DO

2  Two main types ◦ Adenocarcinoma ◦ Squamous cell carcinoma  Asymptomatic  Develop slowly  Risk factors

3  Cytology ◦ High sensitivity ◦ Conventional glass slide ◦ Liquid-based cytology ◦ ASCUS, ASC-H, LGSIL, HGSIL, AIS, AGUS  HPV Testing Normal vs. Abnormal Cervical Cells

4  Histology: Colposcopy ◦ Visual examination ◦ Biopsy ◦ High specificity ◦ CIN-1, 2, or 3; Cancer  Excisional Procedures ◦ Loop Electrosurgical Excision Procedure (LEEP) ◦ Cold cone excision LEEP

5  ASCCP – algorithms for cytological and histological results 4

6  Barriers to screening  Imperfect tests  Loss of follow-up to abnormal results ◦ Patient factors ◦ Provider error  Special challenges at residency clinics

7 InterventionResults Telephone counseling on psychological concerns/barriersImproves initial and long-term adherence Educational brochure/pamphletImproves adherence Electronic tracking systemImproves adherence Family physician involvement in follow-upImproves adherence Result reminder letters from cytologist to physicianImproves adherence, especially with older patients Framing of result messages to patientNot shown to be effective Economic ReimbursementImproves adherence in disadvantaged patients

8 Using an electronic tracking system to manage patients with abnormal cervical cytology will improve both communication of next steps to the patient and patient adherence with these steps at two family medicine residency clinics

9  Data sources: ◦ UW-Verona Family Medicine Clinic ◦ UW-Wausau Family Medicine Clinic  Timeframes: ◦ Index Pap ◦ Pre-intervention: 11/ /2007 ◦ Post-intervention: 11/ /2010  Intervention ◦ Spreadsheet  Scoring care: ◦ Follow ASCCP guidelines (3 month window) ◦ Early testing appropriate ◦ Extra vigilant care appropriate

10  If appropriate care took place, assumed communication was appropriate  Inappropriate steps ◦ Review communication ◦ Attribute loss of follow-up (patient or provider)  Scoring stopped after an inappropriate step  Referrals appropriate  Transfer of care  Adolescents excluded from post-intervention results

11 72 Patients 5 Patients Excluded 4 History Questions 1 Chart Incomplete 67 Patients

12 62 Patients 9 Patients Excluded 6 Care Transferred 2 Index Pap not at Clinic 1 Chart Incomplete 53 Patients

13  Las 127 Patients 23 Patient Excluded 13 Adolescents 9 Care Transferred 1 Superceding Provider Judgment 104 Patients

14  Las 77 Patients 8 Patients Excluded 5 Care Transferred 3 Adolescents 69 Patients

15  Patient Care: ◦ Percentage of follow-up steps that were appropriate  Provider Communication: ◦ Percentage of follow-up steps that had correct provider communication  Significance of Results: ◦ analyzed with Fisher’s test

16 Key: V – Verona W - Wausau # of Steps with Appropriate Care # of Steps with Delayed or Absent Care Percent of Steps with Appropriate Care ClinicVWVWVW Pre- intervention %76.0% Post- intervention %76.8% Improvement:5.9% P= % P=1

17 Key: V – Verona W - Wausau # of Steps where Patient Received Adequate Communication # of Steps where Patients Received Either No or Erroneous Communication Percent of Steps with Adequate Communication ClinicVWVWVW Pre- intervention %87.0% Post- intervention %89.9% Improvement:9.7% P= % P=0.66

18  Study not complete  Challenges: ◦ Change in ASCCP guidelines ◦ Implementation of EMR ◦ Difficulty in judging communication of next steps ◦ Clinicians not interpreting algorithms correctly, especially post-colposcopy follow-up  Next Steps ◦ Continue spreadsheet use ◦ Track remaining patients ◦ Provider Education ◦ Intervention Tailoring: Initiating incentives, paying for care or transportation, informational brochures

19  Ann Evensen, MD - project advisor  Anna Hendrickson, RN – project member  Laura Kutzke – program coordinator  Helen Luce, DO – project advisor  Clarissa Renken, DO – project member  Mark Shapleigh – clinic manager  Jon Temte, MD,PhD – program director

20 1. American Cancer Society - Cancer Facts & Figures At: s/document/500809webpdf.pdf (Accessed July 13th 2010). 2. Parkin, DM, Pisani, P, Ferlay, J. Global cancer statistics. CA Cancer J Clin 1999; 49: National Cancer Institute – Current Research: Health Disparities: Cervical Cancer. At: (Accessed July 13th 2010). 4. American Society for Colposcopy and Cervical Pathology – Consensus Guidelines: At: df (Accessed July 13th 2010).


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