Jt Comm J Qual Patient Saf. 2021 Aug;47(8):510-518. doi: 10.1016/j.jcjq.2021.04.006. Epub 2021 Apr 28.
Universal screening is a strategy for addressing the limitations of risk-based screening for gonorrhea and chlamydia (GC/CT). This quality improvement (QI) initiative aimed to improve GC/CT screening by implementing universal annual screening for all adolescents ≥ 13 years old.
At an academic pediatric resident continuity clinic, an interdisciplinary team designed and conducted multiple Plan-Do-Study-Act (PDSA) cycles over one year. The primary aim, and process measure, was to increase the percentage of encounters with screening for GC/CT in the 12 months prior to the encounter to 80%. The secondary outcome measure was rate of detection of GC or CT infection. Further, pulse checks of provider/staff knowledge and adherence were conducted. The balancing measure was denied insurance claims.
The mean screening rate of 29.2% increased during the project implementation to 65.1% with several bundles of PDSA cycles. There were no cases of gonorrhea detected in the baseline period or implementation period. The case rate of chlamydia was similar during both periods (from 9.7 per 1,000 adolescent encounters to 10.8 per 1,000 adolescent encounters, p = 0.74). There was similarly high provider/staff knowledge about (p = 0.35) and adherence to (p = 0.06) the screening protocol at 6 and 12 months of implementation. There was no increase in percentage of denied insurance claims.
This QI initiative doubled rates of GC/CT screening with no statistically significant increase in number of cases.
通用筛查是解决淋病和衣原体（GC/CT）基于风险的筛查局限性的一种策略。这项质量改进（QI）计划旨在通过对所有≥13 岁的青少年进行年度通用筛查来改善 GC/CT 筛查。
在一家学术性儿科住院医生门诊，一个多学科团队在一年的时间里设计并进行了多个计划-执行-研究-行动（PDSA）循环。主要目标和过程衡量标准是将在就诊前 12 个月内进行 GC/CT 筛查的就诊次数百分比提高到 80%。次要结果衡量标准是 GC 或 CT 感染的检出率。此外，还对提供者/员工的知识和依从性进行了脉搏检查。平衡措施是拒绝保险索赔。
在项目实施期间，筛查率从 29.2%的平均值提高到 65.1%，实施了多个 PDSA 循环。在基线期和实施期都没有发现淋病病例。两个时期的衣原体病例发生率相似（从每千名青少年就诊 9.7 例到每千名青少年就诊 10.8 例，p=0.74）。在实施 6 个月和 12 个月时，提供者/员工对筛查方案的了解程度（p=0.35）和遵守程度（p=0.06）也很高。保险索赔被拒绝的百分比没有增加。
这项 QI 计划将 GC/CT 筛查率提高了一倍，而病例数没有显著增加。
