THE EFFECT OF PUBLIC AND PHYSICIAN EDUCATION ON COMMUNITY COLORECTAL CANCER SCREENING. Michael D Sarap MD, FACS Ohio CoC Co Chair

Transcription

1 THE EFFECT OF PUBLIC AND PHYSICIAN EDUCATION ON COMMUNITY COLORECTAL CANCER SCREENING Michael D Sarap MD, FACS Ohio CoC Co Chair Disclosures None

2 Colon Cancer in Ohio ~6,600 Ohioans will be diagnosed with colorectal cancer this year ~2,600 will die from the disease C R cancer is the 2nd leading cause of cancer related death in Ohio If diagnosed at an early stage, survival rate is over 90% At later stages, survival drops to 8% Only 39% of C R cancers are detected at early stages

3 The Colon Cancer Problem in Rural Ohio Higher incidence of colorectal cancer Higher mortality rate from colorectal cancer Higher percentage of late stage colorectal cancers at diagnosis Lower numbers of people having screening tests for colorectal cancer This is Rural! Seven counties in SE Ohio with no health care facilities Two other counties with only critical access hospitals No tertiary medical center or level Itrauma center in SE Ohio

4 The Problem

5 Conception April 2005 initial Guernsey county colorectal cancer summit Discussion with Ohio department of health and American Cancer Society A local taskforce was formed and began work in early 2006 Taskforce Makeup Physicians Nurses SE Med Associates Southeastern Med Hospital administration American Cancer Society Local and state dept of health Local industry Cancer survivors

6 Implementation Mission: To raise awareness of the significance of colorectal cancer and to enhance early detection by disseminating information and mobilizing community resources Vision: To decrease colorectal cancer incidence and mortality in Southeastern Ohio and improve the quality of life for all colorectal cancer survivors A Four Pronged Approach Physician education and awareness Public education Free and reduced cost screening tests for indigent patients Legislative advocacy

7 A Four Pronged Approach Physician education and awareness Blue sticky note project Flashdrive project Presentations to medical staff/medical society Office information Blue Sticky Note

8 Flashdrive Project Distribution of a flashdrive presentation on colorectal cancer screening and cancer follow up to 200 primary care physicians in SE Ohio Family practice/internal med offices Ob/gyn offices Physician extenders Health departments Clinics A Four Pronged Approach Public education Video (CEO takes one for the team!!!!) Service clubs Church groups (including cancer awareness event for minority groups) Brochures Radio, movie, newspaper ads Direct mailing postcards Industry events

9

10

11 Public and Industry Awareness * Front page newspaper ads and inserts in local papers of Cambridge and all outlying communities reached 28,000 households * Radio spots reached 258,000 households Informed local industry leaders of gaps in screening coverage by their employee health plan (school superintendents, county commissioners, etc) Presentation to local industry CEOs regarding economic value of cancer screening The supercolon is born!!!!!! SE Med Supercolon

12 Supercolon Chariot

13 Grand Ballroom at the Hyatt in Cincinnati!!!! Breast Education Torso

14 A Four Pronged Approach Free and reduced cost screening tests for indigent patients Home stool testing kits Colonoscopies (over 500 procedures) Free and Reduced Cost Colonoscopies 500 free or reduced cost colonoscopies completed since 2006 by local surgical endoscopists The majority of these procedures are being done totally free of any charges to the patient!!!! Donation of time and services by hospital administration and staff, surgical endoscopists and pathology department No grant money has gone to physicians, only used for continued educational efforts

15 A Four Pronged Approach Legislative and regional advocacy Testimony to health and insurance committees Engaged Ohio chapter American College of Surgeons to join with American Cancer Society to support Senate bill 328 (colonoscopy mandate) Participation in lobby days Presentations at other facilities to encourage similar community efforts (a tough sell to other endoscopists) The Tina Kiser Cancer Concern Coalition (TKC3)

16 The Logo The Tipping Point That magic moment when an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire Malcolm Gladwell

17 The Tipping Point Wonderful buy in from primary care providers in entire region Value of electronic medical records in prompting screening questions Incredible public enthusiasm Pastors, blue collar males, elderly, etc Great networking among tkc3, providers, county health departments, American Cancer Society offices and many others Colonoscopies Performed at Southeastern Med nly 2 surgeons

18 Diagnosed Colon Cancer Cases at Southeastern Med AVERAGE CASES/YR = = 16!!! Number of Cases Diagnosed # Cases repurposed 30without written 35 permission of the 33American College 40 of Surgeons. 16 Percentage of Late Stage Diagnosis % Best Counties in Ohio < 46% Worst County > 53.5% 90.0% 80.0% 70.0% 60.0% 64% Ohio Average 49% 50.0% 53.5% 51% 40.0% 41% 45% 46% 46% 42% 36% 30.0% 29% 20.0% 23% 10.0% 12% 0.0% % Late Stages 53.5% 64% 41% 45% 36% 51% 46% American College 46% Surgeons 29% 2016 Content 42% cannot be 23% reproduced or 12% of

19 The Quality Factor The providers involved in screening and treating colon cancer patients must collect, monitor, and report information regarding local quality metrics and compare the data to national benchmarks This activity provides appropriate loop closure to assure that quality care is being delivered The information needs to be transparent to other providers and the community Quality Assurance Benchmarks Associated with the Program Adenoma detection rate at colonoscopy Withdrawal time during colonoscopy Adequacy of the prep Number of lymph nodes harvested at surgery Appropriate follow up intervals for colonoscopy % Of appropriate colon cancer patients receiving post op chemo and radiation therapy

20 Data Points Colonoscopy withdrawal time Total number cases with polypectomy Pathology documentation of adenomatous, villous or serrated polyps Adenoma detection rate (ADR) Total number colonoscopies/endoscopist Initial screening colonoscopies/endoscopist Cecal intubation rates Documentation of Male/Female subsets Colonoscopy Withdrawal Times Avg/Year 2013 Physician A = 11.3 min Physician B = 7.1 min Physician C = 12.2 min Physician D = 21.8 Conclusion wide variability in withdrawal times per endoscopist

21 Adenoma Detection Rate as Function of Withdrawal Time in Minutes ADR % D A C B ADR Minutes

22 CoC CP 3 R Colon Comparison Data 2011 Southeastern Med State Region 100% 100% 100% 100% All CoC Programs 97% 95% 93% 90% 89% 88% 93% 88% 92% 80% 87% 70% 60% 50% 40% 30% 20% 10% 0% Chemo Treatment 12 + Nodes Radiation Treatment

23 Commission on Cancer CQIP Stage Distribution Colon Cancer Diagnosed in 2013, My Facility vs. All CoC

24 In/Out Migration Colon Cancer, My Facility American Cancer Society Excellence In Mission Award 2013, 2014, 2015 National Colorectal Cancer Roundtable Blue Star Award Third Place 2014 American Hospital Association Charitable Services Program of Excellence Award % By 2018 National Achievement Award 2016

25 Take Home Message The barrier to reducing the number of deaths from colorectal cancer is not a lack of scientific data but a lack of organizational, financial and societal commitment. Daniel K. Podolsky, MD (NEJM 7/20/00)