Brigham and Women's Hospital

Improving Colposcopy Rates for Women Screened for Cervical Cancer: Actively Managing Care Among Women at Risk

Project Lead: Sarah Feldman, MD, MPH 

Project AIM(s): The creation of the colposcopy referral order within our health record (Epic), which was accomplished in the first quarter of the grant. We had 285 referrals placed and scheduled in our faculty colposcopy clinic during the grant period, using this additional referral option we created.

Narrative Description: 

Our key findings were that we can successfully increase the rates of colposcopy for women with abnormal screening Pap/HPV tests at our institution by identifying those with abnormal results who have not received appropriate follow up and providing proactive outreach, facilitating appointments with patient navigators, and identifying barriers to care. We found that our colposcopy rate increased, particularly for high-grade abnormal pap results, from about 71% to 80% for those with complete data (1 year from their abnormal screening test). These are the women at highest risk of developing cervical cancer in their lives, and by ensuring completion of colposcopy and subsequent treatment, we will reduce the burden of cervical cancer in our community.

In conclusion, we found that a streamlined patient navigation program and active quality improvement interventions were able to improve our colposcopy rate for high grade abnormal pap/HPV tests at our institution from about 71% to 80%. We achieved this by obtaining a monthly list of all abnormal screening results which was reviewed by our primary care QI team who, checked for colposcopic referrals and compliance with appointments, and referred those without appropriate follow up to our Gyn Oncology new patient service for further evaluation and triage. We simplified the referral process, though the creation of an easy “colposcopy referral” option in EPIC, followed by an organized outreach program. This program included screening every patient for food, childcare, and transportation needs at their initial phone call to schedule their colposcopy, implementing patient-specific navigation to reduce barriers to  care, and developing the patient navigation toolkit to educate our own staff and to make our approach easily replicable in other settings. This has increased our follow-up colposcopy rates and decreased our no show rates – improving both cancer detection and prevention and also the efficient use of resources. In the future, we plan to expand this work to other sites, roll out the new paradigm for cervical cancer screening (primary HPV testing), and ensure that there are adequate educational materials for patient and providers around this new system once rolled out at our hospital. Moreover, we hope to roll the principles we developed across our institution and to use automated EHR approaches to identify and remind the high-risk patients of the need for colposcopy.   

Diagnostic quality problem type, failure, or category (symptoms, observed problems, gaps in performance) addressed by the intervention

  • Patient delayed or unable to access to care
  • Information gathering
  • Information integration
  • Information interpretation
  • Establishing an explanation (diagnosis)
  • Communicate the explanation to the patient

Root causes/causative factors addressed by the intervention

  • Patient-clinician interaction (includes patient and family engagement)
  • Workflow (includes testing, follow-up, and referrals)
  • Health information sharing and accessibility via health IT
  • Knowledge gaps/inexperience

Setting of the diagnostic quality improvement intervention

  • Ambulatory medical care setting (e.g., clinic, office, urgent care)