80% by 2018 FORUM II. Workshop: Implementing Screening Across Community Health Centers. Decatur B

Transcription

1 80% by 2018 FORUM II Workshop: Implementing Screening Across Community Health Centers Decatur B

2 Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Community Health Centers Laura Makaroff, DO Senior Director, Cancer Control Intervention American Cancer Society

3 Structure of Today s Workshop Welcome & Introductions 10 min CRCCP Overview 20 min Overview of Manual 15 min Review Group Instructions 5 min Group Discussion 30 min Report to Group 15 min Wrap up 5 min 3

4 Objectives Highlight 4 steps to increase CRC screening: Make a plan Assemble a team Get patients screened Coordinate care across the continuum Review resources Group discussion 4

5 How Do I Use this Manual?

6 Organized into three primary sections Introduction Steps to Increase Cancer Screening Rates Tools, Templates, Resources The manual can be used in segments Use live links to navigate throughout the manual: "Alt+Left Arrow" on PC "Command+Left Arrow" on Mac 6

7 Step #1 Make A Plan Step #2 Assemble A Team Step #3 Get Patients Screened Step #4 Coordinate Care Across The Continuum Determine Baseline Screening Rates Identify your patients due for screening Identify patients who received screening Calculate the baseline screening rate Improve the accuracy of the baseline screening rate Design Your Practice's Screening Strategy Choose a screening method Use a high sensitivity stoolbased test Understand insurance complexities. Calculate the clinic's need for colonoscopy Consider a direct endoscopy referral system Form An Internal CHC Leadership Team Identify an internal champion Define roles of internal champions Utilize patient navigators Define roles of patient navigators Agree on team tasks Partner with Colonoscopists Identify a physician champion Prepare The Clinic Conduct a risk assessment Prepare The Patient Provide patient education materials Make A Recommendation Convince reluctant patients to get screened Ensure Quality Screening for Stool- Based Screening Program Track Return Rates and Follow-Up Measure and Improve Performance Coordinate Follow-Up After Colonoscopy Establish a medical neighborhood 7

8 Step #1: Make a Plan Baseline Screening Rates Denominator (A) Numerator (B) Screening Rate (C) Total number of patients, age 51-74, with at least one reportable medical visit during the reporting year Number of active patients, age 51-74, who have received appropriate CRC screening Number of patients with up to date screening % See HRSA UDS Manual for full measure definition 8

9 Step #1: Make a Plan Design a Screening Strategy There is no evidence from randomized controlled trials that one screening method is the best Years of life saved through an annual highquality stool blood screening program are COMPARABLE to a high-quality colonoscopybased screening program when positive stool tests are followed by colonoscopy 9

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11 Inadomi, Arch Intern Med 2012 Patient Preferences

12 Stool Test Quality Issues Growing evidence that FIT is a superior option for annual stool testing. Remember that not all FITs are created equal. Traditional stool guaiac tests such as the Hemoccult II are no longer recommended In-office stool testing and digital rectal exams are not appropriate methods of screening for colorectal cancer. All positive stool tests must be followed up with colonoscopy 12

13 Step #2: Assemble a Team Find your internal and external champions! Your champions can help you establish team workflows and links of care 13

14 Step #3: Get Patients Screened A recommendation from a provider is the most influential factor on patient screening behavior 14

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17 Step #4: Coordinate Care Across the Continuum The creation of a medical neighborhood is critical to coordinate care Includes the facility, pathology, anesthesia, back up surgery, radiology, hospital, and possibly oncology 17

18 Tools, Templates and Resources Appendix A Work Sheets for Completing the Action Steps Appendix B Electronic Health Record Screen Shots Appendix C Program Tools and Materials Appendix D Resources 18

19 Appendix A-7: Action Plan Increasing Quality Colorectal Cancer Screening: An Action Guide for Working with Health Systems Source: Centers for Disease Control and Prevention. Increasing Colorectal Cancer Screening: An Action Guide for Working with Health Systems. Atlanta: Centers for Disease Control and Prevention, US Dept of Health and Human Services; Page 55 19

20 Appendix A-8: Tracking Template 20

21 Appendix B-1: Electronic Health Records Sample NextGen Screenshot How to Order Colonoscopy in EHR 21

22 Appendix B-2: Electronic Health Records Sample E Clinical Works Screen Shot How to Generate a Report on Colonoscopies Ordered 22

23 Appendix C-1: Sample Screening Policy Source: Adapted from the New Hampshire Colorectal Cancer Screening Program 23

24 Appendix C-6: Preparation Checklist Source: Colonoscopy Preparation Navigator Checklist from New Haven CHC 24

25 Appendix C-6: Preparation Checklist Source: Colonoscopy Preparation Navigator Checklist from New Haven CHC

26 Appendix C-6: Preparation Checklist Source: Colonoscopy Preparation Navigator Checklist from New Haven CHC

27 Appendix D Additional Resources 1 - Patient Education Materials 2 Guidelines on CRC Screening (ACS, USPSTF) 3 - Patient Navigation (Training Programs) 4 - Electronic Health Records 5 - Practice Management 27

28 Appendix D-1: Resources Centers for Disease Control and Prevention cdc.gov/cancer/dcpc/publications/colorectal.htm cdc.gov/cancer/crccp/pdf/guidance_measuring_crc_scree ning_rates.pdf Screen for Life Campaign Materials Fact Sheets, Brochures, Brochure Inserts, Posters, Print Ads, Other TA National Cancer Institute cancer.gov/cancertopics/pdq/screening/colorectal/patient Patient information about colorectal cancer, colorectal cancer screening, and other topics National Colorectal Cancer Roundtable nccrt.org/tools/ Tools and Resources 28

