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Background: Erie County 15-24 year old (y.o.) females have the highest New York State (NYS) burden of CT infections (2014 data: 4,267/100,000 15-19 y.o.; 3,883/100,000 20-24 y.o.). CT screening is a cost-effective preventive service for young women; however, Erie County HEDIS CT screening rates are low in both Medicaid managed care (70%) and commercially-insured females (<60%). The project goals were to evaluate strategies to improve appropriate CT screening in Erie County primary care settings.
Methods: The QI project was implemented May 2015 – February 2016 in one family medicine, two pediatric clinics and one federally qualified health center located in high CT morbidity Buffalo, NY ZIP codes. Each clinic’s QI team received a one-day QI training which produced a clinic flow value stream map and a list of CT screening strategy recommendations. Recommended strategies were tested during four PDSA cycles. Monthly QI nurse clinic visits and two peer Learning Collaboratives provided technical assistance and data feedback. Two outcome measures were evaluated extracting EMR data every six weeks: Sexual Activity Assessment (percentage of 13-24 year old patients with sexual activity status documentation) and CT Screening Conducted (percentage of those sexually-active patients CT screened) with an 80% goal for each. Specialty board Maintenance of Certification Part IV and 20 hour of CME were offered.
Results: Sexual Activity Assessment increased from 22% to 77% and CT Screening increased from 82% to 98%. Successful strategies included EMR systems changes to document sexual activity and to flag eligible patients for CT testing, and clinic flow changes to promote adolescent confidentiality and specimen collection. Barriers included limited staff time, staffing turnover, and limited availability for QI meeting and data collection time.
Conclusions: QI training, on-site technical assistance, tools and data feedback led to provider confidential sexual history documentation improvements and adolescent CT screening increases in each clinic.