A Multicomponent, Team-Based Quality Improvement Project for Improving Cervical Cancer Screenings in Primary Care

To increase cervical cancer screening (CCS) adherence by 10% over 4 months and improve provider knowledge and use of evidence-based guidelines, as measured by the Evidence-Based Medicine Questionnaire.

An evidence-based, 10-min slide presentation on improving CCS was delivered to clinicians, medical assistants, and front desk staff at internal medicine offices.

Cervical cancer is highly curable, with a 5-year relative survival rate of 91% when detected at a localized stage. In 2023, a multisite primary care group in northeast Massachusetts reported a CCS adherence rate of 60.5%, well below the national average of 73.9%.

Ninety-seven staff members across six sites were eligible to participate, including 40 clinicians (18 physicians, 22 advance practice providers), 43 medical assistants, and 14 front desk staff. All 40 clinicians participated, but medical assistants and front desk staff were not surveyed.

Using a pretest and posttest design with convenience sampling, internal medicine clinicians completed the Evidence-Based Medicine Questionnaire 1 month before and 3 months after watching the slide presentation.

CCS adherence increased from 58% in June 2024 to 62% in October 2024, a 4% gain. The number of Papanicolaou smears performed also rose by 4%, from 618 in 2023 to 640 in 2024. With the highest possible Evidence-Based Medicine Questionnaire score of 205 representing high knowledge of evidence-based guidelines, pretest scores (n = 9) ranged from 122 to 194 (mean = 157) and posttest scores (n = 8) ranged from 125 to 198 (mean = 166), suggesting a modest improvement in knowledge and application of evidence-based guidelines with fewer perceived barriers.

Continued use of evidence-based practices may further improve CCS adherence rates across this multisite primary care group, bringing them closer to national benchmarks.