The purpose of this R-18 Phase III demonstration project is to improve cervical cancer screening in primary care practices using two strategies: (1) to develop and implement a pap smear adequacy feedback system and (2) in conjunction with the reporting system to communicate information on the Cytobrush collection method to primary care providers. The research will measure the effect of the two interventions on performance of pap smears. Two hundred primary care practices using the Roche Biomedical Laboratories at Burlington, NC, in which the majority of providers submitted at least 50 pap smears per provider in the previous year, will be recruited. Baseline pap smear adequacy rates and collection techniques of individual providers will be studied for 12 months. The practices will be randomized into four groups, using a 2 x 2 factorial design to determine the effect of a specifically designed pap adequacy feedback system in changing provider behavior. Each will continue to receive the standard patient reports on pap smears from Roche. In addition, two groups will receive individual provider feedback (intervention) and two will receive no individual provider feedback (control). One of the intervention and one of the control groups will receive a Cytobrush information packet quarterly in order to examine the effects of promoting the Cytobrush on pap smear adequacy rates. Over a 12 month period, the providers in the intervention groups will receive monthly individual reports of their own performance regarding adequacy of pap tests including comparisons with peers. At the end of the intervention phase, pap adequacy data will continue to be collected without feedback for nine months to monitor the long term effects of the intervention on provider behavior. This project provides a unique opportunity to evaluate a cancer screening intervention using one of the largest independent cytology laboratories. It is anticipated that once the system has been tested and shown effective it will be implemented in the other Roche laboratories and will contribute significantly in setting criteria and standards for reporting pap smear results to primary care practices as well as improving adequacy rates.
