Examination of current clinical guidelines of HMOs regarding management of women with cervical cytological abnormalities

Abstract

Since the early 1990s, there has been a proliferation of practice guidelines and
recommendations among Federal agencies and professional health organizations with respect to cervical cancer screening. However, the Centers for Disease Control and Prevention (CDC) remains concerned about variations in the management of women with abnormal Pap tests by geographic location and provider type. This study explores whether or not there is concordance between (1) recommendations of the United States Preventive
Services Task Force (USPSTF), American College of Obstetricians and Gynecologists (ACOG), and American Cancer Society (ACS) for cervical cancer screening and follow-up and (2) the policies of health management organizations (HMOs), hereafter referred to as managed care organizations (MCOs). Because of the exploratory nature of the study, we selected 9 MCOs from the original 29 we had identified. We selected three each of large (5 million or more members), medium-sized (1 to 4 million members), and small (less than 1 million members) organizations, which also represented various types of coverage and
geographic locations. Three MCOs actively participated in the study through interviews, email
correspondence, and sharing of guidelines and materials. We reviewed and summarized cervical cancer screening guidelines and recommendations from Federal agencies and professional health organizations, and selected tracer features to compare with the MCO policies. When we compared MCO policies with USPSTF, ACOG, and ACS recommendations, we noted a concerted effort on the part of the MCOs to keep abreast of
clinical practice norms and to disseminate current information regarding cervical cancer
screening to providers and members/patients. Because our sample consists of only three
MCOs, albeit large national organizations, the information we gathered cannot in any way
be generalized to all MCOs. Our study sheds light on three MCOs’ awareness of USPSTF,
ACOG and ACS recommendations and how they have developed and communicated policies
for screening of cervical cancer to their physicians.