Using reminder systems to improve Papanicolaou test follow-up. An example of continuous quality improvement.

Objective: Using continuous quality improvement principles, we developed a Papanicolaou test recall system with the goal of increasing first and second follow-up Papanicolaou tests after cryotherapy by 20%.

Design: An initial study showed rates of 67% for the first follow-up Papanicolaou test and 31% for the second follow-up test. We formed a dysplasia project team. Using continuous quality improvement principles, we instituted a Papanicolaou test recall system. We remeasured first and second follow-up rates for Papanicolaou tests after cryotherapy. The staff and providers were surveyed regarding their acceptance of the system. No attempt was made to control for confounding factors.

Setting: The study was performed at the Family Medicine Clinic in Eau Claire, Wis. This is a community-based, university-administered family practice residency training clinic.

Participants: The first 53 consecutive women who had cryotherapy beginning August 1, 1991, were included in the study. All staff and providers were invited to answer a survey questionnaire.

Intervention: Patients received a reminder postcard when they were due for a Papanicolaou test. They received a follow-up letter the next month if no Papanicolaou test was done.

Main Outcome Measures: First and second follow-up Papanicolaou test rates after cryotherapy. Staff and provider satisfaction as measured by a survey.

Results: Eighty-four percent of the women returned for their first follow-up Papanicolaou test, and 53% returned for their second after cryotherapy. Staff and providers supported the recall system.

Conclusion: Continuous quality improvement principles led to a Papanicolaou test reminder system. Follow-up Papanicolaou test rates appeared to increase by 17% for the first Papanicolaou test and by 22% for the second.