The Effect of the Patient Centered Medical Home on Cervical Cancer Screening Rates in a Navy Family Medicine Clinic

Abstract

Background: Since the introduction of cervical cancer screening tests such as the Pap smear, cervical cancer, once a common cause of cancer death in women, is now an infrequent cause of morbidity and mortality. Recognized as one of the most preventable types of female cancers, the 2008 screening rate in the US was 84.5%. The U.S. Department of Health and Human Services' Healthy People initiative aims for a 93% screening rate by 2020. It has been hypothesized that the Patient-Centered Medical Home (PCMH) can assist in achieving this critical preventive health goal. Methods: This cross-sectional study was designed to test if the implementation of the PCMH model was associated with improved cervical cancer screening rates in a Navy family medicine clinic. The primary outcome was the up-to-date cervical cancer screening rate during the specified time periods, before implementation in 2008 and after implementation of the PCMH in 2012. A secondary outcome compared the cervical cancer screening rates between active duty females in the pre- and post-implementation groups. Regression analysis was utilized to show if an association between up-to-date cervical cancer screening status and the PCMH existed. Results: The post-PCMH group screened a higher proportion of females than the pre-PCMH group, with a statistically significiant difference (75.9% vs. 83.5%, p<0.001). Among the active duty population in the two study groups, there was a small drop in screening rates in the 2012 group compared to the 2008 group, but was not statistically significant (94.3% vs 91.5%, p=0.315). Regression analysis suggests that the older the age of a woman, the stronger the effect the PCMH had on her Pap status being up-to-date. Conclusion: The implementation of the PCMH was associated with improved cervical cancer screening rates at a Navy family medicine clinic, and more strongly associated in women over the age of thirty-six.