Table 2.

Proposed Minimum and Comprehensive Quality Measures for the Colposcopic Examination

Recommendation	Context/background	Calculation for provider or unit	Minimum Target	Comprehensive Target	References and notes
1. Document that squamo-columnar junction is visualized (fully visualized/ not fully visualized)	Adequate visualization at the time of colposcopy is important in managing abnormal screening tests. Lack of documentation may impact current or future management.	Numerator: Number colposcopy notes with documentation of visualized (fully/not) Denominator: Number total colposcopies performed by individual provider or group	90%	100%	European Federation of Colposcopy 2013 [6], Massad et al. [11], WHO/IARC 2003 [12], New Zealand 2013 [13] Germany 2015 [14]
2. Documentation of whether any acetowhite lesion is present (yes/no)	Documentation of the presence of a lesion is important in correlating cytology, histology, clinical impression and clinical management. Lack of documentation can alter management and lead to suboptimal outcomes	Numerator: Number colposcopy notes with documentation of lesion present Denominator: Number total colposcopies performed by individual provider or group	90%	100%	Massad et al. [11], British 2016, New Zealand 2013 [13], Italy 2006 [15]
3. Documentation of colposcopic impression (normal/benign; low grade; high grade; cancer)	Documentation of colposcopic impression is clinically important and is a quality assurance and precision metric for colposcopy	Numerator: Number colposcopy notes with documentation of colposcopic impression Denominator: Number total colposcopies performed by individual provider or group	80%	100%	Massad et al. [11], WHO/IARC 2003 [12], New Zealand 2013 [13] Germany 2015 [14]
4. Documentation of cervix visibility (fully visualized, not fully visualized)	Adequate visualization of the cervix at the time of colposcopy is important in management of abnormal screening tests. Lack of documentation may result in over or under treatment of abnormal findings.	Numerator: Number colposcopy notes with documentation of adequate visualization of the cervix at the time of colposcopy Denominator: Number total colposcopies performed by individual provider or group	70%	100%	Britain 2016 [4] WHO/IARC 2003 [12], New Zealand 2013 [13],
5. Documentation of extent of lesion visualized (fully/partial)	Adequate visualization of the extent of the lesion(s) at the time of colposcopy is important in management of abnormal screening tests. Partial visualization of the lesion(s) can alter management. Lack of documentation may result in over or under treatment of abnormal findings.	Numerator: Number colposcopy notes with documentation of visualization of extent of any/all lesion(s) or no lesion Denominator: Number total colposcopies performed by individual provider or group	70%	100%	Britain 2016 [4] WHO/IARC 2003 [12], New Zealand 2013 [13],
6. Documentation of location of lesion(s)	Knowledge of the location of the cervical lesions and size of the lesion allows the practitioner to tailor any necessary extirpative procedure to the abnormal pathology. Lack of documentation may result in overly large or inadequate cervical excision.	Numerator: Number colposcopy notes with documentation of location of the lesion(s) or no lesion Denominator: Number total colposcopies performed by individual provider or group	0%	100%	New Zealand 2013 [13]
7. Provider should take multiple biopsies targeting all areas with acetowhitening, metaplasia or higher abnormalities (at least two and up to four biopsies)	A single biopsy, targeting the worst appearing lesion may miss up to a third of prevalent precancers.	Numerator: Number colposcopy notes with documentation of any acetowhite lesion and 2 to 4 biopsies taken OR a biopsy and endocervical sampling taken. Denominator: Number colposcopy notes with documentation of any acetowhite lesion	85%	100%	Britain 2016 [4], Canada 2012 [7], Gage JC, et al [16] Stoler MH, et al. [17], Pretorius RG, et al. [18] Wentzensen N, et al. [19]
8. An attempt should be made to contact a patient with suspected invasive disease* within 2 weeks of receipt of report or referral.	Optimally a patient with suspected invasive disease should be seen as soon as possible after the diagnosis has been confirmed. Multiple factors may impact the ability to complete that contact among patients with a high acuity abnormality were identified including: 1) screening environment 2) insurance status 3) health literacy 4) social/cultural/language barriers	Numerator: Number of patients with suspected invasive disease with attempted contact within 2 weeks Denominator: Number of patients with suspected invasive disease	60%	90%	New Zealand 2013 [13], Expert/committee opinion.
9. Patients with suspected invasive disease* should be seen within 2 weeks of contact.	Time to definitive treatment for invasive cervix cancer is associated with improved outcomes. Therefore, timely evaluation, diagnosis and referral is integral to appropriate care and patients should be provided prompt treatment.	Numerator: Number of patients with suspected invasive disease seen within 2 weeks of contact Denominator: N of patients with suspected invasive disease	60%	90%	New Zealand 2013 [13], Expert/committee opinion.
10. An attempt should be made to contact a patient with high grade cytology results** within 4 weeks of receipt of report or referral.	Patients with high grade cytology results** have a risk of CIN2+ of >10%. Therefore, timely evaluation is critical for diagnosis and management of dysplastic disease.	Numerator: Number of patients with high-grade cytology results** with attempted contact within 4 weeks Denominator: Number of patients with high grade cytology results	60%	90%	New Zealand 2013 [13], Expert/committee opinion.
11. Patients with high grade cytology results** should be seen within 4 weeks of contact.	See #9.	Numerator: Number of patients with high-grade cytology results** seen within 4 weeks of contact Denominator: N of cytology tests with high grade disease	60%	90%	New Zealand 2013 [13], Expert/committee opinion.

^*Suspected invasive disease includes cytology tests with neoplasia or suspected neoplasia or with clinical suspicion for invasive disease.

^**A high grade cytology result includes any of the following cytology results: High-grade Squamous Intraepithelial Lesion, Atypical Squamous Cells: Cannot Exclude High-grade Squamous Intraepithelial Lesion, Atypical Glandular Cells

Contact is defined as communications by any HIPAA compliant means for the purpose of informing the patient of the status of their clinical investigation and the plan for their continued follow up. The communication should document a response from the patient acknowledging the future plan, acknowledging understanding of the information being discussed, and documentation of the interaction.