Variation in the receipt of human papilloma virus co-testing for cervical screening: Individual, provider, facility and healthcare system characteristics.
Variation in the receipt of human papilloma virus co-testing for cervical screening: Individual, provider, facility and healthcare system characteristics.
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DOI：
10.1016/j.ypmed.2021.106871
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发表时间：
2022-01
影响因子：
5.1
通讯作者：
Kobrin SC
中科院分区：
文献类型：
--
作者：
Haas JS;Cheng D;Yu L;Atlas SJ;Clark C;Feldman S;Silver MI;Kamineni A;Chubak J;Pocobelli G;Tiro JA;Kobrin SC
自2012年以来，宫颈癌筛查指南允许30-65岁妇女选择筛查检测（即每3年进行一次巴氏试验，或每5年进行一次巴氏试验和人乳头瘤病毒联合检测）。这种灵活性旨在给患者和提供者提供选择，反映了筛查指南日益复杂的趋势。我们的目的是表征子宫颈筛查在个人、提供者、诊所/设施和医疗保健系统水平上的变化。该分析包括2010年至2017年在三个医疗保健系统的136家诊所/设施的3,626名提供者中接受筛查的296,924人。主要结局是接受联合检测与单独巴氏试验。在2012年指南发布之前，联合检测在一个医疗保健系统中更为常见（其他系统相对于该系统的联合检测的调整优势比（AOR）为0.00和0.50），但随着时间的推移，在第二个医疗保健系统中越来越多地实施，第三个医疗保健系统的调整优势比（AOR）下降（2017年：AOR转变为7.32和0.01）。尽管系统层面存在差异，但与诊所/设施相比，与提供者相关的联合检测的接收存在更大的异质性。在三个医疗保健系统中，使用联合检测的最高四分位数的提供者为具有相同特征的妇女提供联合检测的几率是最低四分位数的8.35倍，8.81倍和25.05倍。同样，使用联合检测的最高四分位数的诊所/设施提供联合检测的几率是最低四分位数的4.20、3.14和6.56倍。即使在考虑了患者特征后，筛查试验使用的差异也与卫生系统、提供者和诊所/设施水平有关。
Since 2012, cervical cancer screening guidelines allow for choice of screening test for women age 30–65 years (i.e., Pap every 3 years or Pap with human papillomavirus co-testing every 5 years). Intended to give patients and providers options, this flexibility reflects a trend in the growing complexity of screening guidelines. Our objective was to characterize variation in cervical screening at the individual, provider, clinic/facility, and healthcare system levels. The analysis included 296,924 individuals receiving screening from 3,626 providers at 136 clinics/facilities in three healthcare systems, 2010 to 2017. Main outcome was receipt of co-testing vs. Pap alone. Co-testing was more common in one healthcare system before the 2012 guidelines (adjusted odds ratio (AOR) of co-testing at the other systems relative to this system 0.00 and 0.50) but was increasingly implemented over time in a second with declining uptake in the third (2017: AORs shifted to 7.32 and 0.01). Despite system-level differences, there was greater heterogeneity in receipt of co-testing associated with providers than clinics/facilities. In the three healthcare systems, providers in the highest quartile of co-testing use had an 8.35, 8.81, and 25.05-times greater odds of providing a co-test to women with the same characteristics relative to the lowest quartile. Similarly, clinics/ facilities in the highest quartile of co-testing use had a 4.20, 3.14, and 6.56-times greater odds of providing a co-test relative to the lowest quartile. Variation in screening test use is associated with health system, provider, and clinic/facility levels even after accounting for patient characteristics.
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影响因子：
39.2
作者：
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通讯作者：
Moyer, Virginia A.
影响因子：
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作者：
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作者：
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作者：
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