Implementing Cancer Screening & Referrals within Community Behavioral Health Organizations

Transcription

1 Implementing Cancer Screening & Referrals within Community Behavioral Health Organizations Tuesday, April 28 th, 2015 Alicia Kirley, MBA J. Todd Wahrenberger, MD Va a Tofaeono Pam Pietruszewski, MA

2 Welcome! Shelina D. Foderingham MPH MSW Director of Practice Improvement Project Director, National Behavioral Health Network for Tobacco & Cancer Control National Council for Behavioral Health Margaret Jaco MSSW Policy Associate Project Coordinator, National Behavioral Health Network for Tobacco & Cancer Control National Council for Behavioral Health

3 Jointly funded by CDC s Office on Smoking & Health & Division of Cancer Prevention & Control Provides resources and tools to help organizations reduce tobacco use and cancer among people with mental illness and addictions 1 of 8 CDC National Networks to eliminate cancer and tobacco disparities in priority populations Visit and Join Today! Free Access to Toolkits, training opportunities, virtual communities and other resources Webinars & Presentations State Strategy Sessions Community of Practice #BHtheChange

4 Congratulations to Community of Practice participating organizations! American Samoa Community Cancer Coalition Arapahoe/Douglas Mental Health Network CODAC, Inc. (dba CODAC Behavioral Healthcare) Coleman Professional Services CommuniCare, Inc. Credo Community Center for the Treatment of Addictions, Inc. Mirror, Inc. Northern Lakes Community Mental Health Pittsburgh Mercy Health System Way Station, Inc. 3

5 An Integrated Approach to Cancer Screening and Prevention in a Community Primary and Behavioral Health System Pittsburgh Mercy Health System Alicia Kirley, MBA Director of Integrated Services J. Todd Wahrenberger, MD Chief Medical Officer National Behavioral Health Network for Tobacco & Cancer Control

6 Pittsburgh Mercy Family Health Center A 2010 survey of over 25,000 patients showed that only 50% of Pittsburgh Mercy Health System service consumers were receiving any routine primary care PMFHC opened its doors in May 2012, providing a fully integrated Primary and Behavioral Health Practice Engaging a highly complex population with complex needs takes a TEAM! ACT Model in Primary Care: > Multi-disciplinary Care Team approach, pulling in resources from all programs > Highly engaging team meets the patient where they are in their lives 5

7 It takes a team! Community Teams PCP Employment Peer Support Specialist Medical Assistant Service Coordination Patient Consulting Psychiatrist Care Manager Housing Tobacco Cessation Specialist Homeless Services 6

8 Pre-visit, Huddle Planning & Team Meetings EHR Clinical Decision Support Systems Daily Huddle Checklist: Care Management Tobacco Cessation Mammogram Weekly Multidisciplinary Team Meeting Sticky Notes Accountability Follow Up on Referrals 7

9 Embedding Tobacco Cessation and Cancer Screening in Behavioral Health 8

10 Cancer Prevention and Screening An ounce of prevention is worth a pound of cure Benjamin Franklin 9

11 Tobacco Cessation and Lung Cancer Screening Make tobacco cessation a part of your workflow > Know your upcoming schedule: is patient a tobacco user? If so, plan to have a TTS or other staff counsel on tobacco use Ask at EVERY encounter! > Create a system for flagging enabling services Develop a tobacco cessation protocol that is efficient and effective Track referrals to Tobacco Support Specialists and lung cancer screens Document patient progression through stages of change to continuously improve your process 10

12 PMFHC Tobacco Cessation Protocol 11

13 Tobacco Screening & Cessation: The Evidence 12

14 In God we trust; all others bring data How can you choose the best screening and prevention guidelines? 13

15 U.S. Preventative Services Task Force Recommendations for Grading A There is high certainty that the net benefit is substantial. Offer this service. B There is moderate certainty that the net benefit is moderate to substantial. Offer this service. C It depends there may be a benefit depending on individual patient and their S/S. D No benefit and possible harm. Discourage using this service. I I Statement: I/We don t know 14

