Background:
Chlamydia trachomatis (CT) screening rates are low among enrollees in commercial and Medicaid health insurance plans, and systems-level efforts to improve adherence to recommended routine CT screening would be beneficial.

Objective:
To evaluate the effectiveness of a Continuous Quality Improvement (CQI) protocol undertaken in a busy public hospital's family medicine clinic to improve rates of CT screening among sexually active women ages 15-26, per Centers for Disease Control and HEDIS guidelines.

Method:
This study involved implementation of a chlamydia screening tool prompting medical assistants to administer a brief behavioral questionnaire, collect a urine specimen, and complete lab slips for providers to sign. This CQI approach was in place for 6 months. A retrospective chart review (covering a 12 month period) provided comparison data.

Result:
Screening levels at this clinic were higher at baseline than national averages, and improved somewhat during the CQI period. Preliminary chart review from a three-month comparison suggests that more women were screened for CT during the CQI project period than before the CQI project's initiation: 89% of eligible women vs. 72% respectively (chi2 = 7.06, p = 0.008). Provider concerns about CT screening implementation included patient out-of-pocket costs for CT labs, and sensitivity to sexual behavior questions being asked of immigrant population attendees.

Conclusion:
Women ages 15-26 are at highest risk for asymptomatic CT. Annual screening of sexually active women in this age range is the best way to identify this silent infection and to treat it before it produces negative clinical sequelae. Implementation of such protocols can be difficult but achievable within busy practices.

Implications:
The challenges inherent in implementing a national guideline into everyday practice in a medical clinic include staff buy-in, consistent presence, and “championing”; as well as optimal mechanics to ensure that CT screening criteria are assessed and specimens are collected.