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J Pediatr Adolesc Gynecol. 2019 Feb;32(1):32-38. doi: 10.1016/j.jpag.2018.10.004. Epub 2018 Oct 28.

Effectiveness of a Quality Improvement Intervention to Improve Rates of Routine Chlamydia Trachomatis Screening in Female Adolescents Seeking Primary Preventive Care.

Author information

1
Craig A Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. Electronic address: woodsa@email.chop.edu.
2
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
3
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
4
Craig A Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
5
Craig A Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

Abstract

STUDY OBJECTIVE:

To determine the impact of a multicomponent quality improvement (QI) intervention on Chlamydia trachomatis screening for young women in primary care.

DESIGN:

Observational cohort analysis.

SETTING:

Urban primary care site providing adolescent primary and confidential sexual health care.

PARTICIPANTS:

Female adolescents aged 15-19 years.

INTERVENTIONS:

From December 2016 to April 2018, we designed and implemented a multiphase QI intervention. The final intervention, beginning March 2017, consisted of the following at all adolescent well visits: (1) dual registration for well and confidential sexual health encounters; (2) urine collection during the rooming process; and (3) electronic health record-based prompts for chlamydia screening.

MAIN OUTCOME MEASURES:

Annual chlamydia screening rates before and after the intervention, with a goal of achieving a relative increase of 10%.

RESULTS:

There were 1550 well adolescent encounters from December 2016 to April 2018. The preimplementation chlamydia screening rate among 15- to 19-year-old female adolescents was 312/757 (41.2%) (95% confidence interval, 20.9%-61.5%). Postintervention, this increased to 397/793 (50.0%) (95% confidence interval, 28.6%-71.5%; P < .001). The clinic chlamydia test positivity rate remained stable, at 10.7% and 11.1% in the pre- and postintervention periods, respectively. There was no significant change in median visit length in the pre- (79.2 minutes; interquartile range, 59.5-103.3) and postintervention periods (80.4 minutes; interquartile range, 61.7-102.8; P = .63).

CONCLUSION:

This practice-based QI intervention resulted in a statistically significant 21% relative increase in annual Chlamydia trachomatis screening rates among female adolescents, without lengthening median visit time.

KEYWORDS:

Adolescent; Chlamydia trachomatis; Primary care; Screening; Sexually transmitted infection

PMID:
30394335
PMCID:
PMC6413877
DOI:
10.1016/j.jpag.2018.10.004
[Indexed for MEDLINE]
Free PMC Article

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