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Cervical Cancer Screening

Once a company has conducted assessment and planning for cervical cancer screeningScreening means checking your body for cancer before there are signs or symptoms of the disease. The routine performance of screening tests may find many kinds of cancer early, when treatment is likely to work best. programs, and developed the specific tasks of implementation for these programs, it is time to develop the evaluation plan. This evaluation plan should be in place before any program implementation has begun.  

Metrics for worker productivity, health care costs, heath outcomes, and organizational change allow measurement of the beginning (baseline), middle (process), and results (outcome) of workplace health programs. It is not necessary to use all these metrics for evaluating programs. Some information may be difficult or costly to collect, or may not fit the operational structure of a company. These lists are only suggested approaches that may be useful in designing an evaluation plan.

These measures are designed for employee group assessment. They are not intended for examining an individual’s progress over time, which would raise concerns of employee confidentiality. For employer purposes, individual-level measures should be collected anonymously and only reported (typically by a third party administrator) in the aggregate, because the company’s major concerns are overall changes in productivity, health care costs, and employee satisfaction.

In general, data from the previous 12 months will provide sufficient baseline information and can be used in establishing the program goals and objectives in the planning phase, and in assessing progress toward goals in the evaluation phase. Ongoing measurements every 6 to 12 months after programs begin are usually appropriate measurement intervals, but measurement timing should be adapted to the expectations of the specific program. 

Cervical Cancer screening is a valuable early detection tool that can identify cervical cancer at an early stage when treatment is more effective and less expensive.

  • In 2007, 12,280 women in the United States were diagnosed with cervical cancer, and 4,021 died from the disease1
  • The direct medical care costs associated with cervical cancer were estimated to equal $1.7 billion in 1996 dollars2
  • HPV infection, tobacco use, and obesity increase the risk of cervical cancer
  • One study estimated that the cost-effectiveness ratio of a conventional Pap test repeated every three years up to the age of 75 was $11,830 per quality adjusted life year (QALY) saved (in year 2000 dollars).3 In comparison with other preventive interventions and with cost-effectiveness benchmarks, cervical cancer screening is highly cost-effective4

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Worker productivity measures for cervical cancer screening5-12

Healthier employees are less likely to call in sick. Companies can sometimes assess sick day use as the most direct measure to determine whether health programs are increasing worker productivity.

Baseline
Process
  • Re-assess the average number of sick days per employee at the first follow-up evaluation
    • If employee education programs are successful, these measures may increase in the short term as screening and detection rates increase
  • Periodic repeats of baseline measures
Outcome
  • Assess changes in the average number of sick days per employee in repeated follow-up evaluations
  • Assess changes in costs from baseline

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Health care costs measures for cervical cancer screening5-8

In contrast with the worker productivity costs described above, health care costs are measures of the direct medical expenses of providing employee health care and preventive health programs.

Baseline

  • Determine costs and use for health care such as outpatient visits, screening, diagnostic procedures (e.g., biopsies), one-on-one education counseling, hospitalizations, and treatment (e.g., surgery or chemotherapy) for cervical cancer related illness and disability
  • Determine the health care use and costs of program participants before education and other programs are initiated and after operation of these programs
Process

  • Periodic repeats of baseline measures
Outcome

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Health outcomes measures for cervical cancer screening5-8

The effectiveness of cervical cancer screeningScreening means checking your body for cancer before there are signs or symptoms of the disease. The routine performance of screening tests may find many kinds of cancer early, when treatment is likely to work best. programs depends on the intensity of program effort and the use of multiple interventions. A rule of thumb is that the more programs implemented together as a package or campaign, the more successful the interventions will be.

Baseline
Process
  • Periodic repeats of baseline measures
Outcome
  • Assess changes in levels of employee cervical cancer screening rates such as:
    • Increases in the number of employees screened
    • Changes in the percentage of employees reaching cervical cancer screening guidelines
  • Assess changes in the percentage of employees with health behaviors or conditions where individuals have a higher risk associated with cervical cancer such as tobacco use; HPV infection, or HIV infection (the virus that causes AIDS), or another condition that weakens the immune system (making it hard for the body to fight off health problems)
  • Compare health status changes of program participants before education and other programs are initiated and after operation of these programs
  • Determine changes in the levels of diagnostic and treatment procedures from health care and pharmaceutical claims data
  • Assess changes in employee knowledge, attitudes, and beliefs about cervical cancer screening
    • Measure changes in employee knowledge of current cervical cancer screening health benefits and guidelines
    • Assess changes in employee awareness of existing workplace cervical cancer screening programs and benefits

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Organizational change measures for cervical cancer screening5-8

Cervical cancer screeningScreening means checking your body for cancer before there are signs or symptoms of the disease. The routine performance of screening tests may find many kinds of cancer early, when treatment is likely to work best., along with other health habits, requires ongoing support from employers. New programs can be added over time and evaluated periodically for their effectiveness. For best results, recognition of the benefits of cervical cancer screening should become an inherent part of organizational change and corporate culture.

Measuring organization change is an assessment of company-initiated programs and policies that affect most employees regardless of their health status (e.g., communications/media campaign).  These efforts need to be integrated for greatest effectiveness and will require time for full implementation. Regular measures of employee attitudes and program development are key in determining whether new programs are effective or require further adaptation to prevent continuing expenditure on ineffective efforts.

