Cervical Cancer: Follow-Up and Referral

Introduction

This page is part of the Cervical Cancer Screening Change Package.

Change concepts are "general notions that are useful for developing more specific strategies for changing a process."1 Change ideas are evidence-based or practice-based "actionable, specific ideas or strategies."1 Each change idea is linked to tools and resources that can be used or adapted to improve cancer screening.

Note: See a list of acronyms used in this change package.

Change concept: Establish relationships with specialists for diagnostic testing and treatment.

Identify and partner with referral services or specialists who can provide follow-up diagnostic tests and/or cancer screening.

• IOM — Primary Care and Public Health: Exploring Integration to Improve Population Health
• Nekhlyudov L, Latosinsky S, 2010 — The Interface of Primary and Oncology Specialty Care: From Symptoms to Diagnosis

Establish two-way communication with referral services or specialists to find out if patients followed up with referrals.

• AHRQ — Coordinating Care in the Medical Neighborhood: Critical Components and Available Mechanisms
• Nekhlyudov L, Latosinsky S, 2010 — The Interface of Primary and Oncology Specialty Care: From Symptoms to Diagnosis

Change concept: Adopt policies and procedures for patient referral and follow-up for diagnostic testing and treatment.

Develop protocols and workflows, such as reminder systems, to ensure follow-up referrals are made.

• Nekhlyudov L, Latosinsky S, 2010 — The Interface of Primary and Oncology Specialty Care: From Symptoms to Diagnosis

Implement best practices for notification of abnormal test results and follow-up instructions to the patient.

• Evidence-Based Cancer Control Programs – Fox Chase Cancer Center — Tailored Communication for Cervical Cancer Risk – Program Materials
• ONC — SAFER: Self-Assessment Test Results Reporting and Follow-Up, pages 5–7

Create a tracking system for documenting patient follow-up after an abnormal test result.

• ACOG — Tracking and Reminder Systems
• ECRI on behalf of HRSA — Using the EHR for Care Management and Tracking

Use EHR-based clinical decision management tools to guide follow-up care.

• ECRI on behalf of HRSA — Using the EHR for Care Management and Tracking

Change concept: Overcome barriers to follow-up and treatment.

Identify sources for low-cost or free transportation services for follow-up care.

• ACS — Road to Recovery [English and Spanish]
• AHA — Social Determinants of Health Series: Transportation and the Role of Hospitals
• CMS — Non-Emergency Medical Transportation (NEMT)
• Livestrong — Transportation and Other Cancer Support Services

Offer same-day and open-access scheduling and services outside of traditional hours.

• The Community Guide — Cancer Screening: Reducing Structural Barriers for Clients – Cervical Cancer

Use patient navigation to help individuals access follow-up services.

• ACCC — I Am a Financial Navigator
• GW Cancer Center — Guide for Patient Navigators: A Supplement to the Oncology Patient Navigator Training: The Fundamentals

Change concept: Implement follow-up processes for regular screening.

Develop tracking systems to document when patients are due for their next regular screening.

• Good Samaritan Health Center — Tracking Abnormal Cervical Cancer Screening Follow-Up