Electronic data review, client reminders, and expanded clinic hours for improving cervical cancer screening rates after the COVID-19 pandemic shutdowns: A multicomponent quality improvement program
- East Boston Neighborhood Health Center, United States
- Boston University, United States
Figures
Figure 1
Patient satifaction survey.
Patient survey given to patients who attended the cervical cancer screening (CCS) clinics in the evenings/weekends. The survey was also given in a Spanish version for patients who identified their preferred language of care as ‘Spanish’ in the electronic medical record (EMR).
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Figure 1—source data 1
Editable version of patient satisfaction survey.
- https://cdn.elifesciences.org/articles/85724/elife-85724-fig1-data1-v2.pdf
Figure 2
Overdue cervical cancer screening (CCS) project flowchart.
This flowchart is a summary of the overdue CCS project, including a summary of why CCS was not done for the 118 validated charted reviewed and a summary of the patient outreach for the CCS clinics done in the gynecology clinic (220 patients) vs. those done in the evening/weekend clinics (1155 patients).
Figure 3
Cervical cancer screening results from cervical cancer screening (CCS) clinics.
The CCS cytology results from the 459 screenings done during this project.
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Figure 3—source data 1
Spreadsheet with screening results from CCS clinics.
- https://cdn.elifesciences.org/articles/85724/elife-85724-fig3-data1-v2.xlsx
Figure 4
Cervical cancer screening (CCS) rates at the East Boston Neighborhood Health Center (EBNHC).
The proportion of active patients up to date with CCS each month from 2019 to 2021. The proportion of patients up to date with CCS was the lowest in October 2020 at 63.5%, representing a nadir for the health center during COVID-19. The overdue CCS project started in March 2021 when the CCS up-to-date rate was 68.2%. After completion of the project in August, 2021, the CCS up-to-date rate had increased to 72.7%.
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Figure 4—source data 1
Spreadsheet of CCS rates from 2019 - 2021 for EBNHC.
- https://cdn.elifesciences.org/articles/85724/elife-85724-fig4-data1-v2.xlsx
Figure 5
Annual overdue cervical cancer screening (CCS) number.
Each bar represents the number of patients flagged as overdue for CCS on December 31 per year. From 2019 to 2020, there was an increase in the number of overdue CCS likely due to the COVID-19 pandemic. From March to August 2021, the overdue CCS project was done. The number of overdue CCS decreased by 1309 by December, 2021. Once the project concluded, the level of emphasis on pap screening gradually decreased and reached a point close to the numbers observed prior to the initiation of the project.
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Figure 5—source data 1
Spreadsheet with overdue CCS number for 2019 - 2022 at EBNHC.
- https://cdn.elifesciences.org/articles/85724/elife-85724-fig5-data1-v2.xlsx
Figure 6
Cervical cancer screening (CCS) clinic outreach in the Gynecology Department.
The gynecology clinic outreached to 220 patients with a history of abnormal CCS from the validated overdue CCS list to schedule into one of five CCS clinics done during regular gynecology clinic hours. 57% of patients had the CCS done.
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Figure 6—source data 1
Spreadsheet with CCS Outreach for CCS clinics done in the Gynecology Department.
- https://cdn.elifesciences.org/articles/85724/elife-85724-fig6-data1-v2.xlsx
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Figure 6—source data 2
Spreadsheet for Outreach for CCS clinics done in Gynecology Department part 2.
- https://cdn.elifesciences.org/articles/85724/elife-85724-fig6-data2-v2.xlsx
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Figure 6—source data 3
Spreadsheet of outreach data for CCS clinics done in Gynecology Clinic part 3.
- https://cdn.elifesciences.org/articles/85724/elife-85724-fig6-data3-v2.xlsx
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Figure 6—source data 4
Spreadsheet for outreach data for CCS clinics done in Gynecology Department part 4.
- https://cdn.elifesciences.org/articles/85724/elife-85724-fig6-data4-v2.xlsx
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Figure 6—source data 5
Spreadsheet for outreach data for CCS clinics done in Gynecology Department part 5.
- https://cdn.elifesciences.org/articles/85724/elife-85724-fig6-data5-v2.xlsx
Figure 7
Cervical cancer screening (CCS) clinic outreach for evening/weekend sessions.
The project outreach team attempted to call 1155 patients from the validated overdue CCS list to schedule into one of eight CCS clinics done during evening/weekend hours. 24% of patients had the CCS done.
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Figure 7—source data 1
Spreadsheet for outreach data for CCS clinics: weekend/evening clinic 1.
- https://cdn.elifesciences.org/articles/85724/elife-85724-fig7-data1-v2.xlsx
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Figure 7—source data 2
Spreadsheet for outreach data for CCS clinics: weekend/evening clinic 2.
