Using reminder systems to improve Papanicolaou test follow-up. An example of continuous quality improvement

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Abstract
Using continuous quality improvement principles, we developed a Papanicolaou test recall system with the goal of increasing first and second follow-up Papanicolaou tests after cryotherapy by 20%. An initial study showed rates of 67% for the first follow-up Papanicolaou test and 31% for the second follow-up test. We formed a dysplasia project team. Using continuous quality improvement principles, we instituted a Papanicolaou test recall system. We remeasured first and second follow-up rates for Papanicolaou tests after cryotherapy. The staff and providers were surveyed regarding their acceptance of the system. No attempt was made to control for confounding factors. The study was performed at the Family Medicine Clinic in Eau Claire, Wis. This is a community-based, university-administered family practice residency training clinic. The first 53 consecutive women who had cryotherapy beginning August 1, 1991, were included in the study. All staff and providers were invited to answer a survey questionnaire. Patients received a reminder postcard when they were due for a Papanicolaou test. They received a follow-up letter the next month if no Papanicolaou test was done. First and second follow-up Papanicolaou test rates after cryotherapy. Staff and provider satisfaction as measured by a survey. Eighty-four percent of the women returned for their first follow-up Papanicolaou test, and 53% returned for their second after cryotherapy. Staff and providers supported the recall system. Continuous quality improvement principles led to a Papanicolaou test reminder system. Follow-up Papanicolaou test rates appeared to increase by 17% for the first Papanicolaou test and by 22% for the second.

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