A Kaiser Permanente study published by NEJM Catalyst Innovations in Care Delivery provides real-world data on a new approach to cervical cancer screening: giving patients the option to skip the traditional pelvic exam and collect their own vaginal samples to test for the human papillomavirus (HPV) — the cause of nearly all cervical cancers. The study is the first within a U.S. health care organization to demonstrate the potential of large-scale, population-based HPV self-collection — both via mail and in clinics — to improve access to preventive care and overcome barriers to traditional screenings.
"Kaiser Permanente has led the way on this important innovation — first through trials showing that HPV self-collection is an effective and cost-efficient approach to increasing cervical cancer screening, and now by evaluating the adoption of this approach throughout Kaiser Permanente Washington," said lead researcher Beverly Green, MD, MPH , a family physician and senior investigator with Kaiser Permanente Washington Health Research Institute (KPWHRI) . "The response from clinicians and patients has been extremely positive."
The evaluation included more than 95,000 Kaiser Permanente Washington members ages 30 to 64 who were due or overdue for screening during 6-month periods either before or after the HPV self-collection program began. Comparing the 2 groups, the researchers found that after the program started:
Cervical cancer screening completion increased significantly, by 2.2% on average.
Screening gains were higher among Black/African American, Asian, and Hispanic populations.
The number of clinician-performed pelvic exams for screening dropped by more than a third, with 37% of patients completing screenings via self-collection.
For people with screening results positive for high-risk HPV, follow-up colposcopy rates improved from 50% pre-program to 75.8% post-program, with support from a centralized safety-net system focused on outreach and follow-up.
In interviews and site visits, clinicians highly favored the program overall, noting that it improved appointment access due to fewer pelvic exams, allowed for more time to address other health concerns, and offered patients a more comfortable and convenient screening option.
The research was conducted by the Center for Accelerating Care Transformation ( ACT Center ), which is part of KPWHRI and leads Kaiser Permanente Washington's Learning Health System Program . The study authors said their findings could offer a practical roadmap for health systems considering adoption of HPV self-collection — highlighting the importance of standardized workflows, electronic health record (EHR) tools, and reporting and safety-net systems, which are essential for managing follow-up care and ensuring program quality.
"This is a real-world example of a learning health care system in action," said senior author Paula Lozano, MD, PhD , co-director of the ACT Center and senior associate medical director for research and translation with Kaiser Permanente Washington. "We are using research evidence to inform implementation, continuously evaluate performance, and iterate to better meet the needs of patients and clinicians."
This study was funded through Kaiser Permanente Washington's Learning Health System Program.
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