Evaluating the HEDIS Guidelines for Measuring Cervical Cancer Prevention Efforts

Abstract

Objective. Our goal was to evaluate the Health Plan Employer Data and Information Set (HEDIS) age criteria for measuring the quality of cervical cancer screening promulgated by the National Committee for Quality Assurance as a tool for assessing health plan performance. Methods. Using a prospectively accrued database of women undergoing initial colposcopy at an urban teaching hospital between July 1, 1996, and December 31, 1997, we compared results of cytology, histology, and colposcopic impression for women within and outside the HEDIS age specifications for cervical cancer screening (ages 21-64 years). Histology was recorded as the highest-grade result from any cervical tissue obtained at or within 8 to 26 months after colposcopy. Women without cervices were excluded. Statistical analysis was by chisquare testing. Results. As compared to 985 women meeting HEDIS age limits, 178 women aged 14 to 20 years had lower rates of histologically proven cervical intraepithelial neoplasia grade 2 (CIN2) or CIN3 or cancer (288 of 985 [29%] versus 22 of 78 [28%]), as well as lower rates of high-grade cytology on referral and at the time of the colposcopy and lower-grade colposcopic impression (p < .001 for all). For 22 women older than age 64, rates of CIN2 or CIN3 or cancer on histology (6 of 22 [29%]), cytology, and colposcopic impression did not differ from those who were aged 20 to 64 (p > .15 for all). Conclusions. Adolescents referred for colposcopy are at lower risk for high-grade cervical disease than are women aged 21 to 64, but their 12% frequency of CIN2 and CIN3 and cancer suggests that they deserve screening despite HEDIS recommendations.