As health care costs continue to rise, policymakers look for ways to reduce spending. One way to do this is by identifying low-value preventive services, such as annual Pap tests for women at low-risk for cervical cancer. Electronic health record (EHR) data may help contribute to this identification process, according to a new study.
Researchers used an electronic query of EHR data to identify women aged 30 to 65 years old who were at low-risk of cervical cancer and therefore eligible for an extended Pap testing interval of 3 years instead of the usual once-a-year Pap test. Patient data were obtained from a large general internal medicine clinic in Chicago consisting of 38 internists and 60,000 clinic visits annually. The EHR system included a clinical decision support feature with a point-of-care reminder to perform Pap testing yearly or less often if changed by the physician.
An electronic query identified women with a negative Pap test in 2007 and two prior negative tests in 2004–2006. These women, as well as those with negative Pap and human papillomavirus tests in 2007 were all deemed as low-risk women for cervical cancer and eligible for extended screening intervals.
The electronic query identified 4,002 women who received a negative Pap test in 2007. Of these, 1,705 were eligible for extended screening. A total of 66 percent of low-risk women received a Pap test sooner than the recommended interval for them. The query was accurate at identifying women at low risk of cervical cancer and low-value Pap testing. When the researchers calculated the costs of these unnecessary Pap tests and of colposcopies for false-positive results, the cost was estimated to be $100,000. The study was supported by the Agency for Healthcare Research and Quality (T32 HS00078).
See “Use of electronic health record data to evaluate overuse of cervical cancer screening,” by Jason S. Mathias, M.D., Dana Gossett, M.D., and David W. Baker, M.D., M.P.H., in the June 1, 2012 Journal of the American Medical Informatics Association 19, (e1), pp. e96-e101.