Women of African-American and Hispanic descent in the United States experience excessive mortality from cervical cancer. It is well documented that regular Pap screening is an effective means for detecting pre-malignant disease, or Cervical Intraepithelial Neoplasia. Prompt evaluation and treatment of this condition will modify the progression of the disease and result in improved outcomes. However, resources for follow up of abnormal Pap smears, particularly in rural or medically underserved areas and for uninsured women are limited. The long-term goal of this research is to increase the accessibility of resources for evaluation and treatment of cervical dysplasia through the utilization of alternative providers. The purpose of this study is to develop a pilot methodology for determining the efficacy of nurse practitioner colposcopists in the evaluation and treatment of cervical dysplasia.
The specific aims of the investigation are to: 1) establish the validity of practice standards, which include measures of clinical efficacy and patient outcomes, for cervical dysplasia evaluation and treatment; 2) conduct a pilot study to determine the feasibility of implementing a multi-site, longitudinal study of the effectiveness of nurse practitioner colposcopists in evaluating and treating cervical dysplasia; and 3) develop the methodology and identify a sample appropriate for conducting a multi-site, longitudinal study of the efficacy of nurse practitioner colposcopists. The proposed study is an outgrowth of previous research by the investigators on access to health care and physician and nurse practitioner performance conducted in the Texas-Mexico border region. An expert panel will be convened to validate performance measures and standards. These measures will be piloted with a sample of nurse practitioner colposcopists in rural Texas. Modifications to performance measures and standards will be made, based on the results of the pilot study, and these measures will be incorporated into the design of a multi-site, longitudinal study.
