Chlamydia screening rate is low in Washington; The Alliance is working to address this
For National STI Awareness month, the Washington Health Alliance is drawing attention to the low rates of chlamydia screenings in primary care settings. Our latest data shows that 6 in 10 commercially insured women age 16 to 24 are not getting screened.
Focus has been put on the spread of sexually transmitted infections throughout the pandemic and chlamydia, an infection caused by the bacterium Chlamydia trachomatis, is among the most common of these infections.
Our 2023 Community Checkup, which relies on our voluntary All-Payer Claims Database of more than 4 million Washington residents, shows the average rate for screenings for commercially insured is 37 percent. For Medicaid-insured residents, the rate increases slightly to 45 percent, but both remain well below the national 90th percentile. (The measure tracks screening for women age 16 to 24 who report being sexually active.) 
Easily treated with antibiotics when caught early, undiagnosed chlamydia can lead to pelvic inflammatory disease (PID), infertility, and ectopic pregnancy. And often it can be present without any symptoms.
However, screening is shown to have a substantial impact on prevention and reduction of serious complications.
In a study published in the Journal of Infectious Diseases, researchers found that chlamydia screening led to a 60% reduction in PID among young women. The study also found that screening and treating men and women for chlamydia reduced the incidence of ectopic pregnancy by 43%.
Another study from the Journal of Infectious Diseases shows that screening for chlamydia can reduce the incidence of infection in a population by as much as 59%.
Acknowledging the low rates through our annual Community Checkup results, the Alliance’s Quality Improvement Committee flagged chlamydia screening as one of two measures as a focus for measured improvement.
According to Alliance Medical Director Sharon Eloranta, M.D., who is the staff member coordinating with the QIC (Quality Improvement Committee), the committee selected the measure in part because it was viewed as a “canary in the coal mine” for the general increase in sexually-transmitted conditions following the pandemic.
Also, in Washington state, she said this metric has underperformed the national 25th percentile for at least the past four reporting periods; is clinically impactful; is amenable to improvement; affects large numbers of patients; and most important, presents significant equity aspects.
According to our latest analysis, which pairs quality measures with the Neighborhood Atlas (Area Deprivation Index), the rate of screenings for commercially insured declines across some areas based on socioeconomic advantage.
The QIC has come together to identify the top drivers of poor performance, and to choose top areas for action: 1) “normalize” chlamydia testing; 2) create standardized provider education on normalization; home/alternative testing/ types of testing options; efficacy of tests; collection, costs and coverage; and 3) interview high and low performers to inform best practices.
The QIC, made up of more than 20 physicians, plans to continue to meet and develop avenues for action to address this declining metric.