Creation of a hybrid quality improvement framework tailored to the needs of a national breast and cervical cancer screening program

Several recent trends in U.S. healthcare have highlighted the need to improve the quality of care provided to patients. The pay-for-performance movement, an emphasis on evidence-based practice, and rising healthcare costs have required many healthcare providers to reconsider how they provide care and how the quality and efficiency of that care can be improved. As a result of these issues, there has been a recent notable increase in quality improvement (QI) initiatives in a variety of healthcare settings.

Recognizing the need to address such quality issues, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC) recently undertook a QI project to assist program grantees in identifying and correcting problem areas and ensuring that current best practices were being utilized in program-related care activities. The NBCCEDP is a national program that offers funding to U.S. state, territory, and tribal-level grantees to provide breast and cervical cancer screening and diagnostic services to low-income, uninsured, and underserved women. Since its inception in 1991, the program has served more than 3 million women, providing more than 7.2 million screening examinations.

This project sought to develop a QI framework tailored to the specific needs of the NBCCEDP. While many QI efforts in healthcare have focused on the hospital, inpatient care environment, a unique aspect of this project is the public health, outpatient setting for which the QI framework was developed, making it the first of its kind. To inform the framework's development, the literature was reviewed from 1997 to the present (2007) to identify QI conceptual models and cancer screening best practices that were applicable to the needs of the NBCCEDP. Drawing upon several QI frameworks (Clinical Microsystems, Lean Methodology/Six Sigma, and the Malcolm Baldridge National Quality Program (MBNQP)), cancer screening best practices identified in the literature, information collected during a grantee site visit, and conference calls with grantee QI coordinators, a hybrid QI framework was created for use by the NBCCEDP grantees. Grantee input on this framework was sought by involving the grantees at different points during its development. As a result of this project, QI coordinators were provided with a manual that details the framework and its practical tools and strategies. The use of this hybrid QI framework and associated tools, which are also adaptable to other public health settings, will ensure that grantees meet established quality benchmarks in the provision of care.