On April 5, 2007, and June 28, 2007, the National Quality Center (NQC) hosted two national quality improvement technical assistance webconferences on improving Pap completion rates, a new HIV/AIDS Bureau (HAB) quality initiative. During this session, HAB Deputy Associate Administrator Laura W. Cheever, MD, ScM, discussed the importance of the initiative. Other distinguished presenters included Gina Brown, MD, and Maryann Pietrowski, NP, and they shared technical knowledge as well as successful improvement strategies to increase the rates for cervical cancer screening for HIV-infected women.

The three presentations from the April 5 call, available here, included:

• Welcome (Cheever)
• Engaging HIV+ Women in Gynecological Care (Pietrowski)
• Screening for Cervical Cancer (Brown)

During the June 28 session, the importance of this initiative was reviewed with talking points to engage HRSA Project Officers in a discussion of what grantees are currently doing. NQC shared how to move from data to action to improvement, as well as examples of what peers have done to improve Pap test completion rates. The webconference also included a presentation from staff at Christiana Care Health Services, who shared their best practices and lessons learned.

The presentations and materials from the June 28 call, available here, included:

• Overview and purpopse of HAB’s initiative
• Improving Cervical Cancer screening rates
• Example from the field: Christiana Care Health Services
• Talking points for Project Officers regarding Paps

Background
HAB's goal is for all patients to receive optimal HIV care each and every time they access care and treatment services. This new quality initiative is about using data to identify areas for improvement and then taking steps to make those improvements happen. Each HAB program and division will undertake strategies and improvement cycles to bring our completion rates in line with Healthy People 2010 objectives. This initiative strives to meet several objectives. Its primary objective is to increase the completion rate of cervical cancer screening by all grantees managing HIV care.

Additional objectives of the initiative include:

• Raise the awareness of PHS guidelines on screening and need to improve current rates
• Increase the capacity of providers to provide and document Pap Cervical Cancer Screening tests
• Train Project Officers to facilitate improvement
• Improve the quality of data submissions
• Provide technical assistance and training on how to do this
• Apply lessons learned here to other service areas.

Current data indicates that of 785 medical providers that shared data:

• The top 25% had a Pap completion rate of 59%
• The lowest 25% had a Pap completion rate of 18%
• The average Pap smear completion rate was 40%

The Agency for Healthcare Research and Quality (AHRQ), recommends that the Pap test be completed twice during the first year after diagnosis of HIV infection and annually thereafter, if the results are normal. HAB aims to use Pap tests as a way of learning how to examine an issue (using data) to make an impact. Lessons learned from this process can then be applied to other issues for improvement.