Assurance in Action: Technical Assistance to Improve Ct Screening Rates Among Young Females in Federally Qualified Health Centers (FQHCs) in New York City

Background:  As part of the Program Collaboration and Service Integration (PCSI) initiative at the New York City Department of Health and Mental Hygiene (DOHMH), the Bureau of STD Control (BSTDC) assessed primary care providers’ chlamydia (Ct) screening practices and sought to improve documentation of sexual histories and appropriate testing and treatment of adolescent females. Three FQHCs (designated as Entity A, B and C) each with clinics in NYC neighborhoods with high rates of co-occurrence of Ct, HIV and Hepatitis C were recruited to participate.

Methods: FQHCs extracted baseline (January-June 2012) and follow-up (January-June 2013) data from their electronic health records (EHRs). Technical assistance offered in the interim included: aggregation and discussion of submitted data, targeted recommendations, materials on screening and treatment guidelines, provider training, and access to STD-related webinars.  

Results: Compared to baseline, documentation of sexual activity (a reflection of appropriate sexual history taking) in its structured field increased at Entity A (49% to 58%, p<.0001) and Entity B (83% to 90%, p<.0001). Furthermore, Ct screening among women ≤25 years increased (p<.0001) from 36% (772/2131) to 47% (1760/3770) at Entity A and from 70% (1280/1825) to 77% (1437/1856) (p<.0001) at Entity B. While Ct screening among women >25 years increased slightly at Entity A and B, Entity C showed a significant (p<.0001) decrease in Ct screening among women >25 years from 50% (307/608) to 41% (157/385). 

Conclusions: Structured fields for sexual activity are often under-utilized by providers and therefore do not accurately reflect the number of sexually active patients. Provision of provider training on the importance of taking and documenting sexual histories helped one FQHC improve its EHR documentation. Technical assistance to FQHCs appears to have a positive impact on facilities’ screening rates among young women, but may be less effective in curbing over-screening of women >25 years.