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cervical cancer, cervical cancer screening, Pap test, quality improvement



  1. Kiser, Lisa Heidi DNP, CNM, WHNP
  2. Butler, Judith DNP, CNM, CNE


Background: Each year, 13,000 women in the United States are diagnosed with cervical cancer and 4,000 die from it. Moreover, 8 million women 21 to 65 years of age haven't had a Pap test in five years. Hispanic women have the highest incidence of cervical cancer and are less likely to be screened or return for care. Migrant women can face additional barriers to cervical cancer screening, including federal prohibitions against their participation in public health insurance exchanges and nonemergency Medicaid.


Purpose: Improving cervical cancer screening rates was identified as a priority in a federally qualified health center when only 40% of eligible women were properly screened in 2016. Forty-five percent of the population the clinic serves is uninsured and 60% are Hispanic. The aim of this quality improvement project was to have 75% of the women 21 to 65 years of age who sought care at this clinic during the 60-day project period receive Pap test eligibility screening, enrollment in a state and federal screening program, and case management.


Methods: Four rapid plan-do-study-act cycles were used. Tests of change included team engagement, patient engagement, eligibility screening, and case log management. Data were analyzed using run charts to evaluate the impact of interventions on outcomes. The interventions consisted of team meetings, a patient engagement tool, an eligibility screening tool, and case log management.


Results: Among the women who completed care at the clinic during the 60-day project period, 80% were uninsured and 86% were Hispanic. A total of 87% of women received effective care, which consisted of same-day Well Woman Health Care Program enrollment and a same-day Pap test or an appointment to return for a well-woman visit.


Conclusion: A multicomponent approach led to underserved women receiving equitable access to cervical cancer screening and timely enrollment in a cervical cancer screening program.