Problems with Using Women's Cancer Screening Rates to Measure Performance
Paul A. Heineken, MD, Cheryl Wenell, RNP, MS, Karla Kerlikowske, MD, and Louise C. Walter, MD
Dr. Heineken is the associate chief of staff of ambulatory care, Ms. Wenell is the coordinator of the Women Veterans Program, Dr. Kerlikowske is the director of the Women's Clinic, and Dr. Walter is a staff physician, all at the San Francisco VA Medical Center, San Francisco, CA. In addition, Dr. Heineken is a clinical professor in the School of Medicine, Ms. Wenell is an associate clinical professor in the School of Nursing, Dr. Kerlikowske is a professor in residence in the departments of medicine and epidemiology and biostatistics in the School of Medicine, and Dr. Walter is an associate professor in the division of geriatrics and the codirector of the Geriatrics Research Program in the School of Medicine, all at the University of California, San Francisco.
When a VA audit determined that the San Francisco VA Medical Center had underperformed with regard to breast and cervical cancer screening, these authors reviewed the medical charts of patients who were counted as screening failures. Their findings point to flaws with the VA’s auditing process and its use of women’s cancer screening rates as performance measures.