| Primary Author: | Larissa Meyer, MD, MPH |
| Co-Principal Investigators/Collaborators: | Kathleen Schmeler, MD, John Wallbillich, MD, Elizabeth Garcia, RN, Diana Urbauer, MS, Pamela Soliman, MD, Michael Frumovitz, MD, Cathy Burke, APN, Diane Bodurka, Charles Levenback, MD |
| Organization | UT Medical School of Houston |
Abstract
Purpose
- To create and implement Pap test guidelines for a GYN Oncology practice
- To decrease Pap tests performed for disease surveillance in survivors of gynecologic malignancies by 50%
- To estimate cost savings
Background
The widespread use of the Pap test hasn’t significantly improved the early diagnosis of recurrent disease in survivors of gynecologic malignancies(1-5). The use of clinical practice guidelines (CPGs) is a well-described approach to control health care expenditure and improve the consistency and quality of health care delivery(6).
Materials & Methods
A fishbone diagram identified factors contributing to overutilization of Pap tests. Peer educators communicated to key stakeholders. Convenience samples of patient visits during weeks 2 and 4 of August 2009 and of August 2010 was utilized to represent practice patterns pre- and post-implementation of the CPG. The percent of total and unindicated Pap tests performed out of all visits during each 2-week period were calculated. Fishers’ exact test was performed. We estimated 80% power to detect a difference of 10.5%.
Results
466 patient visits occurred in the 2009 study period. 102/466 (21.88%) of patients underwent Pap tests. Unindicated Pap tests were performed at 41/466 visits (8.80%). 438 patient visits occurred in the 2010 study period. 66/438 (15.06%) had Pap tests performed. Unindicated Pap tests were performed at 19/438 (4.34%) of visits, indicating 50% reduction.
The introduction of the CPG correlated with a statistically significant decrease in the proportion of total Pap tests performed (OR 0.63, p=0.01), as well as in the proportion of visits where an unindicated Pap test was performed (OR0.47, p=0.01). The cost per test is estimated at $170. By decreasing the percentage of Pap tests from 22% to 15% of visits, we estimate 938 fewer tests would be performed annually with an estimated savings of $159,535.
Conclusion
Small-scale performance improvement can achieve change in busy clinical settings. CPG can effectively decrease overutilization of Pap tests in survivors of gynecologic malignancies.
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© Improvement Science Research Network, 2012
The ISRN published this as received and with permission from the author(s).