Variation in the receipt of human papilloma virus co-testing for cervical screening: Individual, provider, facility and healthcare system characteristics

Jennifer S. Haas, David Cheng, Liyang Yu, Steven J. Atlas, Cheryl Clark, Sarah Feldman, Michelle I. Silver, Aruna Kamineni, Jessica Chubak, Gaia Pocobelli, Jasmin A. Tiro, Sarah C. Kobrin

Research output: Contribution to journalArticlepeer-review

Abstract

Since 2012, cervical cancer screening guidelines allow for choice of screening test for women age 30–65 years (i.e., Pap every 3 years or Pap with human papillomavirus co-testing every 5 years). Intended to give patients and providers options, this flexibility reflects a trend in the growing complexity of screening guidelines. Our objective was to characterize variation in cervical screening at the individual, provider, clinic/facility, and healthcare system levels. The analysis included 296,924 individuals receiving screening from 3626 providers at 136 clinics/facilities in three healthcare systems, 2010 to 2017. Main outcome was receipt of co-testing vs. Pap alone. Co-testing was more common in one healthcare system before the 2012 guidelines (adjusted odds ratio (AOR) of co-testing at the other systems relative to this system 0.00 and 0.50) but was increasingly implemented over time in a second with declining uptake in the third (2017: AORs shifted to 7.32 and 0.01). Despite system-level differences, there was greater heterogeneity in receipt of co-testing associated with providers than clinics/facilities. In the three healthcare systems, providers in the highest quartile of co-testing use had an 8.35, 8.81, and 25.05-times greater odds of providing a co-test to women with the same characteristics relative to the lowest quartile. Similarly, clinics/ facilities in the highest quartile of co-testing use had a 4.20, 3.14, and 6.56-times greater odds of providing a co-test relative to the lowest quartile. Variation in screening test use is associated with health system, provider, and clinic/facility levels even after accounting for patient characteristics.

Original languageEnglish (US)
Article number106871
JournalPreventive Medicine
Volume154
DOIs
StatePublished - Jan 2022

Keywords

  • Cervical cancer screening
  • Guideline implementation

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

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