TY - JOUR
T1 - Variation in the receipt of human papilloma virus co-testing for cervical screening
T2 - Individual, provider, facility and healthcare system characteristics
AU - Haas, Jennifer S.
AU - Cheng, David
AU - Yu, Liyang
AU - Atlas, Steven J.
AU - Clark, Cheryl
AU - Feldman, Sarah
AU - Silver, Michelle I.
AU - Kamineni, Aruna
AU - Chubak, Jessica
AU - Pocobelli, Gaia
AU - Tiro, Jasmin A.
AU - Kobrin, Sarah C.
N1 - Publisher Copyright:
© 2021
PY - 2022/1
Y1 - 2022/1
N2 - Since 2012, cervical cancer screening guidelines allow for choice of screening test for women age 30–65 years (i.e., Pap every 3 years or Pap with human papillomavirus co-testing every 5 years). Intended to give patients and providers options, this flexibility reflects a trend in the growing complexity of screening guidelines. Our objective was to characterize variation in cervical screening at the individual, provider, clinic/facility, and healthcare system levels. The analysis included 296,924 individuals receiving screening from 3626 providers at 136 clinics/facilities in three healthcare systems, 2010 to 2017. Main outcome was receipt of co-testing vs. Pap alone. Co-testing was more common in one healthcare system before the 2012 guidelines (adjusted odds ratio (AOR) of co-testing at the other systems relative to this system 0.00 and 0.50) but was increasingly implemented over time in a second with declining uptake in the third (2017: AORs shifted to 7.32 and 0.01). Despite system-level differences, there was greater heterogeneity in receipt of co-testing associated with providers than clinics/facilities. In the three healthcare systems, providers in the highest quartile of co-testing use had an 8.35, 8.81, and 25.05-times greater odds of providing a co-test to women with the same characteristics relative to the lowest quartile. Similarly, clinics/ facilities in the highest quartile of co-testing use had a 4.20, 3.14, and 6.56-times greater odds of providing a co-test relative to the lowest quartile. Variation in screening test use is associated with health system, provider, and clinic/facility levels even after accounting for patient characteristics.
AB - Since 2012, cervical cancer screening guidelines allow for choice of screening test for women age 30–65 years (i.e., Pap every 3 years or Pap with human papillomavirus co-testing every 5 years). Intended to give patients and providers options, this flexibility reflects a trend in the growing complexity of screening guidelines. Our objective was to characterize variation in cervical screening at the individual, provider, clinic/facility, and healthcare system levels. The analysis included 296,924 individuals receiving screening from 3626 providers at 136 clinics/facilities in three healthcare systems, 2010 to 2017. Main outcome was receipt of co-testing vs. Pap alone. Co-testing was more common in one healthcare system before the 2012 guidelines (adjusted odds ratio (AOR) of co-testing at the other systems relative to this system 0.00 and 0.50) but was increasingly implemented over time in a second with declining uptake in the third (2017: AORs shifted to 7.32 and 0.01). Despite system-level differences, there was greater heterogeneity in receipt of co-testing associated with providers than clinics/facilities. In the three healthcare systems, providers in the highest quartile of co-testing use had an 8.35, 8.81, and 25.05-times greater odds of providing a co-test to women with the same characteristics relative to the lowest quartile. Similarly, clinics/ facilities in the highest quartile of co-testing use had a 4.20, 3.14, and 6.56-times greater odds of providing a co-test relative to the lowest quartile. Variation in screening test use is associated with health system, provider, and clinic/facility levels even after accounting for patient characteristics.
KW - Cervical cancer screening
KW - Guideline implementation
UR - http://www.scopus.com/inward/record.url?scp=85118849065&partnerID=8YFLogxK
U2 - 10.1016/j.ypmed.2021.106871
DO - 10.1016/j.ypmed.2021.106871
M3 - Article
C2 - 34762966
AN - SCOPUS:85118849065
SN - 0091-7435
VL - 154
JO - Preventive Medicine
JF - Preventive Medicine
M1 - 106871
ER -