INCREASING PAP SMEAR ADEQUACY RATES

这个R-18第三阶段示范项目的目的是提高 在初级保健实践中采用两种策略进行宫颈癌筛查： (1)制定和实施巴氏涂片检查充分性反馈系统，以及（2） 结合报告制度， 初级保健提供者的细胞刷收集方法。这项研究将 衡量两种干预措施对巴氏涂片检查的效果。 使用罗氏生物医学实验室的200个初级保健实践 在北卡罗来纳州伯灵顿，大多数供应商提交了至少50份 将招募前一年每位提供者的子宫颈抹片检查。基线 个别提供者的子宫颈抹片检查合格率和收集技术 将研究12个月。实践将被随机分为四个 组，使用2 × 2析因设计，以确定 专为更换供应商而设计的纸张充足性反馈系统 行为每个人将继续收到标准的pap病人报告 罗氏公司的涂片此外，两个小组将获得个人提供者 反馈（干预）和两个将收到没有个人提供者 反馈（控制）。一个干预组和一个对照组 我将每季度收到一份Cytobrush信息包， 推广细胞刷对巴氏涂片合格率的影响。通过 12个月期间，干预组的提供者将获得 每月单独报告自己的业绩， 巴氏试验，包括与同龄人的比较。干预结束时 阶段，将继续收集pap充分性数据，而不提供反馈， 9个月来监测干预措施的长期影响， 供应商行为 这个项目提供了一个独特的机会来评估癌症筛查 使用最大的独立细胞学实验室之一进行干预。它 预计，一旦系统经过测试并显示有效， 将在其他罗氏实验室实施， 在制定报告巴氏涂片检查的标准和准则方面， 结果，初级保健的做法，以及提高充足率。

The purpose of this R-18 Phase III demonstration project is to improve cervical cancer screening in primary care practices using two strategies: (1) to develop and implement a pap smear adequacy feedback system and (2) in conjunction with the reporting system to communicate information on the Cytobrush collection method to primary care providers. The research will measure the effect of the two interventions on performance of pap smears. Two hundred primary care practices using the Roche Biomedical Laboratories at Burlington, NC, in which the majority of providers submitted at least 50 pap smears per provider in the previous year, will be recruited. Baseline pap smear adequacy rates and collection techniques of individual providers will be studied for 12 months. The practices will be randomized into four groups, using a 2 x 2 factorial design to determine the effect of a specifically designed pap adequacy feedback system in changing provider behavior. Each will continue to receive the standard patient reports on pap smears from Roche. In addition, two groups will receive individual provider feedback (intervention) and two will receive no individual provider feedback (control). One of the intervention and one of the control groups will receive a Cytobrush information packet quarterly in order to examine the effects of promoting the Cytobrush on pap smear adequacy rates. Over a 12 month period, the providers in the intervention groups will receive monthly individual reports of their own performance regarding adequacy of pap tests including comparisons with peers. At the end of the intervention phase, pap adequacy data will continue to be collected without feedback for nine months to monitor the long term effects of the intervention on provider behavior. This project provides a unique opportunity to evaluate a cancer screening intervention using one of the largest independent cytology laboratories. It is anticipated that once the system has been tested and shown effective it will be implemented in the other Roche laboratories and will contribute significantly in setting criteria and standards for reporting pap smear results to primary care practices as well as improving adequacy rates.