Pap Hub and Spoke Program
Last updated
Share PrintThere are 14,100 new cases of cervical cancer, and 4,280 deaths annually. Cervical cancer usually develops over years. Optimizing screening participation and follow-up after an abnormal result will reduce cancer incidence and mortality. During an audit in 2019, the VA Office of Inspector General (OIG) found that 20 out of 42 VA facilities (48%) were non-compliant with VA requirements to notify patients of abnormal results within 7 days and to track abnormal results to ensure that patients receive indicated follow-up.
Origin:
January 2022, Minneapolis VA Medical Center (Minneapolis, Minnesota)
Adoptions:
5 successful
Awards and Recognition:
VA Women's Health Research Impact Award
Partners:
Women’s Health
Recent Updates
Overview
The problem
In 2019 the American Society of Colposcopy and Cervical Pathology (ASCCP) Guidelines changed to be more complex and multifaceted. The guidelines incorporate the patient's risk for developing cervical cancer and a thorough Cervical Cancer Screening history is needed to use the guidelines. The chart audit takes 30-60 minutes to complete for each patient. P
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In 2019 the American Society of Colposcopy and Cervical Pathology (ASCCP) Guidelines changed to be more complex and multifaceted. The guidelines incorporate the patient's risk for developing cervical cancer and a thorough Cervical Cancer Screening history is needed to use the guidelines. The chart audit takes 30-60 minutes to complete for each patient. Primary Care Providers (PCPs) were tasked with sorting complex guidelines with limited access to history.
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more
Images
Above:
The image depicts the 5 Whys of using the complicated ASCCP guidelines
The solution
Implement a centralized Pap Hub and Spoke program to ensure all women Veterans in VISN 23* receive appropriate cervical cancer screening as outlined by The American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines and timely results notification as defined by VHA Directive 1088 (1) (within 7 days for abnormal and 14 days for normal results). R
...
Implement a centralized Pap Hub and Spoke program to ensure all women Veterans in VISN 23* receive appropriate cervical cancer screening as outlined by The American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines and timely results notification as defined by VHA Directive 1088 (1) (within 7 days for abnormal and 14 days for normal results). Recommendations for appropriate follow-up are made according to ASCCP guidelines.
*VISN 23: Black Hills, Central Iowa, Fargo, Iowa City, Minneapolis, Nebraska,
Sioux Falls and St. Cloud See more
*VISN 23: Black Hills, Central Iowa, Fargo, Iowa City, Minneapolis, Nebraska,
Sioux Falls and St. Cloud See more
The results
We have developed a consistent and effective system that can be replicated across VA sites, with evidence for:
-Increased cervical cancer screening completion by Veterans
-Timely communication of results and recommendations to patients
-Improved accuracy of ASCCP management recommendations
-Provider and patient satisfaction with process changes
-Increased cervical cancer screening completion by Veterans
-Timely communication of results and recommendations to patients
-Improved accuracy of ASCCP management recommendations
-Provider and patient satisfaction with process changes
Files
- Clinical Outcomes, Provider and Patient Satisfaction Data Pap Hub Outcomes and Feedback
- Quotes taken from post Pap Hub Implementation Survey Pap Hub Provider Satisfaction Quotes
- Chart audit data prior to Pap Hub program implementation Pap Hub Pre-Implementation
- Chart audit data post Pap Hub Implementation Pap Hub Post Implementation
- This slide depicts the current Pap Hub and Spoke Program implementation to date Pap Hub and Spoke Model
Metrics
- Improvement in adherence to ASCCP guidelines from an error rate of 8.7% to 2.6%
- Time to patient contact of Pap results has been 100% within the VHA Directive 1088(1), average patient contact is within 24 hours
- 100% of clinicians surveyed with a patient who required referral to Gynecology were satisfied with the Pap Hub referral process
- 94% of patients surveyed agreed results were communicated in a way that was easy to understand
- 100% of follow-up results letters were sent
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
-
1-2 months
Identify if will be a VISN or VA facility process implementation -
3-6 months
Identify and/or hire 2 Registered Nurses -
3-6 months
Identify and/or hire a Nurse Practitioner and/or Gynecologist -
1-2 months
Set up Pap Hub program with CPRS templates, alerts, letters, build clinic -
1-2 months
Set up computerized clinical tracking system -
1-2 months
Provide staff training
Departments
- Gynecology
- Administration
- Nursing services
- Primary care
- Women Veteran care
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
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PROCESSES |
|
TOOLS |
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Optional Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
TOOLS |
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Support Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
PROCESSES |
|
TOOLS |
|
Risks and mitigations
| Risk | Mitigation |
|---|---|
| Incorrect interpretation of ASCCP guidelines and follow-up management |
Provide training and resources, utilize Gynecology and clinical supervisor for questions. Regular interval auditing of process and result recommendations |
| Lack of buy in to the Pap Hub by Providers and staff |
Education of Pap Hub processes and sharing of outcomes Discuss the time saving aspect to Primary Care Providers and the benefit of utilizing the Pap Hub for low frequency -high risk patient interactions |
Contact
Comment
Comments and replies are disabled for retired innovations and non-VA users.
