Study Variables
The ASCCP online application as well as the published updated guidelines
were used to determine if patients were referred correctly and if the
correct recommendation was then made by the receiving VCU gynecology
provider (2). The primary outcome was if the referral was concordant
with guidelines. A secondary outcome variable of interest was if the
receiving VCU gynecology provider made the correct post-colposcopy
recommendation that is concordant with the guidelines. The main
explanatory variable is cervical cytology from pap-test results which is
categorical in nature (atypical squamous cell of undetermined
significance (ASCUS), Atypical squamous cells, cannot exclude high-grade
squamous intraepithelial lesion
(ASCH), low-grade squamous intraepithelial lesion (LSIL), high-grade
squamous intraepithelial lesion (HSIL) , Atypical Glandular Cells (AGC),
and Negative for Intraepithelial Lesion or Malignancy (NILM)). Other
variables representing adherence to the guidelines includes the VCU
provider recommended procedure (colposcopy, LEEP, or re-screen) and HPV
test results. Other covariates include patient’s race/ethnicity,
patient’s age, type of referring provider (gynecologist, family
medicine, internal medicine, health departments, veteran affairs,
others), prior cervical dysplasia, and if the patient was seen at the
VCU clinic. A variable representing the length of time from when the
ASCCP guidelines were published and when the referral was received was
included to control for the effect of the amount of passed time since
the implementation of the guidelines and a referral to the VCU clinic.
It is anticipated that the greater the amount of time passed will result
in fewer discordant referrals. Due to the small sample size and
unbalanced frequencies within variable categories some variable
categories were combined or not included in the adjusted model. The
variables for HPV result and prior colposcopy had many patients which
were categorized as not applicable, likely due to the age
recommendations for HPV testing and colposcopies therefore, these
variables were not included in the multivariable logistic regression.