Massachusetts General Hospital
The goal of this PREDICT is to assess a personalize approach to screening and management of cervical cancer testing. The investigators will evaluate patients who are due for a follow up cervical cancer screening in the primary care clinics in the Massachusetts General Brigham system. Patients will be randomized by clinic into three different arms (Arm 1: standard care, Arm 2: visit based reminders, Arm 3: visit based reminders and population health outreach)
Cancer screening and management guidelines are moving from a "one size fits all" approach to one that is tailored to an individual. Cervical Cancer Screening Management (CCSM) is the first example of a guideline that incorporates longitudinal screening history to personalize risk assessment. While a personalized approach offers the promise of enhancing the balance of benefits vs. harms of screening and management, this ideal can only be realized through strong systems to support care delivery. Without IT tools that integrate personalized algorithms with care delivery, more errors of judgement…
Inclusion Criteria, Individuals who: * have a cervix and are 21-70 years old * receive care at a participating primary care practice (i.e. PCP team visit within past 3 years) * have had a Pap and/ or HPV test within the past 3.5 years * has a CCSM result that suggest a 5-year risk of developing CIN3+ that warrants surveillance at 1 or 3 years, diagnostic colposcopy, or treatment (i.e., above average risk). Inclusion of those up to age 70 is intended to identify individuals whose prior history does not meet screening exit criteria, and warrants surveillance or diagnostic care even though wome…
To identify patients due for CCSM, simplify test ordering/referral, and track follow-up, PREDICT will include: 1) automated updating of a patient's problem list with the current cervical screening finding, 2) automated updating of cervical cancer health maintenance topics to the appropriate time interval and follow-up test/ procedure through the use of modifiers, 3) "SmartSets" to standardize ordering of procedures/ specialty referrals.
Patients will be sent a reminder letter 90 days prior to the due date via the patient portal or mailed if no portal account (Outreach 1). If needed, four weeks later a phone call from the outreach coordinator reminds patients of the follow-up date if scheduled or helps establish follow-up (Outreach 2). The coordinator could also place an order for a referral and send a reminder to the practitioner to sign it if appropriate. The coordinator will review and document any "alternative care plans" discussed by the PCP and patient.
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