Baseline

  • Determine workplace barriers to employee’s engagement in cervical cancer screening
  • Assess current workplace cervical cancer screeningScreening means checking your body for cancer before there are signs or symptoms of the disease. The routine performance of screening tests may find many kinds of cancer early, when treatment is likely to work best. programs
    • List current cervical cancer screening options for employees through worksite and identify number of employees (i.e., participation) using each option. Examples:
      • Number of cervical cancer screening programs (e.g., education seminars, individual education) and participation in these programs
      • Availability of educational materials on cervical cancer screening
      • Number of communications/media campaigns regarding cervical cancer screening
        • Percentage of women receiving a telephone call (or a reminder) to obtain a pap test among:
          • Women due or overdue for a pap test
          • Women due or overdue for a pap test who are new health plan members
        • Percentage of women who scheduled a pap test appointment during a telephone reminder call
      • Number of partnerships with community resources for cervical cancer screening such as the American Cancer Society or a local health department
    • Determine costs of current company cervical cancer screening programs such as:
      • Staffing, equipment, and space
      • Employee time to participate in cervical cancer screening programs during work hours (e.g., education)
    • Conduct survey of employee satisfaction with current workplace supported cervical cancer screening programs
 Process
  • Reassess barriers to employee engagement in cervical cancer screening programs
  • Document steps taken and progress toward implementing each intervention selected
    • List numeric goals (e.g., desired increases in employee screening rates) in each form of intervention within a designated time period (e.g., 12 months from startup):
      • Employee reach (e.g., number of educational pamphlets distributed; number of employee reminders sent)
      • Employee participation (e.g., number of desired participants in cervical cancer screening; number of pap test appointments scheduled; number of pap tests delivered; number of one-on-one education sessions conducted)
    • Describe timeline for implementation of each planned intervention (e.g., length of time and timing of tasks to develop, initiate, and conduct a mass campaign)
    • Create a baseline budget for new interventions including classes, instructors, classroom space, materials, etc
    • Identify opportunities for new partnerships with community groups who provide cervical cancer screening programs (e.g., The American Cancer Society, local health department, local hospital, etc.)
  • Reassess employee satisfaction regarding workplace supported cervical cancer screening programs
 Outcome
  • Measure reductions in the number and type of employee barriers to cervical cancer screening
  • Assess changes in workplace cervical cancer screening programs including progress in achieving goals and in implementation of each intervention (e.g., length of time and timing of tasks to develop, initiate, and conduct a mass campaign)
    • Measure changes in the number of cervical cancer screening options for employees through the worksite and changes in employee participation using each option before and after the cervical cancer screening program or campaign. Examples:
      • Number of new programs developed and offered to employees
        • Measure participation (e.g., number of pap tests delivered) in screening programs
        • Number of employees identified as recommended for cervical cancer screening who have been sent a reminder for screening
        • Number of employees sent reminders who actually scheduled a pap test and received the screening
      • Number of new educational materials developed and made available to employees
      • Number of new workplace communications/media campaigns, including posters, brochures, employee success stories, etc., established
        • Was there an increase in pap test appointments directly following an informational or awareness campaign
        • What was the percentage increase in pap test appointments
      • Number of new partnerships with community groups created to enhance access and opportunity for employee cervical cancer screening
    • Assess changes in program costs from baseline
      • Increases in staffing or equipment needs due to new program offerings
      • Changes in employee participation time during work hours (e.g., education)
    • Assess changes in survey responses for employee satisfaction following implementation of a workplace supported cervical cancer screening program and compare with baseline

Depending on goal success, evaluate the need to adjust workplace programs.

Tools and Resources

Cervical Cancer Screening Baseline Measures

The assessment tools described in the assessment module include specific questions related to cervical cancer screening.

  Health-related Programs

  • Q11; Q12; Q20h; Q22; Q23; Q24a,b,d,e,h,i; Q26; Q27; Optional Questions A, B, I, J, K, M, JJ, OO

  Health-related Policies

  • Q28a

  Health Benefits

  • Q29; Q30; Q31; Q32; Q33; Q36; Q37; Optional Questions T, V, W, Z

  Environmental Support

  • Q39; Q40; Q41; Q47; Optional Questions CC

Additional Tools

  • In addition to the following suggestions for measures of worker productivity, health care costs, health outcomes, and organization change in cervical cancer screening programs, see measurement recommendations for obesity, physical activity, and tobacco use
  • Health Risk Appraisals at the Worksite: Basics for HRA Decision Making [PDF - 2.3MB] is a guide developed by the National Business Coalition on Health in collaboration with the Centers for Disease Control and Prevention (CDC) in the selection and use of health risk appraisals in the workplace available for employers
  • The CDC Healthy Communities Program developed the Community Health Assessment aNd Group Evaluation (CHANGE) assessment tool to provide communities with a picture of the policy, systems, and environmental change strategies currently in place throughout the community, where gaps exists and facilitate action planning for making improvements. The CHANGE tool address five community sectors including worksites and health indicators related to physical activity, nutrition, tobacco use, chronic disease management, and leadership

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