How many sexually active young women are tested for Chlamydia infection as recommended?

Only about one-third to one-half of sexually active young female health plan members (ages 16 to 25) were tested for Chlamydia infection during 2005. Screening rates increased modestly from 2000 to 2005.

Percentage of Sexually Active Female Managed Care Enrollees Ages 16–25 Who Received a Test for Chlamydia Infection in the Past Year, by Age Group, 2000–2004

Why is this important?

• Genital Chlamydia is the most common bacterial sexually transmitted disease (STD) in the United States (CDC 2004). Treatment of its complications costs $3 billion or more annually.
• Most infected people do not have symptoms and are thus unaware that they need treatment. In women, untreated Chlamydia can lead to pelvic inflammatory disease and chronic pelvic pain, infertility, or life-threatening tubal pregnancy.
• Screening females at risk for Chlamydia reduces the incidence of pelvic inflammatory disease and is very cost-effective (USPSTF 2003; Hu et al. 2004).

Findings

Among sexually active young females (ages 16 years to 25) enrolled in managed care plans, only about one-third (34% to 35%) with private insurance and about one-half (49% to 52%) with Medicaid coverage were tested for Chlamydia infection during 2005 (NCQA 2005). Screening rates increased by about 10 to 14 percentage points from 2000 to 2005.

Implications

The rate of Chlamydia screening remains very low in private health plans, although the higher rate in Medicaid plans is encouraging. In other studies, only one-third to one-half of primary care physicians report regularly testing for Chlamydia when they determine that an adolescent girl is sexually active (Torkko et al. 2000; Cook et al. 2001; Guerry et al. 2005).

Improvement Ideas and Resources

• Physician adherence to screening guidelines is associated with a sense of responsibility for STD prevention, confidence in addressing teen sexuality, and an understanding of the risk of infection and effectiveness of screening (IOM 1997; Torkko et al. 2000; Cook et al. 2001).
• Teens say that assuring privacy and confidentiality is important to receiving STD screening (Blake et al. 2003).
• Health plan STD service delivery is facilitated by public health collaboration, regulatory and performance incentives and monitoring, and supportive information infrastructure (Chorba et al. 2004).
• Multifaceted and systems interventions aimed at improving clinical practice have been associated with substantial increases in Chlamydia screening rates in some health plans (Shafer et al. 2002; Burstein et al. 2005).

Measure:

The denominator includes female health plan members ages 16 to 25 who were continuously enrolled (no more than a 45-day gap) in the health plan during the measurement year and who received a service or medication likely to be provided to sexually active females. The numerator includes those in the denominator who received a test for Chlamydia infection in the measurement year. The U.S. Preventive Services Task Force recommends that clinicians routinely screen all sexually active females ages 25 and younger for Chlamydia infection (USPSTF 2003).

Limitations:

These data are not representative of all adolescents in the United States. Health plan administrative data may under-identify sexually active women and undercount Chlamydia tests among those whom it does identify (Downey et al. 2004; Tao et al. 2002; Wei and Walsh 2003).

Source:

Health plans used administrative claims data to voluntarily report this Health Plan Employer Data and Information Set (HEDIS) measure to the National Committee for Quality Assurance (NCQA 2006). These data are not representative of all adolescents in the United States.

References:

* Indicates source of data used in the chart(s).Blake, D. R., M. H. Kearney, J. M. Oakes et al. 2003. Improving Participation in Chlamydia Screening Programs: Perspectives of High-Risk Youth. Archives of Pediatric and Adolescent Medicine 157 (6): 523–9. Burstein, G. R., M. H. Snyder, D. Conley et al. 2005. Chlamydia Screening in a Health Plan Before and After a National Performance Measure Introduction. Obstetrics and Gynecology 106 (2): 327–34. CDC (Centers for Disease Control and Prevention). 2004. Chlamydia Fact Sheet. Atlanta, Ga.: U.S. Department of Health and Human Services. Chorba, T., D. Scholes, J. Bluespruce et al. 2004. Sexually Transmitted Diseases and Managed Care: An Inquiry and Review of Issues Affecting Service Delivery. American Journal of Medical Quality 19 (4): 145–56. Cook, R. L., H. C. Wiesenfeld, M. R. Ashton et al. 2001. Barriers to Screening Sexually Active Adolescent Women for Chlamydia: A Survey of Primary Care Physicians. Journal of Adolescent Health 28 (3): 204–10. Downey, L., W. E. Lafferty, G. Tao et al. 2004. Evaluating the Quality of Sexual Health Care Provided to Adolescents in Medicaid Managed Care: A Comparison of Two Data Sources. American Journal of Medical Quality 19 (1): 2–11. Hu, D., E. W. Hook, 3rd, and S. J. Goldie. 2004. Screening for Chlamydia Trachomatis in Women 15 to 29 Years of Age: A Cost-Effectiveness Analysis. Annals of Internal Medicine 141 (7): 501–13. IOM (Institute of Medicine). 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, D.C.: National Academy Press. * NCQA (National Committee for Quality Assurance). 2006. The State of Health Care Quality, 2006. Washington, D.C.: National Committee for Quality Assurance. Shafer, M. A., K. P. Tebb, R. H. Pantell et al. 2002. Effect of a Clinical Practice Improvement Intervention on Chlamydial Screening Among Adolescent Girls. Journal of the American Medical Association 288 (22): 2846–52. Tao, G., C. M. Walsh, L. A. Anderson et al. 2002. Understanding Sexual Activity Defined in the HEDIS Measure of Screening Young Women for Chlamydia Trachomatis. Joint Commission Journal on Quality Improvement 28 (8): 435–40. Torkko, K. C., K. Gershman, L. A. Crane et al. 2000. Testing for Chlamydia and Sexual History Taking in Adolescent Families: Results from a Statewide Survey of Colorado Primary Care Providers. Pediatrics 106 (3): e32. USPSTF (U.S. Preventive Services Task Force). 2003. Screening for Chlamydial Infection: Recommendations and Rationale. American Journal of Preventive Medicine 20(3S): 90–94.Wei, F., and C. M. Walsh. 2003. Validation of Data Collection for the HEDIS Performance Measure on Chlamydia Screening in an MCO. American Journal of Managed Care 9 (9): 585–93.