OBJECTIVE: to enhance the delivery of services, using continuous quality improvement, and an outreach strategy. DESIGN AND SETTING: pre and post measurements in a Primary Health Care system in El Salvador. Outcome indicators: women screened for the first time in their lifetime, unsatisfactory samples, turnaround time, and follow-up. INTERVENTION: involvement of policy, service provision and community levels in 4 plan-do-study-act cycles, facilitating linkages between work processes and a quality control group. RESULTS: 3,408 women screened for the first time in their lifetime in 1 year in regular services; unsatisfactory samples reduced by 1/2; turnaround time reduced by almost 1/3; follow-up increased from 24% (22/90) to 100% (196/196) .146 of the 151 women cytologically defined as low and high-grade squamous intraepithelial lesions (L-HSIL) were confirmed on histology as cervical intraepithelial neoplasia (CIN), while 5 showed benign changes. Of the 43 women classified as having high-grade squamous intraepithelial lesion on cytology, 36 were diagnosed with CIN2 lesions, 7 with CIN3 and 2 were confirmed with invasive carcinoma. CONCLUSION: improvements in delivery of screening can be made with few additional resources in the absence of an organized system. We promoted linkages between detection and diagnosis through enhancement of teamwork and functional coordination, which improved follow-up rates. We restored links between screening and reading processes through minor adjustments, which improved the turnaround time of samples. Trained outreach workers created new links between community and health services, identifying women who had never been screened before in their lives and facilitating their access to regular clinic services.
OBJECTIVE: to enhance the delivery of services, using continuous quality improvement, and an outreach strategy. DESIGN AND SETTING: pre and post measurements in a Primary Health Care system in El Salvador. Outcome indicators: women screened for the first time in their lifetime, unsatisfactory samples, turnaround time, and follow-up. INTERVENTION: involvement of policy, service provision and community levels in 4 plan-do-study-act cycles, facilitating linkages between work processes and a quality control group. RESULTS: 3,408 women screened for the first time in their lifetime in 1 year in regular services; unsatisfactory samples reduced by 1/2; turnaround time reduced by almost 1/3; follow-up increased from 24% (22/90) to 100% (196/196) .146 of the 151 women cytologically defined as low and high-grade squamous intraepithelial lesions (L-HSIL) were confirmed on histology as cervical intraepithelial neoplasia (CIN), while 5 showed benign changes. Of the 43 women classified as having high-grade squamous intraepithelial lesion on cytology, 36 were diagnosed with CIN2 lesions, 7 with CIN3 and 2 were confirmed with invasive carcinoma. CONCLUSION: improvements in delivery of screening can be made with few additional resources in the absence of an organized system. We promoted linkages between detection and diagnosis through enhancement of teamwork and functional coordination, which improved follow-up rates. We restored links between screening and reading processes through minor adjustments, which improved the turnaround time of samples. Trained outreach workers created new links between community and health services, identifying women who had never been screened before in their lives and facilitating their access to regular clinic services.
Authors: Karla M Alfaro; Julia C Gage; Alan J Rosenbaum; Lauren R Ditzian; Mauricio Maza; Isabel C Scarinci; Esmeralda Miranda; Sofia Villalta; Juan C Felix; Philip E Castle; Miriam L Cremer Journal: BMC Public Health Date: 2015-10-16 Impact factor: 3.295
Authors: Miriam Cremer; Mauricio Maza; Karla Alfaro; Mario Morales Velado; Juan Felix; Philip E Castle; Jane Kim; Julia C Gage Journal: J Low Genit Tract Dis Date: 2017-01 Impact factor: 1.925
Authors: Mauricio Maza; Karla Alfaro; Jillian Garai; Mario Morales Velado; Julia C Gage; Philip E Castle; Juan Felix; Silvana Luciani; Nicole Campos; Jane Kim; Rachel Masch; Miriam Cremer Journal: Gynecol Oncol Rep Date: 2017-03-03