Email berdette.berger@va.gov with questions about this innovation.
About
Origin story
The concept of a Pap Hub had developed in the private sector in 2010-2012 and has demonstrated success among patients and providers. They have shown significant cost and time savings as well as improved adherence to the American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines.
In 2019, the VA Office of Inspector General (OIG) found that
...
The concept of a Pap Hub had developed in the private sector in 2010-2012 and has demonstrated success among patients and providers. They have shown significant cost and time savings as well as improved adherence to the American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines.
In 2019, the VA Office of Inspector General (OIG) found that 20 out of 42 VA facilities (48%) were non-compliant with VA requirements to notify patients of abnormal results within 7 days and to track abnormal results to ensure that patients receive indicated follow-up. There are fewer female patients in the VA health care system, versus the private sector, ultimately leading to VA Primary Care Providers (PCPs) performing infrequent Pap tests. This creates the opportunity for errors in low frequency, high risk encounters which led to the creation of the Minneapolis Pap Hub and Spoke program through a Strategic Initiative in the Fall of 2021.
The goal of the Strategic Initiative was to implement a centralized Pap Hub and Spoke program to ensure all women Veterans in VISN 23, (Black Hills, Central Iowa, Fargo, Iowa City, Minneapolis, Nebraska, Sioux Falls and St. Cloud), receive appropriate cervical cancer screening as outlined by the ASCCP guidelines and timely results notification and follow-up of abnormal results, as defined by VHA Directive 1088 (1) (within 7 days for abnormal and 14 days for normal results). All patients have a cervical cancer screening history compiled through chart review and phone contact with patients, when possible, follow-up results letters are sent with detailed results and follow-up recommendations as well as educational information. The problem list and clinical reminders are updated to align with the follow-up recommendation.
In April of 2022 the Pap Hub was born in Minneapolis and the CBOC’s in May of 2022. The first Spoke site expansion occurred in November 2022 and to date there are 4 sites actively using the Pap Hub Spoke program and a 5th site will be activated in October 2023.
The hard work of the team of RN’s and Providers and the support of the Leadership of the Women’s Health Clinic and the administration have made this initiative into a permanent program, and it is now supported and funded by the Minneapolis VA.
Original team
Rhonda Groebner
Nurse Practitioner/Pap Hub and Spoke Clinical Supervisor
Berdette Berger
MSN, RN/Pap Hub and Spoke Program Manager
Jill Bowman Peterson
MD/Deputy Chief of Women's Health
Elisheva Danan
MD/Clinical Researcher/Women's Health Provider
Kristy Kapfhamer
MD/Gynecologist
Michele Bruesehoff
RN/Pap Hub Coordinator
Emma O'Brien
MPH. RN/Women Veteran Program Manager
Catherine Hutchison
RN/Pap Hub Coordinator
Jill Finnigan
RN/Gynecology Care Manager
AWESOME ! CONGRATULATIONS 2023 INNAVATORS !