Simple Screening Prevents Disease, Improves the Health of Young Women and Unborn Children
ROCKVILLE, Md., July 29 -- Simple steps by health care institutions can increase the number of women tested for and diagnosed with chlamydia according to a study conducted by Kaiser Permanente, in partnership with the Centers for Disease Control (CDC) of Atlanta, Georgia. The analysis, which evaluated almost 75,000 electronic medical records of 15-to 26-year-old female members of Kaiser Permanente of the Mid-Atlantic States from 1998 through 2001, appears in the August issue of Obstetrics & Gynecology, the scientific journal of the American College of Obstetricians and Gynecologists. Chlamydia screening, which involves performing a simple and inexpensive test can prevent infertility, lower a woman’s risk of acquiring HIV, and decrease the incidence of pelvic inflammatory disease (PID).
CDC and several major medical professional organizations recommend regular chlamydia screening for young sexually active women. In 2000, to evaluate adherence to these national clinical guidelines, the National Committee for Quality Assurance (NCQA) introduced a new Health Plan Employer Data and Information Set (HEDIS) performance measure to determine the proportion of sexually active adolescent and young adult women who are tested annually for chlamydia.
Kaiser Permanente worked with the CDC to evaluate chlamydia screening policies, testing practices, and the proportion of 15- to-26 year-old female patients screened in their mid-Atlantic region before and after the measure was implemented.
“When we thought about changes in how we do this screening at Kaiser Permanente, we decided to keep it straightforward. For instance, the clinical assistants in our OB/GYN department now set out a chlamydia test along with any Pap test, so it’s effortless for our physicians,” states Mark Snyder, M.D., associate medical director of information technology, Kaiser Permanente of the Mid-Atlantic States. Other Kaiser Permanente primary care departments provided screenings, recommendations, and provider training with a lower increase rate than the OB/GYN department.
And, these standardized changes led to noticeable change. From 1998 to 2001, for women ages 15-26 years-old, screening rates increased by almost a third.
-- 1998-1999 -- 37,438 sexually active members -- 55 percent tested
-- 2000-2001 -- 37,237 sexually active members -- 72 percent tested
As a result of increased testing, there was a 10 percent increase in the number of new chlamydia diagnoses. The proportion of the patient populations testing positive remained fairly even at eight percent in 1998-1999 and seven percent in 2000-2001, demonstrating the high burden of chlamydia in this commercially insured population
The changes made in the OB/GYN department, where there was a 42 percent increase in screening over two years -- from 57 percent to 81 percent of eligible women screened --suggest that systems level changes may have the most impact on chlamydia screening. That department was the only one to make a systems- level change.
“Despite national recommendations encouraging annual chlamydia screening for young sexually active women, far too many women with chlamydia go undiagnosed every year,” said Dr. Gale Burstein, the lead CDC researcher on the study. “A relatively simple systems-level change like the one implemented by Kaiser Permanente’s OB/GYN department could help protect the reproductive health of women across the country.”
About 40 percent of women with untreated chlamydia infections develop PID and 20 percent of those become infertile, according to CDC In addition, individuals with chlamydia are three to five times more likely to acquire HIV if exposed, per CDC.
NCQA estimates that health care costs attributable to chlamydia and its consequences exceed $3.5 billion per year in the United States in The State of Health Care Quality 2004. NCQA also estimates that cure rates can be achieved at a very low cost from $2 to $8.
In 2004, 76 percent of female Kaiser Permanente members age 16-to 25-years old were screened and Kaiser Permanente of the Mid-Atlantic States was named a Star Performer for screenings for chlamydia, according to the Maryland Health Care Commission.
About Kaiser Permanente
Kaiser Permanente of the Mid-Atlantic States is a total health organization serving approximately 500,000 people in Maryland, Virginia and Washington, DC. Kaiser Permanente HealthConnect, our integrated electronic medical record and business process, is an advanced system that gives members more personalized medical care. Kaiser Permanente is composed of Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., and the Mid-Atlantic Permanente Medical Group, P.C., an independent medical group that features more than 900 physicians who provide or arrange care for patients in our community. Visit hhtp://www.kp.org for more information.
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