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Percentage of Eligible Population Up to Date with Cervical Screening

Basic Facts

Stage of development

Implemented

Potential or current usage

These measures may be used as a proxy of access to primary health care services. This measure has been part of the PHO Performance Programme's National Indicator Set since 1 January 2011 and is used to measure how many women aged 20 to 69 years have had a cervical smear within the last 3 years.

Brief overview of the measure

General description

This measure focuses on the number of women aged between 20 and 69 years who have had a cervical screen within the last 3 years.

Rationale for selection

A consideration of the effectiveness of screening gives a perspective on prevention that may be not be provided from other measures. Also provides an indication of access to Primary health care services. This is important given the aim to consider aspects of care along the patient journey. Early detection and treatment of cervical cancer and other abnormalities lowers the rate of premature death for women. The available international evidence suggests that women between the ages of 20 and 69 years should be screened for cervical cancer once every three years. Coverage of cervical cancer screening refers to women who have enrolled in the programme and have had a smear in the past three years. Coverage is related to protection: a woman who is covered has her risk of cervical cancer reduced by about 90%

Type of measure

Outcomes

Domain(s) of quality

Effectiveness, Efficiency

Application and interpretation of the measure

Stated intent of the measure

Ensuring appropriate follow up of patients that are eligible for a cervical screen.

Caveats - Considerations

This measure, when reported through the PHO Performance Programme has had a hysterectomy algorithm applied - the algorithm has been developed by the National Screening Unit based on the number of hysterectomies provided from 1987 through to 1992 by age. The algorithm is as follows: Age Group Adjustment Factor (multiplied by women in age group) 20 - 24 years 1 25 - 29 years .996 30 - 34 years .980 35 - 39 years .944 40 - 44 years .886 45 - 49 years .819 50 - 54 years .769 55 - 59 years .743 60 - 64 years .726 65 - 69 years .708

Level of health care delivery/setting

This measure is currently reported by the PHO Performance Programme to PHO level although use of this measure to monitor practice and patient level performance is also possible.

Target population

All women aged 20 to 69 years All women aged 20 to 69 years within the high need population (identified as Māori, Pacific Island and/or Decile 9 or 10)

Stratification by vulnerable populations

The PHO Performance Programme currently uses these measures to monitor at both a total PHO enrolled population level (all PHO enrolled eligible patients) and a high need PHO enrolled population level (whereby high need is identified as Māori, Pacific Island and/or Decile 9 or 10).

Associated incentives

These measures are currently funded through the PHO Performance Programme (high need population only).

Possible sources of bias or confounding

Includes practitioner, organisational and patient factors e.g. demography, case mix, compliance that need to be allowed for when interpreting results.

Calculation of the measure

Output of calculation

Percentage of women aged 20 to 69 years who have had a cervical screen in the past 3 years.

Numerator description

Count of enrolled women 20 to 69 years who have received a cervical smear in the past three years

Denominator description

Count of enrolled women 20 to 69 years (adjusted for the expected number of women who have had a hysterectomy)

Denominator exclusions

None

Time period

3 years

Data source

Numerator: NSU Cervical Screening Database Denominator: PHO Enrolment Register

Method of extraction

The link below will take you to the document that defines how the measure is calculated - see 'Cervical Cancer Screening Coverage' section of the Indicator Definitions for PHOs document. http://www.dhbnz.org.nz/Site/SIG/pho/Operational-Documents.aspx

Key issues and challenges for data management

Many women who have had a hysterectomy do not need a cervical smear. The Programme does apply an adjustment calculation to allow for women with hysterectomies, based on the national rate. However since the rate of hysterectomies within each PHO may vary, this adjustment may not always be correct at the PHO level. Some patients choose to ‘opt off’ the national screening programme’s register (which means that although they have had a cervical screen, they will not be ‘counted’ by the Programme).

Appraisal of the measure

Availability of evidence to support application of the measure

The measure has been developed or endorsed by an organization that promotes rigorous development and use of clinical performance measures (at an international, national, regional or local level).

Evidence of feasibility and reliability of implementation

Reliability - The measure has been demonstrated to be reliable (i.e. free from random error)., Interpretation - The measure allows unambiguous interpretation of better or worse performance., Cultural values - The measure is able to reflect cultural values., Data extraction - Data collection specifications for the measure are well defined., Data sources - Required data elements for the measure can be obtained from existing data sources., Availability of data - Required data elements for the measure can be gathered during routine practice activities, IT software - Existing IT software is sufficient for data collection., Adaptability - Measure is able to be adapted for use in multiple care settings, Validity - The measure has been demonstrated to be valid (i.e. it measures what it purports to).

Development approach

Initial selection of this indicator in 2005 was done by the Ministry of Health using a consensus process. Since then the indicator has been reviewed and refined in consultation with the PHO Performance Programme Advisory Group - refer to link for current membership list: http://www.dhbnz.org.nz/Site/SIG/pho/PHO/Membership-List.aspx All changes have been endorsed by the PHO Performance Programme Governance Group - refer to link for current membership list: http://www.dhbnz.org.nz/Site/SIG/pho/PHO/Governance-Group-Membership-List.aspx

Other items

Links to educational activities

National, regional and PHO organisational level performance against this measure is available through the PHO Performance Programme at: http://www.dhbnz.org.nz/Site/Current-Issues/Performance-Results.aspx

Owner details

Reference number

896

Date of entry to library

2012-05-31 14:38:59

Owner (Organisation name)

Health Quality and Safety Commission, Indicators project team

Owner (Email contact)

richard.hamblin@hqsc.govt.nz

Creator (Organisation name)

PHO Performance Programme

Creator (Email contact)