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This image represents the Pap Hub and Spoke model using color coding, green for sites that are enrolled, orange for those in process and pink for those not yet enrolled.

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Pap Hub and Spoke Program

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There 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.

This innovation is replicating across multiple facilities as its impact continues to be validated. See more replicating innovations.

Adoptions:

5 successful

Awards and Recognition:

VA Women's Health Research Impact Award

Partners:

Women’s Health

This image represents the Pap Hub and Spoke model using color coding, green for sites that are enrolled, orange for those in process and pink for those not yet enrolled.

Tags:

Access to Care Continuity of Care Data and Analytics Health Equity High Reliability Nursing Outpatient Care Primary Care Rural Health Women's Health
Contact Team

Overview

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 ... See more

Images

This image uses a blue box to define the problem of Primary Care Providers not having enough time to gather the comprehensive cervical cancer screening history to be able to correctly use the ASCCP guidelines. The yellow arrows define the why of the problem. The direct cause is defined as providers having too little time to gather information and make a recommendation using the complex ASCCP guidelines.

The image depicts the 5 Whys of using the complicated ASCCP guidelines

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 ... See more

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

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)

Statuses

IA: Des Moines VA Medical Center (Des Moines, Iowa)
  • Started adoption on 02/2023.
IA: Iowa City VA Medical Center (Iowa City, Iowa)
  • Started adoption on 11/2022.
MN: Minneapolis VA Medical Center (Minneapolis, Minnesota)
  • Started adoption on 04/2022.
NE: Omaha VA Clinic (Omaha Dorcas Street)
  • Started adoption on 11/2023.
SD: Royal C. Johnson Veterans' Memorial Hospital (Sioux Falls)
  • Started adoption on 05/2023.

There are no in-progress adoptions for this innovation.

There are no unsuccessful adoptions for this innovation.

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
  • 2 Registered Nurses-40 hours per week
  • Nurse Practitioner and/or GYN MD- .5 per person per pay period for program oversight
  • Clinical Applications Coordinator (CAC)-8 hours to set up the implementation, then as needed for maintenance
  • Pap Hub Program Manager 20-40 hours per week to expand the program into the Spoke sites
PROCESSES
  • Provide training to RN's and Providers regarding the Pap Hub process
  • Provide training regarding Pap results and Cervical Cancer risks and pathology
  • ASCCP guidelines app and management recommendation training
TOOLS
  • 1 Laptop per Registered Nurse
  • 1 Laptop per NP or GYN provider
  • 2 additional computer monitors per nurse
  • ASCCP app purchase
  • Clinical tracking software (i.e.: TheraDoc)
  • Work Space or telework agreement
  • IT provided softphone access

Optional Resources

Resource type Resource description
PEOPLE
  • Research/Quality Improvement .2 to facilitate surveys and chart audit data
  • Data Analyst .2 per pay period
TOOLS
  • VA provided Cell phone for nurses to use the ASCCP app on

Support Resources

Resource type Resource description
PEOPLE
  • Program Manager to facilitate the roll out of the program at your facility
  • Nurse Practitioner/Clinical Supervisor-to oversee the implementation of the training and clinical aspects of the Pap Hub Spoke program
  • Registered Nurse-to facilitate RN training and flow of the process
PROCESSES
  • Ongoing education and training and facilitating the process of the Pap Hub Spoke program
TOOLS
  • Share templates, training materials, PowerPoints
  • Demonstrate current computer data tracking software

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

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VA User (Advanced Medical Support Assistant) posted

AWESOME ! CONGRATULATIONS 2023 INNAVATORS !

1

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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

Search tags

Access to Care Continuity of Care Data and Analytics Health Equity High Reliability Nursing Outpatient Care Primary Care Rural Health Women's Health