Increasing Screening Rates in Practice. Francis R Colangelo MD, FACP February 21, 2017

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1 Increasing Screening Rates in Practice Francis R Colangelo MD, FACP February 21, 2017

2 Purpose of Today s Webinar To maximize options for improving colon cancer screening by following four essential strategies

3 Brought to you by The Pennsylvania Department of Health 80% by 2018 Colorectal Cancer Workgroup Funding for this webinar was made possible (in part) by the Centers for Disease Control and Prevention. The views expressed in written conference materials or publications and by the speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsements by the U.S. Government.

4 Continuing Education This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the New Jersey of Academy of Family Physicians and the American Cancer Society. The New Jersey Academy of Family Physicians is accredited by the ACCME to provide continuing medical education for physicians. The New Jersey Academy of Family Physicians designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity.

5 Conflicts of Interest The Planners, Reviewer, and Faculty have no financial conflict of interest relevant to this activity Planners Reviewer Faculty Kate Mastalski Theresa J. Barrett, PhD Francis Colangelo, MD Cheryl Bumgardner Suzanne Cohen, MPH, PCMH-CCE Karen Breitmayer Michael Colli, MD

6 Agenda Colon cancer impact General background of practice Description of the four essentials How PMA successfully employed the four essentials Results of PMA s 80% by 2018 efforts Recent updates to recommendations Summary

7 THE IMPACT OF COLORECTAL CANCER

8 Burden of Colon Cancer Of cancers that affect both men and women it is the second leading cause of cancer related deaths Per ACS estimates in 2017 (nationally) 95,520 new cases of colon cancer 39,910 new cases of rectal cancer 50,260 deaths

9 The News Is Not All Bad Screening rates have been increasing steadily since the 1990s There has been a 30% reduction in colon cancer mortality in the last 10 years Estimates that 65% of individuals aged have been screened (but still 23 million to go) If adults are screened for colon cancer, the disease can be detected at an early stage and/or polyps can be removed

10 Pennsylvania Colorectal Cancer Stats Incidence 44.6 per 100,000 (national rate is 40.6 per 100,000) 8 th highest Death rate 26.3 per 100,000 (national rate is 15.1 per 100,000) 19 th highest

11 Current Screening Rates PA 66.8% overall rate 1,020,300 still need to be screened PA Health Center Grantee 40.2% screening rate (2015 UDS)

12 PA Impact of 80% by ,587 avoidable cases 8,492 avoidable deaths

13 PREMIER MEDICAL ASSOCIATES

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15 Premier Medical Associates Formed providers 23 specialties 1:1 ratio PCPs to specialists Part of Highmark Health Member of the Allegheny Health Network

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17 Premier Medical Associates ,000 outpatient visits All adult and pediatric offices have level 3 PCMH certification AMGA Analytics For Improvement member

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19 There was work to be done Screening rate was 57.5% Many docs were only ordering colonoscopies Dr Wender came to PMA for a grand rounds presentation 12/13/12 Kicked off efforts 1/1/13

20 THE FOUR ESSENTIALS

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23 Essential 1: Make a Recommendation A recommendation from a doctor is the single most important factor in a patient s decision to be screened for cancer Opportunistic preventive care Need to make sure healthcare disparities do not adversely affect screening for racial or ethnic minorities

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26 Essential 2: Develop a Screening Policy Effective office practice requires: Clear and standardized policies Well designed systems Effective communications Quality reviews

27 Determine Individual Risk

28 Establish Screening Algorithm

29 Offer More Than One Test A practice can reach good screening rates by offering only colonoscopies, but you will not get great screening rates unless other colon cancer screening test are offered, too

30 Essential 3: Be Persistent with Reminders Reminders for patients Reminders for staff and providers

31 Effective Intervention Patients aged 50 to 75 were asked to complete these questions at every single visit beginning 1/1/2013 Staff began conversation about the need for screening Helped with capturing data for EHR

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34 EHR and Registry Reminders Allscripts Touchworks Use point of care registry

35 Essential 4: Measure Practice Progress Rapid progress made in first 15 months of campaign 75% by March 2014 Plateau Monthly progress reports Transparent provider reporting

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38 Colon Cancer Screening Efforts

39 No, we didn t 77.6% 5/31/16

40 FIT Registry Mailed kit on anniversary month of prior FIT > 90% of patients quickly complied Phone reminders for those delaying

41 Yes, we did!

42 Colon Cancer Screening Efforts 1 st Runner Up Recipient of the 80% by 2018 National Achievement Awards

43 Positive FIT Registry In March 2014, calculated that only 57.5% of patients with a positive FIT in previous 12 months complied with follow up colonoscopy Change in provider and staff messaging Lab now sends a weekly list of positive FITs to quality department Certified letters mailed to those refusing follow up colonoscopy Now 87.7% of patients with positive FITs have complied with follow up testing over last 4 years

44 Issaka, R. B., Singh, M. H., Oshima, S. M., Laleau, V. J., Rachocki, C. D., Chen, E. H.,... & Somsouk, M. (2016). Inadequate Utilization of Diagnostic Colonoscopy Following Abnormal FIT Results in an Integrated Safety-Net System. The American Journal of Gastroenterology.

45 RECENT USPSTF UPDATE

46 USPSTF

47 offering choice in colorectal cancer screening strategies may increase screening uptake. As such, the screening tests are not presented in any preferred or ranked order; rather, the goal is to maximize the total number of persons who are screened because that will have the largest effect on reducing colorectal cancer deaths. Bibbins-Domingo, K., Grossman, D. C., Curry, S. J., Davidson, K. W., Epling, J. W., García, F. A.,... & Kurth, A. E. (2016). Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA, 315(23),

48 Stool DNA Pilot 3 years into this pop health effort, over 90% of Medicare beneficiaries had been screened Still 800 who had refused to be screened in spite of multiple outreach attempts Completed a pilot to see if sdna was an acceptable alternative

49 Results of sdna Pilot 19.5% of these previously reluctant patients completed the sdna test Identified as a result of follow up for those who had a positive sdna 3 advanced precancerous lesions 2 colon cancers

50 SUMMARY

51 Meester, R. G., Doubeni, C. A., Zauber, A. G., Goede, S. L., Levin, T. R., Corley, D. A.,... & Lansdorp Vogelaar, I. (2015). Public health impact of achieving 80% colorectal cancer screening rates in the United States by Cancer, 121(13),

52 Wise saying the best screening test is the one that gets done.

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54 Contact