16 Breast Cancer Screening Referral To: > Mammogram (Film and Digital) Women age 40-49: Grade C recommendation Women age 50-74, every 2 years: Grade B recommendation Women age >74: Grade I > MRI: Grade I > Self Breast Exam: Grade D > CBE: Grade I > BRCA Mutation testing only if family history: Grade B 15

17 Cervical Cancer Screening PAP Cytology > Women under 21: Grade D > Women 21 to 65 every 3 years: Grade A > Women 30 to 65 every 5 years with HPV Co-testing: Grade A > Women over 65 (low risk): Grade D > HPV Testing under age 30: Grade D 16

18 Colorectal Cancer Screening FOBT, Flex Sig, Colonoscopy: Grade A > Age 50 to 75: Grade A > Age 76 to 85: Grade C > Age over 85: Grade D > CT and Fecal DNA: Grade I > Gloved Rectal and Prophylactic Aspirin: Grade D 17

19 Tobacco Use & Lung Cancer Screening Low Dose Computed Tomography (CT Scan): Grade B > Asymptomatic adults aged 55 to 80 years who have a 1 pack per day for 30 years smoking history > Screen annually > Discontinue screening when the patient has not smoked for 15 years Tobacco Use: Grade A > Questionnaire: Are you a tobacco user? Frequency and duration Motivation to quit? Counseling and education 18

20 Cancer Screening (what not to do ) Oral Cancer: Grade I Ovarian Cancer: Grade D (unless BRCA gene, etc.) Pancreatic Cancer: Grade D Prostate Cancer PSA Testing: Grade D Skin Cancer: Grade I Testicular Cancer: Grade D Bladder Cancer: Grade I 19

21 Putting Prevention into Practice Embed Tobacco Support Specialists in a variety of settings Trainings to all staff to understand screening criteria Involve your ENTIRE team Use handouts and keep it simple! Use charts and graphs to remind yourself Utilize EHR alerts and CDSS Know the evidence, don t waste time on practices that have no evidence, even if they are easy to perform 20

22 Guest Speaker #2 Va a Tofaeono Special Projects Coordinator, American Samoa Community Cancer Coalition vtofaeono@gmail.com

23 American Samoa Community Cancer Coalition Began in nd Leading Cause of Death Non-Profit Community Based Organization Mission Helping the people of American Samoa Fight Cancer Develops and Maintains a Comprehensive Cancer Control Map Prevention to End of Life 22

24 Cancer Data 23

25 Cancer Data 24

26 Cancer Data 25

27 Cancer Data 26

28 Available Services ASCCC Does Not Provide Direct Clinical Services LBJ Tropical Medical Center DOH Breast and Cervical Cancer Early Detection Program 27

29 Screening Guidelines Gathered current information Comprised Ad-Hoc Committee Established Draft Guidelines Reviewed and Approved by LBJ and DOH Medical Executive Committee Developed Physician Educational Materials 28

30 Outcomes Provider Compliance Chart Audit > Provider Performance > Increase in Quality Care New Electronic Health Record System What s Next? 29

31 Fa afetai Tele Lava Va a Tofaeono Special Project Coordinator American Samoa Community Cancer Coalition vtofaeono@gmail.com or

32 Guest Speaker #3 Pam Pietruszewski, MA Integrated Health Consultant, National Council for Behavioral Health

33 Why Screening? People with serious mental illnesses die 25 years earlier on average than the general population Medications, especially atypical antipsychotic drugs, effect on weight gain, dyslipidemia and glucose metabolism Modifiable risk factors: High rates of smoking, lack of weight management/nutrition, and physical inactivity Morbidity and Mortality in People with Serious Mental Illness, National Assoc of State Mental Health Program Directors, Medical Directors Council

34 Abdominal Aortic Aneurysm Depression Oral Bladder Heart Disease Tdap Cholesterol Ovarian Preventive Care HPV Diabetes Colorectal Hepatitis C

