Journal of General Internal Medicine

, Volume 23, Issue 5, pp 575–580

Variations in Practice Guideline Adherence for Abnormal Cervical Cytology in a County Healthcare System

  • Rita Singhal
  • Lisa V. Rubenstein
  • Mingming Wang
  • Martin L. Lee
  • Anwar Raza
  • Christine H. Holschneider
Original Article

DOI: 10.1007/s11606-008-0528-x

Cite this article as:
Singhal, R., Rubenstein, L.V., Wang, M. et al. J GEN INTERN MED (2008) 23: 575. doi:10.1007/s11606-008-0528-x



Reduction in cervical cancer incidence and mortality is not only dependant on promoting cervical cancer screening but also on providing appropriate follow-up and treatment of abnormal cervical cytology.


The objective of this study was to determine variations in guideline adherence for women requiring abnormal cervical cytology follow-up.


Subjects of the study are women 18 years or older with an abnormal Pap test in 2000 within a large county healthcare system (n = 8,571).


Guideline adherence was determined by the presence or absence of the appropriate follow-up procedure within an acceptable time interval for each degree of cytological abnormality. Patients with no follow-up studies were deemed to be lost to follow-up.


Of study subjects, 18.5% were lost to follow-up care. Of the remaining 6,987 women, 60.3% received optimal care, 9.4% received suboptimal care, and 30.3% received poor care. Follow-up rates were higher for patients with higher degree of cytological abnormality (OR, 1.29, 95% CI, 1.17–1.42), older patients (OR, 1.03, 95% CI, 1.02–1.030) and those receiving the index Pap test at a larger healthcare facility (OR, 1.13; 95% CI, 1.01–1.27). Receiving optimal care was positively correlated with higher degree of cytological abnormality (p < .0001) and larger facility size (p = .002). Regional variations in care demonstrated the largest cluster having the lowest lost to follow-up rate and the most optimal care.


A significant number of women with abnormal cervical cytology are receiving less than optimal care. Further studies are required to determine the specific healthcare delivery practices that need to be targeted to improve guideline adherence for follow-up of abnormal cytology.


cytology quality of care practice guidelines cervical cancer 

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Rita Singhal
    • 1
    • 5
  • Lisa V. Rubenstein
    • 2
  • Mingming Wang
    • 2
  • Martin L. Lee
    • 2
  • Anwar Raza
    • 3
  • Christine H. Holschneider
    • 4
  1. 1.Department of MedicineOlive View–UCLA Medical CenterSylmarUSA
  2. 2.VA Greater Los Angeles HSR&D Center of ExcellenceSepulvedaUSA
  3. 3.Women’s and Children’s HospitalUniversity of Southern CaliforniaLos AngelesUSA
  4. 4.Department of Obstetrics and GynecologyOlive View–UCLA Medical CenterSylmarUSA
  5. 5.Los Angeles County Department of Public HealthOffice of Women’s HealthEl MonteUSA

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