{"id":242,"date":"2024-10-30T19:46:11","date_gmt":"2024-10-30T19:46:11","guid":{"rendered":"https:\/\/iims.uthscsa.edu\/isrn\/?page_id=242"},"modified":"2024-11-07T16:06:42","modified_gmt":"2024-11-07T16:06:42","slug":"development-implementation-of-pap-test-guidelines-in-gyn-oncology-practice-abstract","status":"publish","type":"page","link":"https:\/\/iims.uthscsa.edu\/isrn\/resources\/ereading-room\/abstracts\/development-implementation-of-pap-test-guidelines-in-gyn-oncology-practice-abstract\/","title":{"rendered":"Development-Implementation of Pap Test Guidelines in GYN Oncology Practice"},"content":{"rendered":"

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<\/h1>\n\n\n\n\n\n
Primary Author:<\/td>\nLarissa Meyer, MD, MPH<\/td>\n<\/tr>\n
Co-Principal Investigators\/Collaborators:<\/td>\nKathleen 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<\/td>\n<\/tr>\n
Organization<\/td>\nUT Medical School of Houston<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

<\/h2>\n

Abstract<\/h2>\n

Purpose<\/h3>\n
    \n
  1. To create and implement Pap test guidelines for a GYN Oncology practice<\/li>\n
  2. To decrease Pap tests performed for disease surveillance in survivors of gynecologic malignancies by 50%<\/li>\n
  3. To estimate cost savings<\/li>\n<\/ol>\n

    Background<\/h3>\n

    The widespread use of the Pap test hasn\u2019t 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).<\/p>\n

    Materials & Methods<\/h3>\n

    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\u2019 exact test was performed. We estimated 80% power to detect a difference of 10.5%.<\/p>\n

    Results<\/h3>\n

    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.<\/p>\n

    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.<\/p>\n

    Conclusion<\/h3>\n

    Small-scale performance improvement can achieve change in busy clinical settings. CPG can effectively decrease overutilization of Pap tests in survivors of gynecologic malignancies.<\/p>\n

    Bibliography<\/h3>\n

    Berchuck A, Anspach C, Evans AC, et al.(1995) Postsurgical surveillance of patients with FIGO stage I\/II endometrial adenocarcinoma. Gynecol Oncol;59:20-24.<\/p>\n

    Reddoch JM, Burket TW, Morris M, et al. (1995) Surveillance for recurrent endometrial carcinoma: development of a follow up scheme. Gynecol Oncol;59:221-25.<\/p>\n

    Cooper AL, Dornfeld-Finke JM, Banks HW, et al. (2006) Is cytologic screening an effective method of surveillance to detect vaginal recurrence of uterine cancer? Obstet Gynecol;107:71-6.<\/p>\n

    Patsner B. (2001, July) Papanicolaou smears are of little value in the post-treatment surveillance of patients with ovarian epithelial cancer. J Low Genit Tract Dis 5(3), 130-132.<\/p>\n

    Bodurka-Bevers D, Morris M, Eifel PJ, et al. (2000). Posttherapy surveillance of women with 388-393.cervical cancer: an outcomes analysis. Gynecol Oncol ;78:218-23.<\/p>\n

    Santillan A., Govan L, Zahurak ML, et al. (2008) Feasibility and economic impact of a clinical pathway for pap test utilization in Gynecologic Oncology practice. Gynecol Oncol :388-393.
    \n\u00a9 Improvement Science Research Network, 2012<\/p>\n

    The ISRN\u00a0published this as received and with permission from the author(s).<\/p>\n<\/div>\n<\/div>\n<\/div>\n

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