35 U.S. Preventive Services Task Force Rankings Cervical Colorectal Breast Lung A B The USPSTF recommends the service. There is high certainty that the net benefit is substantial. The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

36 Cervical Cancer Screening Women ages 21 to 65 years with cytology (Pap smear) every 3 years Or For women ages 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years

37 Colon Cancer Screening Adults age 50 to 75 years > High-Sensitivity FOBT (Stool Test): Once a year > Flexible Sigmoidoscopy: Every 5 years, with FOBT every 3 years > Colonoscopy: Every 10 years

38 Breast Cancer Screening Women years, mammography every 2 years Women aged years, individualize decision to begin biennial screening according to patient s circumstances and values. (Grade C)

39 Lung Cancer Screening Adults ages 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years, annual screening with low-dose computed tomography. > Screening should be discontinued once a person has not smoked for 15 years.

40 Why Don t People Get Needed Screenings? Fear of results Misconceptions Embarrassment Don t know they need one Access, wait times, prep No symptoms Costs

41 What Can We Do About It? Response Ability

42 Workflows & System Design 1. Tracking system - Reports, alerts, prompts 2. Logistics - Onsite screening, referral relationships - Access, scheduling 3. Communication At every opportunity - Multiple touch points - Roles & responsibilities

43 Questions to Ask When Developing your Process 1. What is our clinic s approach to whole health & wellness? 2. Which screenings will have the greatest impact on our population, partners and stakeholders? 3. How will I know what screenings are due? 4. Who does what? 5. Who supports & reiterates what? 6. What if the patient refuses? 7. How can my skills and relationships influence behavior?

44 Engagement & Messaging Motivational interviewing is a patient-centered, directional method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. Miller & Rollnick, 2002

45 Instead of 1. Can you cut back on your smoking? 2. Do you know you re due for a colonoscopy? Try 1. What are the good things, and the not so good things about smoking for you? 2. What do you know about screening options for colon cancer? 3. Why haven t you had a mammogram? 3. Tell me about your health goals in relation to prevention & screenings.

46 Enhancing Change Talk What would be good about? What else have you been thinking about? How might you make the best of it? So where does this leave you now? What is your next step?

47 Messaging

48 Social Proof Authority Liking Commitment

49 Social Proof We tend to accept a concept or approach if we know others are doing it We discuss colon cancer screening with all our patients age 50 and older.

50 Authority We respond to those with perceived influence The U.S. Preventive Services Task Force recommends yearly screening for people ages 55 to 80 years who have a 30 pack-year smoking history and currently smoke and even for those who have quit within the past 15 years.

51 Liking We are persuaded by people & things we like We ve partnered with mobile mammogram services and they are going to be in our parking lot every Tuesday!

52 Commitment We want to show we honor commitments Will you stop at the front desk and make an appointment?

53 Screening Strategies Setting screening goals, posting data, promoting data Pre-visit planning Staff training in MI Staff-developed messaging Group events (Ladies Spa Night, Men s Monday) Awareness promos & blitz campaigns: Buttons, posters, freebees Birthday postcards Convenient screening same day, workplace/onsite

54 Resources CDC: Cancer Prevention and Control U.S. Preventive Services Task Force: Published Recommendations Colon Cancer Alliance American Cancer Society: Cervical Cancer Prevention and Early Detection tion/index Affordable Care Act: Preventive Health Services for Adults Motivational Interviewing

55 Comments & Questions?

56 Jointly funded by CDC s Office on Smoking & Health & Division of Cancer Prevention & Control Provides resources and tools to help organizations reduce tobacco use and cancer among people with mental illness and addictions 1 of 8 CDC National Networks to eliminate cancer and tobacco disparities in priority populations Visit and Join Today! Free Access to Toolkits, training opportunities, virtual communities and other resources Webinars & Presentations State Strategy Sessions Community of Practice #BHtheChange

57 Thank you for joining us for the Implementing Cancer Screening & Referral Within Community Behavioral Health Organizations Webinar!