Colorectal Cancer- QI process and clinic success: A Case Study at Atascosa Health Center

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1 Colorectal Cancer- QI process and clinic success: A Case Study at Atascosa Health Center

2 Kaela Momtselidze Health Systems Manager Primary Care Systems American Cancer Society Sheri Frank Director of Corporate Compliance Atascosa Health Center

3 Primary Care Systems Our overarching goal is to partner to improve cancer control policy and practice at community health centers. Together we work to: Understand the community challenges and barriers to cancer screening and prevention Expand the adoption of evidence-based interventions to increase: Colorectal Cancer Screening Breast Cancer Screening Cervical Cancer Screening HPV Vaccination Save lives and reduce health disparities

4 Quality Improvement We use the Model for Improvement to help you create a unique, evidence based approach to meet your cancer screening goals. Some of the QI resources and tools we use are: AIM Statements Process Mapping Data Analysis

5 ACS and Atascosa Health Center Interventions Implemented Navigation/Navigation Training Client Reminders Provider Reminders 1:1 Education Reduction of Structural Barriers Standing Orders Implement/Update Screening Policy

6 Atascosa Health Center, Inc. Federally Qualified Health Center Accredited by Joint Commission Provide quality health care services to all patients without regard to race, sex, age, color, religion, national origin, disability or ability to pay for services. We accept patients with and without insurance coverage.

7 Coverage Area & Services Offered Located in Rural South Texas 5,000 square mile of rural service area coverage Six health care facilities Medical & Behavioral Health Pharmacy Class A at main location only and Class D at all sites Dental at two locations WIC at two locations

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9 Atascosa Health Center Patient Population Total patient population served = just over 12,000 25% of our patients are in the targeted age range UDS Report Data for screening for Colorectal Cancer: 2014 = 13% 2015 = 19% 2016 = 65% HRSA 2016 Health Center Data = 39.9%

10 How AHC Improved Colorectal Cancer Screening Collaborative Relationships American Cancer Society Grant Funding Opportunities Roundtable / Brainstorming Meetings TEAM approach Goal setting / Reduce patient barriers / Process mapping Increase patient education = increase in patients screened

11 Our Project Goal GOAL: To adopt evidence based client and provider directed interventions to increase the number of eligible patients who are screened for colorectal cancer.

12 Screening Objectives Provide 1:1 education to all eligible patients Increase screenings Reduction of structural barriers Travel vouchers Reduction of noncompliance Reminder calls and letters to patients Possible funding towards colonoscopies

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14 Changes Made Towards Improvement TEAM approach 1:1 Education Patient questionnaires Elevator Speech Navigation efforts Reduction of structural barriers Reminder and recall system

15 TEAM Approach Implementing a TEAM approach to screening, educating, reminding patients Front Desk identified targeted age range / questionnaire to patient MA continued interview and eligibility determination Provider 1:1 education and ordered stool test Lab tracked stool kits, provided reminder call to patient to return kit for testing, reminded of travel voucher Project Champion & Navigator on site workflow monitoring for compliance, data collection, co-branded reminder letters and calls to eligible patients

16 1:1 Education Efforts Patient check-in: Front desk identified age range Asked for their participation in screening Provided questionnaire During in taking: MA continued 1:1 education

17 Patient Questionnaires Do you have a history of: Circle all that apply: Do you have a family history of: Circle all that apply: Polyps Polyps Colorectal Cancer Ulcerative colitis Crohn s Disease Colorectal Cancer Hereditary colorectal cancer syndrome When was your last colorectal cancer screening test? What screening method did you use? (Circle One) Colonoscopy or Stool Card Test Do you smoke or use tobacco? (Circle One) Your age: Yes or No

18 Elevator Speech We have a grant funding through the American Cancer Society to improve colorectal cancer screening. With this funding, we are able to provide free FIT stool kit testing which is a simple test that can find cancer early when you don t have any symptoms. The screening test can find cancer early on when is most treatable and can sometime find pre-cancer before turning into full cancer. Based on the answers on the questionnaire, you are able to take the free FIT test and when you bring it back, you will get a gas card, just for returning it.

