Comparing clinical decision support systems for improving follow-up of abnormal cervical cancer screening test results

Steven J. Atlas, Timothy E. Burdick, Adam Wright, Wenyan Zhao, Shoshana Hort, David G. Aman, Mathan Thillaiyapillai, E. John Orav, Amy J. Wint, Rebecca E. Smith, Katherine L. Gallagher, Molly L. Housman, Frank Y. Chang, Courtney J. Diamond, Li Zhou, Jennifer S. Haas, Anna N. A. Tosteson

Abstract: BackgroundMany individuals with abnormal cervical cancer screening test results do not receive timely follow-up care. Clinical decision support systems (CDSS) to improve follow-up are challenged by difficulty identifying clinical elements and applying complex guideline recommendations. As part of a multisite trial, two CDSS models were implemented: one used natural language processes to evaluate extracted data outside of the electronic health record (EHR) (System A); the other used commercial EHR functionality using LOINC-defined result fields (System B). This secondary analysis compared the accuracy and trial outcomes among sites using these two CDSS models.MethodsPrimary care clinics (32 in System A and 12 in System B) were randomly assigned to usual care, CDSS alone, or CDSS with patient outreach with or without navigation. CDSS identified individuals with overdue abnormal screening results and specified the recommended follow-up and time interval. CDSS accuracy was assessed by manual chart review. Patient outreach consisted of portal/mailed letters plus a single phone call. Navigation included one or more phone calls to address barriers to care. Completion of recommended follow-up at 120 days after enrollment was the primary outcome. Clinic was the unit of randomization, and the patient was the unit of analysis.ResultsBetween October 2020 and December 2021, 2596 patients with abnormal results were identified by the CDSS. CDSS true positives were 61.3 % in System A and 70.4 % in System B. CDSS alone versus usual care did not improve outcomes in either system. CDSS with patient outreach with or without navigation versus usual care significantly increased follow-up rates in System A (38.2 % or 37.2 % vs 23.5 %, p < 0.001) and System B (25.4 % or 23 % vs. 19.7 %, p = 0.044).ConclusionsTwo CDSS models developed to identify overdue abnormal cervical cancer screening test results had moderate accuracy. Both models with patient outreach with or without navigation – but not CDSS alone – increased recommended follow-up. Future CDSS for cervical cancer screening may be improved with open-source tools developed in public–private partnerships.

External IDs:dblp:journals/jbi/AtlasBWZHATOWSGHCDZHT25