The Effect of the American College of Physicians Guideline Change on Screening Pelvic Examinations in an Insured Population

Background: Several advancements in evidence and changes in recommendations for screening pelvic examinations (SPEs) have occurred in the last decade, yet their impact on the use of SPEs is unknown. We assessed the impact of two changes: the September 2013 Quality Enhancement Research Initiative (QUERI) Evidence-based Synthesis Program report finding no evidence that SPEs reduce morbidity or mortality; and the July 2014 American College of Physicians (ACP) guidelines recommending against SPEs in asymptomatic, nonpregnant women. Methods: We described monthly rates of SPEs among females ages 15–64 enrolled in a claims database between January 2012 and December 2019. We implemented an interrupted time series analysis to examine the impact of the QUERI evidence report and ACP guidelines on the trend in monthly SPE rates, overall and stratified by age group and geographic region. Main Findings: The average monthly rate of SPEs decreased from 357 per 1,000 person-years at risk in 2012 to 302 per 1,000 person-years at risk in 2019. There were no significant immediate changes in rates of SPEs after either the 2013 QUERI white paper or the 2014 ACP guidelines. Conclusions: Changes in guidelines had no observable impact on the rate of SPEs. Future work is needed to better understand why recent evidence and guideline developments have not impacted real-world practice to target interventions for providers to decrease SPEs efficiently.