19 Implementation of Provider Reminder and Recall System MA hand off Questionnaire to provider Provider continued importance of cancer screening Provide additional education/information Ordered FIT test MA/Lab tech provided instruction on FIT test and incentive to return test

20 Screening Navigation Process 1 week after FIT test was issued to the patient Phone call from lab staff 2 weeks after FIT test was issued to the patient Reminder letter mailed out from lab staff 3 weeks after FIT test was issued to patient Phone call from lab staff

21 Screening Navigation Process Patients with positive FIT tests: Providers received notification of Positive FIT tests Referral nurse assigned tasked to contact patient to schedule follow up Provider educated patient & ordered colonoscopy Referral nurse provides navigation: Appointment scheduling with GI Identification of barriers such as cost and transportation Ensuring patient kept colonoscopy appointment Received results and distributed back to provider for next steps

22 Implementation of Reduction of Client Costs Sliding Scale Discount Fee For Those Who Qualify FREE FIT tests for those on 100% slide Patients on 100% slide received financial assistance for colonoscopy Wesley Nurse Program reduced or no cost for colonoscopy Uninsured and no income Discounted rates with GI specialty offices

23 Implementation of Reduction of Structural Barriers Transportation Barrier Gas cards issued $10 gas cards for returned FIT tests $20 gas cards for traveling to colonoscopy appointment Schedule transportation services Le Fleur Transportation Services Alamo Regional Transportation (ART) Services

24 Positive FIT tests Positive FIT tests = blood detected in stools Does NOT mean patient has cancer! Patient instructed to follow up with provider Navigation of patient to colonoscopy

25 Client Reminder Letters We used to types of letters: Invitation to be screened Reminder letter to return stool kits

26 Invitation Letter to be Screened We here at Atascosa Health Center, Inc. have recently teamed up with The American Cancer Society to help us do everything we can to protect your health. We are reaching out to our patients 51 years old and older to be screened for colorectal cancer. Your chance of getting colon cancer increases as you get older. Anyone can get colon cancer and it is one of the most common cancers. Even if no one in your family has ever had it, you can get it. The American Cancer Society recommends that everyone age 51 and older get tested for colon cancer. You can pick up a test kit at your next follow up appointment or just come by our clinic. The test will be at no cost to you.

27 Reminder letter to Return Stool Kit We show that you have not returned your stool card just yet. If you have any questions about the stool card please feel free to call our clinic and ask. We want our patients in the best health possible, and doing this stool card will help us do just that. Thank you for choosing our clinic for your healthcare needs.

28 Electronic Health Record System Challenges We Faced Had to learn where we could document 1:1 education into extractable data field Colonoscopies are scanned documents Automated patient notification systems We called our patients! Transportation barrier for patients Provided gas cards Hiring a Project Champion 100% dedication to overseeing the project

29 Sustainability Efforts Implementation of Standing Delegate Orders Our MAs and LVN are able to now drop the order and issue the stool kits to all eligible patients Collaboration with MD Anderson and Cancer Prevention and Research Institute of Texas MD Anderson providing stool kits and costs associated with resulting Positive stool kits trigger MD Anderson to provide referral to colonoscopy at no charge to uninsured and underinsured patients Project Champion Role changed to monitoring program and training new hires on measure and workflow

30 Cumulative progress of colorectal cancer screenings completed by quarter in grant year 1 vs grant year 2 (the numbers below are stool test s and colonoscopy s combined) Quarter 1 (November 1 - January 31) Quarter 2 (February 1 - April 30) Quarter 3 (May 1 - July 31) Quarter October 31) (August Grant Year 1 (November October 2015) Grant year 2 (November October 2016) Grant Year 2 Screening Target

31 Number of patients receiving education about colorectal cancer, the number of stool test ordered, and the number of stool test returned for grant year 2 (November 2015 October 2016) Stool Tests Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Total number of patients receiving CRC education Total number of completed stool test received Total number of patients receiving a stool test

32

33 UDS Data Recap Where we started: 2014 = 13% Where we are now: 2016 = 65% HRSA 2016 Health Center Data = 39.9%

34 Process Platform for Improving Other Measures Activities Implemented to Improve HPV Vaccination 1:1 Education Reduction of Client Cost Policy Change Upcoming Activities Client reminder letters Community Forum EHR Improvements

35

36 Together, we are stronger than cancer! cancer.org

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