Monitoring STD screening as part of Continuous Quality Improvement (CQI) in public health primary care clinics for populations with health disparities in San Francisco

Background. The San Francisco Department of Public Health (SFDPH) is a national Program Collaboration and Service Integration (PCSI) demonstration project site. SFDPH also provides care in 15 Community-Oriented Primary Care (COPC) clinics. Using national guidelines and local epidemiology, the department is revising our screening guidelines for STDs. We assessed a COPC baseline screening rate for two populations with the clearest STD guidelines – young women under 25 and men living with HIV/AIDS (LWHA) – before the guidelines were implemented for Continuous Quality Improvement (CQI).

Methods. We used medical record data to pull patients who had at least one COPC visit in the past two years. We created two datasets: young women under 25 and men LWHA. For young women, we looked at testing rates for Chlamydia, gonorrhea, and HIV. For men LWHA, we calculated testing rates for syphilis, Chlamydia, and gonorrhea.

Results. Of the 55489 active patients, 3432 (6%) were young women 13-24 years old; testing for HIV (27%) was lower than for STDs (62% for Chlamydia, 60% for gonorrhea). Highest positive rate was for Chlamydia (N=85, 4%).

There were 1602 (3%) men LWHA. Testing and positivity were highest for syphilis (62% tested, N=97 positive, 10%).

Conclusions. SFDPH is beginning the process of utilizing registries, data walls, and dashboards as a tool to monitor CQI for preventive services in COPC clinics. We will be coaching health centers and creating STD QI bundles to incorporate clinical guidelines into regular health care maintenance screening.