Dissemination of Lean methods to improve Pap testing quality and patient safety
| Autor: | Sandra M. Blaser, Stephen S. Raab, Carey Andrew-JaJa, Deborah L. Sommer, John M. Fisch, Dana M. Grzybicki, Carole M. Chesin, David J. Dabbs, Colleen M. Vrbin |
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| Rok vydání: | 2008 |
| Předmět: |
medicine.medical_specialty
Pap testing media_common.quotation_subject Uterine Cervical Neoplasms Diagnostic accuracy Sensitivity and Specificity Diagnosis Differential Patient safety Medicine Humans Quality (business) Pap test media_common Retrospective Studies Vaginal Smears medicine.diagnostic_test business.industry Obstetrics and Gynecology Reproducibility of Results General Medicine Emergency medicine Physical therapy Carcinoma Squamous Cell Female Clinical Competence business Follow-Up Studies Total Quality Management |
| Zdroj: | Journal of lower genital tract disease. 12(2) |
| ISSN: | 1526-0976 |
| Popis: | To determine if the implementation of Lean methods resulted in improved Pap test quality and diagnostic accuracy in 5 clinician practices.We performed a 1-year case-control study that included 5,384 control (preintervention) and 5,442 case (postintervention) women who had a Pap test procured by 1 of 5 clinicians. Using Lean methods, the clinicians increased their focus of Pap test procurement by creating a "one-by-one" workflow and recorded process completion using a Lean checklist. We compared the case and control Pap test quality and accuracy measures using the proportion of Pap tests lacking a transformation zone component, proportion of unsatisfactory Pap tests, frequency of newly detected cervical intraepithelial neoplasia following a previous benign Pap test, and proportion of Pap tests with a diagnosis of atypical squamous cells of unknown significance.After the intervention, there was a statistically significant decrease in the mean proportion of Pap tests lacking a transformation zone component, p =.011. Two of 5 clinicians showed a statistically significant decrease in their unsatisfactory Pap test frequency, although the overall Pap test unsatisfactory frequency for the case group was not statistically significant lower, p =.087. The case group showed a 114% increase in newly detected cervical intraepithelial neoplasia following a previous benign Pap test, p =.004. There was no statistically significant difference for the proportion of Pap tests with a diagnosis of atypical squamous cells of unknown significance, p =.908.Disseminating Lean methods across a group of clinicians resulted in improved Pap test quality and diagnostic accuracy. |
| Databáze: | OpenAIRE |
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