Through the ACT Center’s Learning Health System (LHS) Program, our team is leading an evidence scan and a mixed methods evaluation of the Self-Collect HPV Screening Program to help Kaiser Permanente Washington continue to improve cervical cancer screening processes and outcomes for members.
Self-Collect HPV Program
Finding cost-effective ways to make cervical cancer screening easier and more convenient
The challenge
In the last 2 decades, cervical cancer screening rates have dropped to about 74% nationwide — an 8% decline that was exacerbated by the COVID-19 pandemic. Nearly all cervical cancers can be prevented with timely screening for HPV (human papilloma virus) — a test that, until recently, has required people to come to the clinic for an in-person visit. The good news is that Kaiser Permanente Washington is at the forefront of the next transformative technology to screen and prevent cervical cancer: self-collect testing for HPV.
In partnership with the University of Washington (UW), Kaiser Permanente Washington physician-researcher, Beverly Green, MD, MPH, conducted federally funded research that led to implementation of home HPV testing as an option for all Kaiser Permanente Washington members age 30 to 64 who are at average risk for cervical cancer. The study showed that, compared to usual care (a reminder to schedule an in-person screening visit), mailing home test kits increased the likelihood of timely screening by 30% among members who were due for recommended screening — and by 90% among those who were overdue.
Now, through the ACT Center’s Learning Health System (LHS) Program, the team is leading an evidence scan and a mixed methods evaluation of the Self-Collect HPV Program to help Kaiser Permanente Washington continue to improve screening processes and outcomes for members.
The work
Conduct an environmental scan summarizing findings from Kaiser Permanente/UW research and other high-quality evidence regarding patient experience, outreach, and cost effectiveness, and health outcomes.
Conduct a mixed-methods (quantitative and qualitative) program evaluation to improve ongoing implementation efforts at Kaiser Permanente Washington. Results will focus on implementation outcomes, the process for following up with members who have an abnormal result on a self-collect HPV test, and disparities in screening rates by race, ethnicity, and language.
What we’re learning
When a program tested as a research project is adopted as standard care, some aspects of the program will inevitably change. Our team is helping our care delivery partners streamline processes and troubleshoot issues with implementation. Here are some adaptations we are learning about:
When Kaiser Permanente Washington implemented HPV self-screening, they added a new access point in response to provider feedback: Making testing kits available to members in the clinic. That means members with average cervical cancer risk can choose to do self-collect HPV screening rather than a pap smear, or self-screening can be added to another clinic visit. Our current evaluation will incorporate tracking outcomes from this novel approach.
Implementation outside the research environment required a new vendor and new packaging for the test kits — the new packaging led to workflow changes for lab staff.
Our team is also helping implementation leaders refine an automated dashboard to track and interpret real-time outcomes so they can continue to evaluate the program after our support ends.
Impact
Regular cervical cancer screening and early detection can save lives. By offering at-home testing for HPV, Kaiser Permanente Washington is using an evidence-based method to reduce barriers that may keep members from getting screened, while also saving them the time and expense of travelling to the clinic. Through the LHS Program the research team continues to study the impact of self-collect testing on demand for in-patient visits, costs, and disparities in screening rates.
Featured publications
Winer RL, Lin J, Anderson ML, Tiro JA, Green BB, Gao H, Meenan RT, Hansen K, Sparks A, Buist DS. Strategies to Increase Cervical Cancer Screening With Mailed Human Papillomavirus Self-Sampling Kits: A Randomized Clinical Trial. JAMA. 2023;330(20):1971-1981. doi:10.1001/jama.2023.21471. Full text
Meenan RT, Troja C, Buist DS, Tiro JA, Lin J, Anderson ML, Gao H, Green BB, Winer RL. Economic Evaluation of Mailed Home-Based Human Papillomavirus Self-sampling Kits for Cervical Cancer Screening. JAMA Netw Open. 2023;6(3):e234052. doi:10.1001/jamanetworkopen.2023.4052. Full text
Winer RL, Lin J, Tiro JA, Miglioretti DL, Beatty T, Gao H, Kimbel K, Thayer C, Buist DS. Effect of Mailed Human Papillomavirus Test Kits vs Usual Care Reminders on Cervical Cancer Screening Uptake, Precancer Detection, and Treatment: A Randomized Clinical Trial. JAMA Netw Open. 2019;2(11):e1914729. doi:10.1001/jamanetworkopen.2019.14729. Full text
