Quality improvement in family practice. Program for Pap smears

With the increasing emphasis on quality improvement, we need programs for improving office practice. To demonstrate a simple and inexpensive program that resulted in improvement in the quality of Papanicolaou smears in a family practice teaching clinic. The performance measure was the proportion of smears containing endocervical components. The program involved annual feedback on the performance of the physicians in the clinic. Feedback was given to physicians at a regular group meeting; brief discussion of the findings also occurred at that time. There were no other interventions. A program involving straightforward feedback and discussion for less than 1 hour contributed to a 7% improvement in the proportion of Pap smears with endocervical components. This "low tech" approach should be tested in other settings and with other procedures and treatments.