1. Addressing Overscreening at MIC: A Team Approach
MHRA / MIC Representatives
Rachel Baum
Alex Ely
Sepia Owens-Villas

2. High rates of testing outside of age criteria
Screening at all initial and annual visits
Half of all 2005 Screens were outside criteria:
13 % (n=2,804) were women years
Positivity 1.6%
38% (n=3,977) were women 30+ years
Positivity 1.2%
From August 2005 through July 2006 an average of 86% of all women 25 and over were screened.

3. Team Approach Created plan with management
Presented information to CDs, CNAs & providers
Letter from Medical Director to providers
Changed exam room set-up protocol
Implemented concurrent review
Disseminated progress results
Chart audits
Created plan with MIC management and Medical Director:
Inform CDs, CNAs and providers about the actual positivity rates for women 25+ at MIC centers.
A letter was issued from the MIC Medical Director to the individual clinic Medical Directors reminding them that FP protocol was to routinely screen only women under 25. All others were to be screened only per high risk or if symptomatic. The protocol would be enforced and all screens 25+ were to have supporting documentation in the chart.
Planned to assess for three months (Aug, Sept, Oct) for progress.
Reassured providers we were not asking them to stop prenatal testing, still had high risk or symptomatic screening option
Did not implement this protocol in one center with especially high morbidity rates (Eastern Parkway 6.4% & 3.9%)
Carrot was NAAT testing and urine based option.
% of patients under 25 (1,095) missed because no pelvic exam

4. Progress in first 2 months

5. July – September 2006
First 2 months, August and September 2006 showed significant reduction in % of women 25 + who were screened. Dropping from average of 86% to 58% and then 45%.
Next step is to verify documentation of risk/need for 25+ screen. CDs to pull charts. Will share progress data with center providers at November meeting. Continue to monitor.
Transition to use of NAAT testing in 2007 and add urine-based test capacity.