Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #105777

Rebecca M. Ferguson, MPH¹, Ingrid H. Morris, MPH², Cindy Brenneman, RN³, Eva Schaff, MD³, Eugenia Eng, DrPH⁴, and Stokes Ann Wilkinson, RN³. (1) School of Public Health, University of North Carolina at Chapel Hill, Department of Health Behavior and Health Education, CB 7440, Chapel Hill, NC 27599, (2) Prevention and Health Education, Blue Cross and Blue Shield of North Carolina, P.O. Box 2291, Quality Improvement, Durham, NC 27702-2291, (919) 765-7331, ingrid.morris@bcbsnc.com, (3) Quality Improvement, Blue Cross and Blue Shield of North Carolina, P.O. Box 2291, Durham, NC 27702-2291, (4) Health Behavior and Health Education, University of North Carolina - Chapel Hill, Rosenau Hall - Campus Box 7440, Chapel Hill, NC 27599-7400

Background: Chlamydia is the most commonly reported sexually transmitted disease in the United States, with approximately 3 million new cases each year. Adherence to the US Preventive Services Task Force recommendation of annual chlamydia screening among sexually active women (ages 25 and younger) remains low. Among Blue Cross and Blue Shield of North Carolina (BCBSNC) members, in 2003 only 22% of sexually active women ages 25 and younger had a screening in the past year. The BCBSNC Quality Improvement Department conducted 39 interviews with health care providers to gain an understanding of chlamydia screening practices at the individual level of physicians and at the organizational level of private practices. An analysis of themes around barriers and facilitators to screening and a comprehensive literature review suggested that a Continuous Quality Improvement (CQI) approach to organizational change is most likely to positively impact chlamydia screening rates. This intervention represents an innovative collaboration between a health insurance company and clinics.

Objective: The purpose of this study was to test the feasibility of a third party organization implementing a practice improvement intervention based on the principles of CQI in OB/GYN practices to increase chlamydia screening rates of sexually active women aged 25 and younger.

Methods: Three large North Carolina OB/GYN practices participated in the CQI intervention implemented in the winter of 2004. A physician champion was selected at each practice to promote the project, and a CQI overview meeting was held with the entire clinic staff to ensure clinic commitment. A team representing all clinic personnel pivotal to chlamydia screening participated in a 2-hour CQI session facilitated by BCBSNC staff trained in CQI initiatives. The aim of the session was to clarify the clinic's workflow, identify specific barriers to chlamydia screening, and develop changes supporting routine chlamydia screening. All three participating clinics developed workflow changes, implemented them, and monitored results by chart review. Follow-up sessions were scheduled to assist the clinics in process assessment and further improvements, as necessary.

Results: Process evaluation results indicated that the intervention was well received among participating practices, there was a high level of practice participation, and clinic expectations were met. Quantitative results from a BCBSNC claims data evaluation of chlamydia screening rates, using 3 comparison group practices, will be presented.

Conclusion: This pilot project illustrates the unique partnership approach of a CQI model that can be used by third party organizations to improve quality of care.

Learning Objectives: Participants will be able to

• Articulate the goals and process of a third party organization implementing and evaluating a successful Continuous Quality Improvement (CQI) project.
• Describe three steps for establishing a collaborative relationship with clinics to allow for a CQI intervention. (e.g. needs assessment, physician champion, encouraging self-monitoring)
• List the roles (practice liaison, physician champion, CQI team, and CQI facilitators) and functions of participants involved in CQI activities.
• Discuss issues and settings to which the CQI model of organizational change could be applied.

Keywords: Quality Improvement, Chlamydia

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.