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J Low Genit Tract Dis. 2008 Apr;12(2):103-10. doi: 10.1097/LGT.0b013e31815ae9a1.

Dissemination of Lean methods to improve Pap testing quality and patient safety.

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1
Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. raabss@upmc.edu

Abstract

OBJECTIVE:

To determine if the implementation of Lean methods resulted in improved Pap test quality and diagnostic accuracy in 5 clinician practices.

MATERIALS AND METHODS:

We performed a 1-year case-control study that included 5,384 control (preintervention) and 5,442 case (postintervention) women who had a Pap test procured by 1 of 5 clinicians. Using Lean methods, the clinicians increased their focus of Pap test procurement by creating a "one-by-one" workflow and recorded process completion using a Lean checklist. We compared the case and control Pap test quality and accuracy measures using the proportion of Pap tests lacking a transformation zone component, proportion of unsatisfactory Pap tests, frequency of newly detected cervical intraepithelial neoplasia following a previous benign Pap test, and proportion of Pap tests with a diagnosis of atypical squamous cells of unknown significance.

RESULTS:

After the intervention, there was a statistically significant decrease in the mean proportion of Pap tests lacking a transformation zone component, p =.011. Two of 5 clinicians showed a statistically significant decrease in their unsatisfactory Pap test frequency, although the overall Pap test unsatisfactory frequency for the case group was not statistically significant lower, p =.087. The case group showed a 114% increase in newly detected cervical intraepithelial neoplasia following a previous benign Pap test, p =.004. There was no statistically significant difference for the proportion of Pap tests with a diagnosis of atypical squamous cells of unknown significance, p =.908.

CONCLUSIONS:

Disseminating Lean methods across a group of clinicians resulted in improved Pap test quality and diagnostic accuracy.

PMID:
18369303
DOI:
10.1097/LGT.0b013e31815ae9a1
[Indexed for MEDLINE]
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