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.