Natasha Parekh, MD, MS
Health-care systems use performance measures for cervical cancer screening based on guidelines from such organizations as the American College of Obstetricians and Gynecologists to monitor the appropriateness of cervical cancer screening. According to the performance measure in the Healthcare Effectiveness Data and Information Set, satisfactory cervical cancer screening involves at least one Pap test every 3 years for average-risk women between the ages of 21 and 64 or at least one Pap and human papillomavirus (HPV) test every 5 years for average-risk women between the ages of 30 and 64.
According to researchers at the University of Pittsburgh investigating current performance measures requiring adherence to strict time intervals for cervical cancer screening, there are two main flaws in these performance measures: They do not distinguish between overscreening and appropriate screening, and they do not allow ranges of intervals in appropriate screening definitions.
The result is the requirements may incentivize health-care providers to overscreen women, which can lead to unnecessary procedures. Changing cervical screening performance measures to align better with clinical guidelines will help reduce the frequency of unnecessary procedures and more accurately measure the quality of women’s health care, said the researchers. The brief research report by Natasha Parekh, MD, MS, et al was published in the Annals of Internal Medicine.
To calculate the actual frequency of screening practices, the researchers used Pennsylvania Medicaid administrative data for women between the ages of 18 and 64 between 2007 and 2013. To determine how frequently screening practices were adherent to traditional performance measures and to alternative measures that incorporated two changes, the researchers accepted existing categories of underscreening and appropriate screening and added a new category for overscreening that applied when intervals between screenings were shorter than guideline-recommended ones. They also replaced the single interval for adherence with ranges of 3 months and 6 months.
The researchers classified 27,076 screening intervals among 14,786 women using traditional and alternative measures. According to traditional measures, 29% of intervals among women younger than 30 and 35% of intervals among women aged 30 or older represented underscreening. Most intervals that were appropriate under traditional measures were classified as overscreening under alternative ones.
After the researchers incorporated ranges of ± 3 months and ± 6 months, underscreening declined slightly; however, most intervals still represented overscreening. They found up to an 11% increase in appropriate cervical cancer screening when they included 6-month ranges instead of a single interval in the definition of performance measures. They concluded that incorporating this flexibility is reasonable and unlikely to negatively affect health and that most Pap screening classified as appropriate actually represented overscreening, even when adding ranges to the adherence intervals.
“Current performance measures that classify overscreening as appropriate may incentivize providers to overscreen, to the detriment of patients and the health-care system. We believe that changing cervical cancer screening performance measures to align better with clinical guidelines will help reduce the frequency of unnecessary procedures and more accurately measure the quality of women’s health care,” concluded the researchers. ■