Milwaukie Family Medicine 2026

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  Breakthroughs in Cervical Cancer Screening: HPV self-collection at PMG Milwaukie Family Medicine Clinic

  Brandon Bartlett, Sataj Johnson, Emily Miyasako, Rachel Gallagher, and Daniel Ruegg

  Background: Cervical cancer screening is a cornerstone of preventative healthcare and cancer screening in primary care. Based on data from the CDC, in the US alone, the rate of new cervical cancers each year is ~13,000, accounts for ~4,000 deaths annually, and disproportionally effects people of color and people of low SES (CDC, 2025). In our clinic (PMG Milwaukie), the rate of cervical cancer screening has remained around 70% for years, which is below the national average of ~75% (Healthy People, 2021). Primary HPV screening with self-collected swabs has been used successfully for years outside of the US, improving screening rates, specifically for under-screened groups. In 2024, the FDA approved a self-collected swab for use in the US. In February 2025, the ASCCP (American Society for Colposcopy and Cervical Pathology) updated guidelines to recommend primary HPV screening (as opposed to co-testing or cytology alone), with self-collected samples as an acceptable option for some patients ages 25-65. This is a seismic shift in cervical cancer screening, allowing for less invasive screening options to a multitude of patients for which exam was a barrier to receiving care. Objectives: The aim of this quality improvement project was to incorporate self collected primary HPV screening as an option for our patients to improve cervical cancer screening rates in our clinic. The Healthy People Initiative has set a goal benchmark for cervical cancer screening of 79.2% by 2030. Methods: Given the understanding that self-collected primary HPV screening is a large change from prior guidelines and is a relatively new concept in the US for cervical cancer screening, we first developed a workflow focused on appropriate patient selection and counseling as well as follow up for positive screening tests. As provider education and adoption is essential to this process, we addressed this through didactic sessions, clinical poster materials, and at the bedside through a PARQ dotphrase to aid providers in counseling and appropriate patient selection. As a precaution to ensure appropriate patient selection during the adoption of this new screening process, we embedded a hard stop acknowledgement to ensure providers reviewed eligibility criteria. The final aspect of our workflow is quality assurance. Acknowledging that a positive or indeterminant result is incomplete screening, we created a report to track results and ensure appropriate follow-up. The next process that we are focusing on is adoption of contemporaneous cervical cancer screening for overdue and/or under-screened patients developing strategies to identify and counsel patients due for cervical cancer screening outside of wellness exams. To prompt patients to request screening outside preventative care visits, those identified during the schedule scrub are given patient education handouts highlighting this recent change in screening options during the rooming process. Additionally, we focused on enhancing medical assistant to provider handoffs through an MA rooming dotphrase, whiteboard magnets, and chart scrubbing. Results: From 10/2025 - 2/2026, we screened a total of 39 patients using self-collected Primary HPV swabs. Of these, there were a total of 4 positive HPV results of which ¾ of those had appropriate follow up testing. Of the 39 completed tests, only one was identified as invalid by the lab and not able to be run. Based on the generated SlicerDicer reports in Epic, we did not see any significant change in the overall cervical cancer screening rates in our clinic after the introduction of self-collected primary HPV swabs, after 4 months of adoption Discussion: The introduction of primary HPV screening is a relatively new idea in the US, and the option for patient-collected swabs is even more so. Most patients in our clinic ages 25-65 are being screened using co-testing or cytology with reflex as recommended by the USPTF. While the American Cancer Society recommended a change to primary HPV screening in 2020, it remains only an option by the USPTF. The addition of a patient collected sample will provide the catalyst for shifting to primary HPV screening, as evidenced by the recent ASCCP recommendations and reflected in the USPSTF draft recommendations. For patients who qualify for self-collected testing, this offers a new opportunity to avoid more invasive pelvic exams. Through the duration of this project, we were able to screen 39 patients using self-collected samples with only one invalid test and one patient lost to follow up after a positive result. With appropriate workflows and understanding of inclusion and exclusion criteria, this can serve as a great screening tool for patients who are under screened and those with difficulty with pelvic exams. While we have yet to show any improvement in the overall screening rates in our clinic after 4 months following this change, it has been shown on large scales that offering self-collected cervical cancer screening options significantly increase screening rates (Sultana et. Al., 2026). The recent changes in the guidelines represent a drastic change from previous recommendations, and change takes time. Incorporating cervical cancer screening into the primary care workflow outside of a traditional wellness exam introduces its own barriers, including additional time constraints. We also recognize that outreach is an important part of preventative care and will likely play a role in ongoing efforts to improve cervical cancer screening at our clinic. Moving forward, our goal is to continue to optimize the workflow to incorporate cervical cancer screening into non-wellness visits by improving provider recognition of patients due for screening as well as introducing an outreach program aimed at under-screened patients. From a system standpoint, creating consensus around screening recommendations, especially in the setting of the effective dissolution of the USPSTF is essential. As we move forward, large scale changes require institutional support. Creating an integrated decision aid to reflect these changes may serve to enhance provider adoption. Creating a system to follow abnormal results, as recently emphasized in October 2025 by the ASCCP, is an essential step in any screening process.