- https://cdn.elifesciences.org/articles/85724/elife-85724-fig7-data2-v2.xlsx
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Figure 7—source data 3
Spreadsheet for outreach data for CCS clinics: weekend/evening clinic 3.
- https://cdn.elifesciences.org/articles/85724/elife-85724-fig7-data3-v2.xlsx
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Figure 7—source data 4
Spreadsheet for outreach data for CCS clinics: weekend/evening clinic 4.
- https://cdn.elifesciences.org/articles/85724/elife-85724-fig7-data4-v2.xlsx
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Figure 7—source data 5
Spreadsheet for outreach data for CCS clinics: weekend/evening clinic 5.
- https://cdn.elifesciences.org/articles/85724/elife-85724-fig7-data5-v2.xlsx
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Figure 7—source data 6
Spreadsheet for outreach data for CCS clinics: weekend/evening clinic 6.
- https://cdn.elifesciences.org/articles/85724/elife-85724-fig7-data6-v2.xlsx
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Figure 7—source data 7
Spreadsheet for outreach data for CCS clinics: weekend/evening clinic 7.
- https://cdn.elifesciences.org/articles/85724/elife-85724-fig7-data7-v2.xlsx
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Figure 7—source data 8
Spreadsheet for outreach data for CCS clinics: weekend/evening clinic 8.
- https://cdn.elifesciences.org/articles/85724/elife-85724-fig7-data8-v2.xlsx
Figure 8
Percentage of cervical cancer screening (CCS) completed during evening/weekend clinics.
CCS completion rates are reported among the patients who were scheduled into the evening/weekend clinics.
Figure 9
Distribution of no-show patients based on time slot: evening clinics.
Number of patients who did not show up for the evening cervical cancer screening (CCS) clinics per time slot.
Figure 10
Distribution of no-show patients based on time slot: weekend clinics.
Number of patients who did not show up for the weekend cervical cancer screening (CCS) clinics per time slot.
Tables
Table 1
Effort vs. value summary for overdue cervical cancer screening (CCS) project.
| Low value | High value | |
|---|---|---|
| Low effort | Identify the number of overdue CCS for the health center, per department, and per provider pulled from an overdue CCS report in the EMR. Sample overdue CCS list to evaluate why CCS are not being done. Use results to focus areas of improvement. Utilize resident clinics for overdue CCSs. Prioritize patients for outreach (prior abnormal,>5 y overdue, etc.) | |
| Medium effort | Patient satisfaction surveys CCS clinics during regular hours
| |
| High effort | Evening and weekend CCS-only clinics
| Single designated provider makes list of all patients overdue for CCS and review for accuracy
|
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EMR, electronic medical record.
Table 2
Lessons learned.
| How many overdue CCSs does your institution have? |
| – Examine details about the numbers: # overdue CCS/provider and # overdue CCS/department to see if education is needed regarding screening guidelines or clinical workflows. |
| – Identify high-risk groups to target patient outreach: no CCS for >5 y, history of abnormal CCS, first CCS overdue. |
| Why is CCS not being done? |
| – Random sampling of overdue list and deep dive into chart and identify why the CCSs were not done and change workflows accordingly. Changes in workflow should consider CCS-only clinics for new providers or providers coming back from leave. Evening/weekend CCS clinics are not necessarily the best use of resources. |
| If your clinic has a high no-show/cancellation rate for CCS, why? |
| – Electronic outreach and education, language-specific messaging to these patients. |
| – Survey these patients to see why they are not coming in for CCS. |
| – Create a targeted Cervical Cancer Awareness campaign if possible. |
| Educate clinical and administrative leaders |
| – Use data from your clinic’s overdue CCS list to obtain buy-in from strategic stakeholders who can support changes in clinical and electronic workflows. |
| Standardize workflows for rescheduling patients who decline/provider who can’t get to CCS during clinic visit. |
| Have a cervical cancer navigator/population health manager to oversee electronic outreach and data collection/analysis. |
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CCS, cervical cancer screening.
Additional files
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MDAR checklist
- https://cdn.elifesciences.org/articles/85724/elife-85724-mdarchecklist1-v2.pdf
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Source data 1
Spreadsheet data for CCS Clinics Evening/Weekends for Figure 8 (% CCS completed/clinic), Figure 9: (no-show distribution of patient for CCS Evening Clinics), and Figure 10 (no-show distribution of patient for CCS Weekend Clinics).
- https://cdn.elifesciences.org/articles/85724/elife-85724-data1-v2.xlsx
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Electronic data review, client reminders, and expanded clinic hours for improving cervical cancer screening rates after the COVID-19 pandemic shutdowns: A multicomponent quality improvement program
eLife 12:e85724.
https://doi.org/10.7554/eLife.85724
