A portable mechanized tool for evaluating procedural and temporal compliance to the American Society for Colposcopy and Cervical Pathology 2006 consensus guidelines

Background: In 2007, the American Society for Colposcopy and Cervical Pathology (ASCCP) issued new Consensus Guidelines (2006CG) for management of women with abnormal cervical cancer test results. The Breast and Cervical Health Check (BCHC) program is offered by the Alaska Department of Health and Social Services for women below 250% of Federal Poverty Level. The program is funded by the CDC as part of its National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Objective/purpose: A baseline evaluation of 2005 and 2006 BCHC cervical cancer screening practices vs. 2006CG was conducted. Methods: Seventy-six allowable paths through ASCCP's sixteen algorithms were encoded into a data structure capturing procedure sequence and timing recommendations. Over 16,700 procedure records for 2,201 patients with abnormal cytology in the study window were extracted from the BCHC database with SQL. Object-oriented software was developed to further cull the patient set (n=1416) and compare patient records to encoded algorithms. Procedural compliance (match, no-match, and lost-to-followup) and temporal compliance (timely, early, and late) were tallied. Noncompliance patterns were further analyzed with the software and advanced spreadsheet features. Results: The ratio of compliant to noncompliant patients was 31%. Of adolescents with low-grade abnormal Pap test results, 40% received a non-recommended colposcopy and 33% received a non-recommended HPV test. Twenty-three percent of adult women with certain low-grade abnormalities received repeat cytology instead of the recommended colposcopy. Conclusions: Mechanized analysis of compliance to the ASCCP algorithms is possible. Such an analysis can detect areas for improved communication with practitioners in publically funded programs. The mechanized process is portable to other cervical cancer screening programs and to other algorithmically defined treatment guidelines.