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  Enhancing Gestational Diabetes Screening

  Sataj Johnson and Daniel Ruegg

  Background: Gestational diabetes mellitus (GDM) screening is recommended between 24–28 weeks of gestation to allow timely diagnosis and treatment and reduce adverse maternal and neonatal outcomes. The two-step glucose tolerance testing method is supported by ACOG, though completion can be delayed due to the need for multiple tests. In 2024 at Providence Milwaukie Family Medicine Clinic, incomplete GDM screening occurred in 23.1% of patients, and incomplete two-step screening occurred in 33.3%, with an average completion time of 12 days. Objective: To increase completion rates of two-step GDM screening and reduce time between abnormal 1-hour and diagnostic 3-hour glucose tolerance tests by offering clinic-based testing instead of lab-only screening. Methods: Clinic-based screening was implemented by obtaining supplies and establishing a workflow. Outcomes were evaluated through chart review and data collection. Results: Prior to implementation, the two-step screening completion rate was 70%, with an average completion time of 15 days. From March 2025 to February 2026, completion increased to 81%, with 72.7% completed in clinic and 9% in the lab. Non-completion decreased to 18%. Average completion time improved to 11 days. Conclusion: GDM affects approximately 1 in 11 pregnancies in the United States and can lead to significant maternal and neonatal complications if untreated. Clinic-based screening modestly improved completion rates and reduced time to diagnostic testing. Patients reported the clinic option as convenient. Expanding clinic-based screening may improve access, patient satisfaction, and timely diagnosis, particularly in settings with limited laboratory access. Larger studies are needed to assess statistical significance and long-term obstetric and neonatal outcomes.

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  Addressing Food Insecurity through partnering with the Community Teaching Kitchen on Lifestyle Medicine Hypertension Class

