Impact of Patient Reminders on Papanicolaou Test Completion for High-Risk Patients Identified by a Clinical Decision Support System

Kathy L. MacLaughlin, Maya E. Kessler, Ravikumar Komandur Elayavilli, Branden C. Hickey, Marianne R. Scheitel, Kavishwar B. Wagholikar, Hongfang Liu, Walter K. Kremers, Rajeev Chaudhry

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: A clinical decision support system (CDSS) for cervical cancer screening identifies patients due for routine cervical cancer screening. Yet, high-risk patients who require more frequent screening or earlier follow-up to address past abnormal results are not identified. We aimed to assess the effect of a complex CDSS, incorporating national guidelines for high-risk patient screening and abnormal result management, its implementation to identify patients overdue for testing, and the outcome of sending a targeted recommendation for follow-up. Materials and Methods: At three primary care clinics affiliated with an academic medical center, a reminder recommending an appointment for Papanicolaou (Pap) testing or Pap and human papillomavirus cotesting was sent to high-risk women aged 18 through 65 years (intervention group) identified by CDSS as overdue for testing. Historical control patients, who did not receive a reminder, were identified by CDSS 1 year before the date when reminders were sent to the intervention group. Test completion rates were compared between the intervention and control groups through a generalized estimating equation extension. Results: Across the three sites, the average completion rate of recommended follow-up testing was significantly higher in the intervention group at 23.7% (61/257) than the completion rate at 3.3% (17/516) in the control group (p < 0.001). Conclusions: A CDSS with enhanced capabilities to identify high-risk women due for cervical cancer testing beyond routine screening intervals, with subsequent patient notification, has the potential to decrease cervical precancer and cancer by improving adherence to guideline-compliant follow-up and needed treatment.

Original languageEnglish (US)
Pages (from-to)569-574
Number of pages6
JournalJournal of Women's Health
Issue number5
StatePublished - May 2018


  • Abnormal Pap management
  • Cervical cancer prevention
  • Clinical decision support
  • Human papillomavirus

ASJC Scopus subject areas

  • General Medicine


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