29 Appendix D-1: Resources Prevent Cancer Foundation (Materials available in Spanish): Fact Sheet: Colorectal Cancer 2009 Fact Sheet American Cancer Society cancer.org/colonmd (Materials available in Spanish and Asian languages): ColonMD: Clinicians Information Source Videos, Wall Charts, Brochures, Booklets Guidelines, Scientific Articles, Presentations, Sample Reminders, Toolbox, CME Course,Medicare Coverage, Facts & Figures, Journals

30 Workshop Group Discussion

31 Instructions for Group Discussion Select a facilitator and note taker Discuss the following questions: 1. Which resources from the manual are key to increasing CRC screening rates in your state? 2. How are you going to mobilize and effect change within your state team? 3. What preliminary ideas do you have for your state action plans (to be developed on day 2)? 31

32 Group Discussion 30 min Report to Group 15 min Wrap up 5 min 32

33 The national goal is to increase the colorectal screening rate to 80% by the year 2018 We can get there together!

34 CDC s Colorectal Cancer Control Program Faye L. Wong, MPH Chief, Program Services Branch fwong@cdc.gov July 18, 2017

35 RELIABLE TRUSTED SCIENTIFIC Objectives To present an overview of CDC s Colorectal Cancer Control Program (CRCCP) CRCCP year 1 findings and some lessons learned

36 CDC currently funds 30 CRCCP grantees 23 states 6 universities 1 tribe CDC DP CRCCP Grantees RELIABLE TRUSTED SCIENTIFIC

37 RELIABLE TRUSTED SCIENTIFIC The program consists of two distinct components: Component 1 All 30 Grantees Partner with health systems to implement evidence-based interventions (EBIs) and supportive activities (SAs). EBIs: Patient reminders Provider reminders Provider assessment & feedback Reducing structural barriers Component 2 6 Grantees Only Provide high quality CRC screening, diagnostic, patient navigation, and other support services to eligible patients. Patient eligibility criteria: Un- or underinsured <250% of the federal poverty level years-old SAs: Small media Patient navigation/community health workers Provider education

38 What does CRCCP evaluation data tell us so far? PY1 PY2 PY3 PY4 PY5 Our data are here We are here We ve got a lot of program left to evaluate!

39 RELIABLE TRUSTED SCIENTIFIC In Program Year 1, CRCCP grantees have partnered with a number of health systems and clinics. 140 Health Systems 413 Clinics 3,438 Providers 706,128 Patients, aged 50 to 75

40 RELIABLE TRUSTED SCIENTIFIC CRCCP grantees are partnering with the right clinics. A closer look at CRCCP partner clinics: 413 CRCCP Clinics 72% are Federally- Qualified Health Centers (FQHCs) 46% serve high percentages of uninsured patients ( 10%) 53% use FOBT/FIT tests as the primary CRC screening test type

41 CRCCP clinics across the US: Grantees are primarily working with FQHCs. Source: Clinic data submission, Component 1 only, all 30 reporting, April 2017 RELIABLE TRUSTED SCIENTIFIC 41

42 RELIABLE TRUSTED SCIENTIFIC In Program Year 1, grantees implemented or enhanced a variety of EBIs and SAs. Priority EBIs Supporting Activities # of clinics Enhanced existing activity Implemented new activity Patient Reminders Provider Reminders Provider Assessment and Feedback Reducing Structural Barriers Small Media Community Health Workers Patient Navigation Provider Education

43 CRCCP grantees also worked with a variety of non-health system partners. Grantees five most common partners: Partner Activities The five most frequently reported activities were: 1. Provider education and professional development. 2. Quality improvement. 3. Health information technology to improve electronic health record systems. 4. Patient reminders. 5. Small media. RELIABLE TRUSTED SCIENTIFIC

44 RELIABLE TRUSTED SCIENTIFIC What did CRCCP achieve in Year 1? 140 Health Systems 413 Clinics 3,438 Providers 706,128 Patients, aged 50 to 75 6% INCREASE IN CRC SCREENING RATES

45 RELIABLE TRUSTED SCIENTIFIC Year 1 findings: Increases in CRC screening was higher in: Urban and Metro clinics vs rural clinics Medium size clinics vs small and large clinics Clinic using FIT vs colonoscopy or FOBT Clinics with an internal CRC screening champion vs no champion Clinics with a written CRC screening policy vs no policy Most clinics received monthly implementation support

46 RELIABLE TRUSTED SCIENTIFIC Lessons Learned (so far): Grantees successfully launched this evidence-based, public health model for increasing CRC screening rates in clinics serving high-need populations. Grantees are targeting clinics with low screening rates and implementing EBIs and Supportive Activities. Baseline data suggest potential for significant reach and impact as grantees recruit more clinics to participate. Measurement and evaluation is important. Funded and non-funded partners are critical to successful implementation. Obtaining accurate screening rate data from EHRs is challenging.

47 The Big Picture of efforts to increase colorectal cancer screening Leveraging Partnerships 9/2015: 11 CRC state teams 7/2017: 11 CRC state teams 65 CDC CCC Grantees 22 CRC state teams CCC National Partners NCI & NCI Cancer Centers HRSA FQHCs CDC CRCCP 30 w/health systems intervention $$ 6 w/screening support $$ 80 by 2018 Screening Goal ACS Health Systems Managers Media and Communications PCAs HCCNs PRCs/CPCRNs Universities NCCRT > by 2018 Partner-Signed Pledges A C A Prevention Benefits covers CRC no cost Private Sector Insurers Hospitals GI specialists Physicians Venders Others

48 Go to the official federal source of cancer prevention information: Follow DCPC The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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