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Cervical Quality Improvement Program (C-QuIP) & the renewed National Cervical Screening Program

19 September 2016

Professor Ian Hammond

Chair, Steering Committee for the Renewal Implementation Project

National Cervical Screening Program, Department of Health Australia.

Colposcopy is used primarily to assess the cervix following an abnormal cervical screening test. It is a relatively simple technical procedure, practised by many O&G specialists. However, the interpretation of the colposcopic findings, cervical histopathology and subsequent clinical management is not simple and requires appropriate training, experience and continuing medical education to provide and maintain an acceptable standard of care.

Audit of individual clinical activity is considered to be an essential part of modern medical practice. Asymptomatic women will be ‘invited’ to participate in the renewed National Cervical Screening Program (NCSP). The program has a responsibility to ensure that the entire screening pathway is of the highest quality. The harms of screening must be minimised. Colposcopy and subsequent management is part of the screening pathway and is the only element of the NCSP that is not currently included in the quality assurance monitoring of the program. This is changing!

Commencing in May 2017, it will be mandatory (through national legislation) for all colposcopists to provide the National Cancer Screening Register (NCSR) with data in accordance with a minimum data set for every diagnostic or therapeutic interaction. Initially, data may be submitted in paper format or electronically, but it is anticipated that eventually all data submission will be electronic. In return, the NCSR will provide individual colposcopists with their performance data, benchmarked to national standards, for quality improvement and certification purposes. This individual data can then be used for certification in a recognised quality assurance program.

In the renewed NCSP, the quality of the colposcopic and therapeutic assessment procedures will be regularly assessed. It is expected that all colposcopists (diagnostic and therapeutic), who provide services to the NCSP, will participate in a cervical management quality assurance program. Quality standards for diagnostic and therapeutic colposcopists have been developed by the NCSP to provide guidance for individual performance review.  RANZCOG has been represented on the Working Party that has developed these standards.

To ensure alignment of the current C-QuIP program with the renewed NCSP, the C-QuIP program will now encompass quality measures of the entire cervical management pathway and not solely colposcopy. As such, the acronym C-QuIP will remain the same but it will stand for Cervical Quality Improvement Program, replacing the current Colposcopy Quality Improvement Program. Certification of participation in the C-QuIP will be dependent on submission of the individual colposcopist’s NCSR benchmarked data, evidence of ongoing CME that may include completion of online or other colposcopy education programs and/or attendance at scientific meetings pertaining to colposcopy (diagnostic and therapeutic) and diseases of the lower genital tract. In the short term, achieving a prescribed number of colposcopies will not be part of the assessment for C-QuIP certification. However, it should be noted that the NCSP program quality standards, consider that most colposcopists should be seeing a minimum of 25 new cases for assessment per annum.

Colposcopists may ask “Why should I enrol in the RANZCOG Cervical Quality Improvement Program (C-QuIP)? What’s in it for me?”

There are several good reasons:

  • The NCSP expects all colposcopists to participate in a Quality Assurance Program (C-QuIP).
  • Submission of your personal NCSR benchmarked data to the C-QuIP will be simple and all that is required to demonstrate personal performance standards.
  • Certification from C-QuIP demonstrates achievement of a standard of practice considered ‘competent’ by a group of his/her peers.
  • Demonstrated commitment to best practice and continuing medical education.
  • Acquisition of points as a component of the triennial CPD requirements.

Finally, the 2005 NHMRC endorsed Guidelines for the Management of asymptomatic women with screen detected abnormalities are to be replaced by a revised set of guidelines* developed by Cancer Council Australia and an expert Working Party, chaired by Professor Ian Hammond. The introduction of primary HPV screening with partial genotyping and reflex liquid based cytology will to some extent increase the complexity of colposcopic cervical management. It is essential that all practising colposcopists familiarise themselves with the new guidelines, which will be made available to you in the near future. In particular, new management algorithms will be of special interest. On line training modules will be made available at the time of the release of the guidelines and this will facilitate learning and improved practice.

* National Cervical Screening Program: Guidelines for the management of screen- detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding.




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