Systems Approach to Universal Teen Chlamydial Screening

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Background" C. trachomatis (CT) remains epidemic among sexually active adolescent females. Yet the goal of universal screening in the office setting has remained elusive even with the recent introduction of the non-invasive accurate urine based tests that eliminate the necessity of pelvic exams to obtain CT specimens. The long term goal of this TRIP I continuation proposal is to develop a Clinical Practice Intervention (CPI) that will increase CT screening of adolescent females at the point of care regardless of the reason for the visit. We have shown success with this CPI process applied to CT screening during health maintenance visits (HMV) which resulted in an increase from 5% screening at baseline to 65% post-CPl. During the course of our initial TRIP I work, we demonstrated that 2/3 of the target teens attended only same day/urgent care visits (UCVs) and were missed by the HMV focused CT screening. We propose to extend our work to meet the needs of these adolescents by providing CT screening in the urgent care setting. Aim: To significantly increase CT screening in sexually active adolescent females in the urgent care setting through the implementation of a new Clinical Practice Improvement intervention (CPI)that will facilitate the redesign of clinic systems to meet the unique demands of the adolescent and of the urgent care setting. HMO Setting and Population: Ten pediatric urgent care clinics will be selected from a large regional HMO of 34 clinics serving 97,000 females aged 14-18 years. Design/Methods" We will evaluate the effectiveness of the CPI-Urgent Care Intervention by randomizing 10 clinics to either the intervention or control group. The CPI-Urgent Care will consist of 1) engaging the leadership and staff; 2) building teams within clinic staff to accomplish the task; 3) re-designing clinical practice using rapid cycle quality improvement and "Plan-Do-Study-Act "cycles"; 4) sustaining the gains through the continuous monitoring the performance; and 5) developing new tools to improve the efficiency of CT screening in urgent care. This study includes a process evaluation component to evaluate how improvements are achieved and sustained over time. Analysis" Analysis will assess whether the changes in the proportions of sexually active adolescent females screened from baseline to post-intervention differ between the intervention and control clinics.