Missed opportunities for cervical cancer screening of HMO members developing invasive cervical cancer (ICC)
Missed opportunities for cervical cancer screening of HMO members developing invasive cervical cancer (ICC)
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DOI：
10.1006/gyno.1998.5135
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发表时间：
1998-12-01
影响因子：
4.7
通讯作者：
Hiatt, RA
中科院分区：
文献类型：
--
作者：
Kinney, W;Sung, HY;Hiatt, RA
目的：通过检查在诊断为宫颈癌前3年内没有进行巴氏涂片检查的妇女的会员历史和医疗记录，确定潜在的错失机会，并建议对预付健康计划成员进行宫颈癌筛查的干预措施。所有642名成员的预付费健康计划发展ICC在1988年至1994年期间的医疗记录进行了审查和病人的互动与医疗保健系统的细节进行了抽象。筛查史和门诊访视史的评估仅限于诊断前36个月，但排除诊断前最后6个月，以避免包括涂片或访视，这是导致识别ICC的评估的一部分。在发生ICC的妇女中，384/642（60%）在诊断前36个月至6个月内没有进行过涂片检查。在这384名未经筛查的妇女中，241名（63%）在诊断前36个月中至少有30个月由我们的HMO投保。在指定的时间段内，这些长期成员中有180/241（75%）在初级保健门诊诊所与医疗系统接触，仅考虑内科和家庭诊所就诊，169/241（70%）至少看过一次，101/241（42%）至少看过3次。大多数长期的HMO成员发展ICC没有受益于最近的巴氏涂片筛查被认为是在初级保健门诊诊所在他们的诊断前3年。(C)北京：科学出版社.
Objective, To identify potential missed opportunities and to suggest interventions for cervical cancer screening in members of a prepaid health plan by examining the membership histories and medical records of women who had no Pap smear performed in the 3 years prior to the diagnosis of ICC.Methods. Medical records of all 642 members of a prepaid health plan developing ICC during the period from 1988 to 1994 were reviewed and details of patient interaction with the health care system were abstracted. Assessment of screening history and history of clinic visits was limited to the period 36 months prior to diagnosis, but excluded the last 6 months prior to diagnosis, so as to avoid including smears or visits which were part of the evaluation that led to the recognition of ICC.Results. Of women developing ICC, 384/642 (60%) had not had a smear in the period from 36 months to 6 months preceding the diagnosis. Of these 384 unscreened women, 241 (63%) had been insured by our HMO for at least 30 of the 36 months prior to diagnosis. Contact with the medical system in one of the primary care outpatient clinics was documented in 180/241 (75%) of these long-standing members during the specified period, Considering only Internal Medicine and Family Practice clinic visits, 169/241 (70%) had been seen at least once and 101/241 (42%) had been seen 3 or more times.Conclusion, Most long-standing HMO members developing ICC without benefit of recent Pap smear screening were seen in primary care outpatient clinics in the 3 years preceding their diagnosis. (C) 1998 Academic Press.