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

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

Research output: Contribution to journalArticle

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 1 2018



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

ASJC Scopus subject areas

  • Medicine(all)

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