Evaluation of an Electronic Health Record Intervention to Decrease Over-screening in Women Beyond the Screening Age Limits or Post-hysterectomy

Abstract

Objectives: 1) To assess healthcare provider adherence to the 2012 cervical cancer screening guidelines beyond screening age limits and post-hysterectomy; 2) To evaluate effects of electronic health record clinical decision support to decrease non-indicated screening. Methods: A retrospective chart review determined cervical cancer screening practices from 2012-2014 in women <21 or >65 years of age or post-hysterectomy. Tests were designated as indicated/non-indicated per 2012 guidelines. To test the effect of clinical decision support, the proportion of non-indicated tests were compared before and after implementation of decision support. Results: Tests were indicated in 51%, 40%, and 29% of women <21 years, >65 years, and post-hysterectomy, respectively. Implementation of clinical decision support did not change the proportion of non-indicated Pap tests (OR 1.08, 95% CI 0.77-1.52). Conclusions: 35% of Pap tests in women beyond the screening age limits or post-hysterectomy were not indicated. A clinical decision support alert did not change practices.