Quality improvement project in cervical cancer screening: practical measures for monitoring laboratory performance

Tarkkanen, Jussi; Geagea, Antoine; Nieminen, Pekka; Anttila, Ahti

doi:10.1034/j.1600-0412.2003.820115.x

Cited by 8 publications

(13 citation statements)

References 11 publications

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“…The most frequently cited conceptual approach to multilevel intervention design was quality improvement (18,24,25,35,48). The most common models or checklists used for multilevel intervention design were PPIP (19,22), PRECEDE (51), the AHRQ checklist of practice items to improve delivery of care (26); strengths, weaknesses, opportunities, and threats analysis (26); and force field analysis (35).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, measures were used both as interventions and as outcomes (38,39,48,49). For example, in the study by Hilarius et al (39), patients completed a health-related quality-of-life survey by computer, which generated a graphic summary for the patient and the nurse (the intervention); health-related quality-of-life data also were used to assess outcomes related to the intervention.…”

Section: Measures and Measurement In Multilevel Cancer Care Interventmentioning

confidence: 99%

“…For example, in the study by Hilarius et al (39), patients completed a health-related quality-of-life survey by computer, which generated a graphic summary for the patient and the nurse (the intervention); health-related quality-of-life data also were used to assess outcomes related to the intervention. In other examples (48,49), performance metric reports (eg, detection rate of abnormalities, the number of surgical procedures to standard) were used as part of the interventions (ie, feedback to people targeted) and also as intervention outcome measures. This approach was used in interventions designed to achieve quality improvements, process improvements, or organizational changes.…”

Section: Measures and Measurement In Multilevel Cancer Care Interventmentioning

confidence: 99%

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Multilevel Interventions: Measurement and Measures

et al. 2012

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Multilevel intervention research holds the promise of more accurately representing real-life situations than single-level intervention research and, thus, with the proper research design and measures, being more likely to facilitate the effective and efficient resolution of complex health-care systems problems (1-3). Taking a multilevel approach to cancer care interventions, however, creates measurement challenges and opportunities. Some measurement issues are similar to those arising in single-level interventions, whereas some are unique to multilevel interventions (4,5). The purpose of this article is to examine the state of measurement in multilevel cancer intervention research and to suggest how opportunities in the field may be addressed by drawing on the measurement literature in other fields.One of the unique aspects of measurement in multilevel intervention research is that consideration of within and between level effects is needed. For multilevel interventions, it is not sufficient to measure effects at the different levels of intervention (eg, patient and healthcare team), cross-level effects must also be taken into consideration (eg, the effect of patients on the team and the team on the patients). Furthermore, some measurement issues may be more complex when conducting multilevel intervention research, and some measurement rules of thumb may be uniquely associated with specific levels of analysis (eg, group or organization levels of analysis) (6,7). Because multilevel interventions are based on systems theory [whether general systems (8-10), social ecological systems (11,12), or complex adaptive systems (13) models], they require identification of key constructs and measures by level and consideration of interactions within and across levels (6). Thus, multilevel intervention research benefits from thoughtful planning and design, an interdisciplinary approach, mixed methods (eg, a combination of objective factors, surveys, interviews, observations) measurement and analysis, and careful attention to the congruence of theory, constructs, and measures.Through a systematic review of the literature, this article examines the state of measurement in multilevel cancer care intervention research, identifies measurement opportunities in the field, and draws upon other fields to provide direction about measures and measurement to multilevel cancer care intervention researchers. Literature ReviewWe conducted a systematic literature review focused on cancer care intervention research and measures published in the past 5 years. This contrasts with Stange et al. in this monograph (14), which focuses on the broad spectrum of health care and prevention research over a 10-year period (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). Thus, our review provides a comprehensive overview of a more recent set of cancerspecific intervention studies.

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Section: Discussionmentioning

confidence: 99%

Section: Measures and Measurement In Multilevel Cancer Care Interventmentioning

confidence: 99%

Section: Measures and Measurement In Multilevel Cancer Care Interventmentioning

confidence: 99%

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Multilevel Interventions: Measurement and Measures

et al. 2012

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“… Administrative tasks include contact with patients, smear takers, general practitioners (GPs), gynaecologists, other laboratories and hospitals. Cytotechnologists must respect patient confidentiality and must be trained in country‐specific legal requirements. Technical laboratory tasks include handling specimens, carrying out relevant laboratory techniques and performing prescribed health‐ and safety procedures. Participation in continuing education, feedback sessions, 8 and quality control programmes is mandatory for all cytotechnologists. …”

Section: Personnel and Organisationmentioning

confidence: 99%

European guidelines for quality assurance in cervical cancer screening: recommendations for cytology laboratories*

Wiener¹,

Klinkhamer

Schenck

et al. 2007

Cytopathology

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European guidelines for quality assurance in cervical cancer screening: recommendations for cytology laboratoriesThe quality of a cervical cytology laboratory depends on adequate handling and staining of the samples, screening and interpretation of the slides and reporting of the results. These guidelines give an overview of procedures recommended in Europe to manage the balance between best patient care possible, laboratory quality assurance and cost effectiveness and will be published as a chapter 4 in the European Guidelines for Quality Assurance in Cervical Cancer Screening. The laboratory guidelines include protocols for personnel and organisation, material requirements, handling and analysing cervical samples, recording of results, quality management and communication. The section on quality management is comprehensive and includes protocols for all aspects of internal and external quality assurance. The guidelines are extensively referenced and as far as possible the recommendations are evidence-based.

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“…The main causes of the low sensitivity are related to mistakes during the collection of material, the examination of the smear or the interpretation of results [3,4,5]. Programs of quality control in cytopathology are an alternative that attempts to minimize these mistakes [6,7]. …”

Section: Introductionmentioning

confidence: 99%

External Quality Control of Cervical Cytopathology: Interlaboratory Variability

Ázara¹,

Manrique²,

Souza³

et al. 2013

Acta Cytologica

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Objective: To compare the variability of screening tests held at laboratories with the Unit for External Quality Control (UEQC), checking the frequency of cases that were discordant, false-positive, false-negative, unsatisfactory or that had a delay in clinical management and diagnostic agreement. Materials and Methods: The study analyzed 10,053 screening tests from January 2007 to December 2008, including all positive cases, all those that fall under unsatisfactory and at least 10% of negative screening tests. The magnitude of the agreement was analyzed using the kappa coefficient. Results: Out of the 10,053 cases analyzed, 7.59% were considered disagreeing, and it was estimated that 1.1% were false-negative. There was a delay in the clinical procedure regarding 2.44% cases. There were 2.82% of cases identified as false-positive and 1.24% as unsatisfactory. The diagnostic agreement was excellent (kappa = 0.81). The agreement of most laboratories concerning screening tests was classified as very good. The agreement of the sample adequacy was reasonable (kappa = 0.30) and the agreement regarding the representation of epithelia was considered excellent. Conclusion: Most laboratories showed very good agreement; however, it is worthy of note that to establish the standardization of diagnostic criteria, and enhance the accuracy of screening and improve the quality of cytopathology test results, it is necessary to perform external quality control.

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Quality improvement project in cervical cancer screening: practical measures for monitoring laboratory performance

Cited by 8 publications

References 11 publications

Multilevel Interventions: Measurement and Measures

Multilevel Interventions: Measurement and Measures

European guidelines for quality assurance in cervical cancer screening: recommendations for cytology laboratories*

External Quality Control of Cervical Cytopathology: Interlaboratory Variability

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