CHOP network raises chlamydia and gonorrhea screening in adolescents from 25% to 75% across 33 practices
In a quality improvement program in 33 pediatric practices, universal opt-out testing gave the largest gain, and monthly detected cases rose in both sexes, the authors report.
Researchers at Children's Hospital of Philadelphia (CHOP) report in PEDIATRICS that a staged quality improvement program, run from 2021 to 2025 in 33 primary care practices of the CHOP Care Network, raised chlamydia and gonorrhea (CT/GC) screening among adolescents. Screening of sexually active females rose from approximately 25% to 75%, and screening of sexually active males from approximately 20% to 75% doi.org
PEDIATRICSdoi.orgOpen source ↗.
During the study period the network cared for 136,241 adolescents aged 15–19 years. Monthly well-care visits grew over time, averaging from 1,472 to 1,681 visits per month doi.org
PEDIATRICSdoi.orgOpen source ↗. The primary outcome was the CT/GC screening rate among sexually active female patients aged at least 15 years at well visits. Secondary outcomes were male screening rates and case detection. The authors evaluated results with statistical process control and run charts.
Stages of the intervention
The changes were introduced one after another. The first was the Adolescent Health Questionnaire, developed and piloted by the Possibilities Project at CHOP. Patients complete it before the visit, and it prompts discussion of key adolescent health topics and helps identify those who may need further care.
The team paired the questionnaire with electronic health record best practice advisories and pre-populated order sets with next steps that depend on the questionnaire answers. Physicians who increased screening rates received financial incentives. The final step was a universal opt-out protocol, under which all eligible adolescents are tested unless they decline. According to the authors, the largest gains in screening followed this change doi.org
PEDIATRICSdoi.orgOpen source ↗.
Case detection
The number of chlamydia cases found in sexually active females rose from approximately 8 per month to a peak of approximately 25 per month during the period of highest testing volume. Among males, monthly cases rose from approximately 4 to 16 doi.org
PEDIATRICSdoi.orgOpen source ↗. The improvements were seen across insurance types, races and ethnicities.
The authors conclude that a systematic intervention built on the electronic health record significantly improved screening and increased case detection. Lead author Brian Jenssen, a pediatrician at CHOP and associate professor at the University of Pennsylvania Perelman School of Medicine, said that moving from risk-based to universal opt-out screening appears to have made the biggest difference.
The CHOP release adds that most chlamydia and gonorrhea infections cause no symptoms, that people aged 15 to 24 account for about half of new sexually transmitted infections in the United States, and that fewer than one-third of adolescents are asked about sexual activity at well visits.