  Emily Miyasako and Jill Christensen

  Background: Food insecurity is defined as limited or unreliable access to adequate and nutritious food. In Oregon, approximately 1 in 8 residents experience food insecurity, with rates disproportionately affecting low-income individuals, racial and ethnic minorities, and households with children or elderly individuals. Food insecurity remains a significant threat to our patients’ health and is associated with obesity, malnutrition, and poor mental health. As a primary care provider, I have seen the effects of food insecurity on my patients, but I am thankful for the presence of our Community Teaching Kitchen. The Community Teaching Kitchen (CTK) at Providence Milwaukie provides nutritional counseling, operates a community garden that provides a sustainable source of fresh produce, and manages a family food pantry providing nutritious foods available to patients experiencing food insecurity. CTK serves a vital role in providing reliable access to healthy foods for individuals in our community. However, after HR 1 was passed in July 2025, SNAP benefits were significantly reduced. This severely impacted CTK’s ability to help support our community due to decreased funding and increased need. Our clinic has been implementing a group hypertension class as part of the lifestyle medicine elective. My passion project involved partnering with the CTK for the lifestyle medicine group hypertension class to help provide revenue for the CTK and the family food pantry, while also introducing our patients to this valuable resource. Goals and objectives: To introduce our patients to the services offered by the Community Teaching Kitchen, as well as to create a sustainable source of revenue for the Community Teaching Kitchen so they can continue to provide nutritious food for our patients with food insecurity. Methods: We adapted the 4-week lifestyle medicine group hypertension course to incorporate services offered by CTK. The classes are scheduled on 3/11, 3/18, 3/25 and 4/1. One of the sessions of the class will be held in the community garden, where we will discuss the importance of exercise and demonstrate a meditation class. The final session will be held at the teaching kitchen, where we will demonstrate how to cook a DASH diet meal by using resources and a recipe provided by the CTK staff. We will measure patient learning and satisfaction with pre and post-course surveys. Results: In order to increase recruitment, I personally reached out to my panel of patients who had uncontrolled hypertension via Mychart messages. We were able to recruit 7 patients (of which 6 attended the first class), thereby meeting our goal of 6-8 participants. We will be able to share the proceeds of the class (each session is billed as a level 3 visit) with our Community Teaching Kitchen, which will be able to fund the family food pantry. We have collected pre-course survey on baseline hypertension knowledge and plan to compare this to post-course survey results to evaluate patient learning. We will also analyze patient satisfaction scores on the post-course survey. Discussion/conclusion: Food insecurity is a highly prevalent yet under-addressed determinant of health among our patients. Our Community Teaching Kitchen has been essential in helping our patients with food insecurity by providing nutritious food and dietary counseling. By partnering with the CTK for our group lifestyle medicine hypertension class, we can introduce our patients to this valuable resource as well as provide a sustainable source of income for our community food pantry to continue to support our patients with food insecurity.

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  Improving Cervical Cancer Screening at PMG Southeast Family Medicine Through Implementing a New Screening Tool: Patient-Collected High-Risk HPV Screening

  Brianna Pickering, August Stuppy, Eric Waelbroeck, Ben Pederson, and Daniel Ruegg

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  Increasing Structured Inpatient Teaching in a Family Medicine Residency

  Eric Waelbroeck and MH Choe

  Background: What is not measured cannot be improved. Residents at Providence Milwaukie Family Medicine Residency identified a need to increase structured teaching on inpatient rotations. Other projects aimed at increasing structured teaching during family medicine training have demonstrated improvements in resident confidence in key areas of practice, licensing exam performance, and resident satisfaction with their training. However, without a system of measurement, the number of teaching opportunities cannot be reliably improved. Objectives: Develop a method of documenting structured inpatient teaching that occurs at Providence Milwaukie Hospital. Then, implement interventions using a quality improvement model to increase structured teaching over time. Methods: A list of inpatient topics was developed referencing inpatient curricula from UCSF and Johns Hopkins. This list was narrowed down to 30 common admitting diagnoses and 10 “common pages” using feedback from the residency inpatient committee. A table was shared on the residency inpatient SharePoint where interns could document who taught them each topic. Then, three PDSA cycles each lasting 4 months aimed to increase the rate of documented teaching over time. Results: The baseline rate of intern-documented structured learning activities during inpatient rotations over the final 4 months of the class of 2027 intern year was 3 per month. This includes the first PDSA, where interns were oriented to the spreadsheet during resident meetings. With this baseline data, a target was selected to improve the number of documented structured learning activities to 4 per month by the end of the subsequent academic year. After providing a space to share teaching materials in the SharePoint, the rate of teaching for the first 4 months of the class of 2028 intern year increased to 3.75 per month. After asking general surgery to teach sessions, the rate of teaching for the subsequent 4 months remained stable at 3.8 per month. Discussion/Conclusions/Next Steps: This project was successful in producing a method of documenting structured inpatient teaching that interns receive in a family medicine residency. Quality improvement efforts were successful in generating a ~25% increase in teaching rates, with the most effective intervention being sharing a space for teaching resources. Comparing adjusted teaching rates on inpatient to obstetric rotations demonstrates a continued discrepancy (5.5 vs 14 per month). This highlights the imbalance that residents experience in their education and reaffirms the need for continued efforts at improving structured learning in the inpatient setting. Future efforts could consider posting the list of teaching topics in the resident workroom, adding teaching topic selection to the list of to-dos on the senior inpatient guide, and engaging faculty to improve teaching rates.