Objective Cervical cancer screening is often conducted in excess of current screening guidelines. The objective of this study was to evaluate the effect of an electronic health record (EHR) clinical decision support alert to decrease guideline-nonadherent cervical cancer screening beyond the age limits of screening or posthysterectomy. Materials and Methods The proportion of guideline-nonadherent Pap tests in women younger than 21 years or older than 65 years or posthysterectomy were compared 4 months before and 3 months after implementation of an EHR clinical decision support alert warning providers that a Pap test is not indicated. Providers could cancel the Pap test or override the alert and place the order. Provider characteristics and Pap test indications were summarized by preintervention/postintervention period using descriptive statistics. The proportions of nonindicated Pap tests were compared by intervention period and provider characteristics using generalized estimating equation models. Results In women beyond the screening age limits or posthysterectomy, a total of 388 Pap tests were ordered before intervention, and 313 tests were ordered after intervention. Proportion of guideline-nonadherent tests was similar before (62%) and after intervention (63%); thus, implementation of the clinical decision support alert did not change the proportion of guideline-nonadherent Pap tests ordered (OR = 1.08, 95% CI = 0.77-1.52). It is notable that 52% of guideline-nonadherent tests were ordered by 11 providers. Even when controlling for providers who ordered more than 1 test during the study period, multivariate analysis showed that male providers were more likely to order guideline-nonadherent Pap tests (OR = 2.30, 95% CI = 1.36-3.89); no other differences by provider characteristics were observed. Conclusions An EHR clinical decision support alert does not decrease guideline-nonadherent cervical cancer screening. These data suggest efforts to optimize clinical decision support should be focused on other aspects of cervical cancer prevention.
Bibliographical noteFunding Information:
1Department of Obstetrics, Gynecology & Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN; 2School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN; 3Department of Surgery, Division of Colon & Rectal Surgery, University of Minnesota, Minneapolis, MN; and 4Institute for Health Informatics, University of Minnesota, Minneapolis, MN Correspondence to: Deanna Teoh, MD, MS, FACOG, FACS, Mayo Mail Code 395, 420 Delaware St SE, Minneapolis, MN 55455. E-mail: firstname.lastname@example.org The authors have declared they have no conflicts of interest. D.T. was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number K12HD055887. R.I.V. was supported by a Masonic Cancer Center Women's Health Scholarship. The Masonic Cancer Center Women's Health Scholar is sponsored by the University of Minnesota Masonic Cancer Center, a comprehensive cancer center designated by the National Cancer Institute, and administrated by the University of Minnesota Deborah E. Powell Center for Women's Health. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health and the Masonic Cancer Center. Institutional review board approval was obtained from the University of Minnesota on July 24, 2015 (Study Number 1506M74821). © 2019, ASCCP DOI: 10.1097/LGT.0000000000000484
© Lippincott Williams & Wilkins.
- best practice alert
- cervical cancer screening
- clinical decision support
- electronic health record