You’re Gonna Need a Bigger Boat: Building the Partnership Framework with Data

Access to Colonoscopy in Louisiana: Gastroenterologists and Medicaid Acceptance

Authors:

Randi Kaufman (Presenter)
LSUHSC School of Public Health

Stephen Patin, LSUHSC School of Public Health
Jordan Karlitz, Tulane University School of Medicine

Public Health Statement: Access to care is complex and influenced by many factors: clinician to patient ration within a geographic area; patients’ insurance status; out of pocket costs, provider acceptance of public or private insurance plans, and convenience of provider locations. With the expansion of Medicaid in Louisiana (LA) in July 2016, more residents have coverage for colorectal cancer early detection. However, participants’ access to colonoscopy depends on the availability of providers who accept Medicaid.

Purpose: Colonoscopies not only are a primary screening method for colorectal cancer, patients with positive FIT screenings also rely on colonoscopy for follow up. Louisiana Colorectal Cancer Roundtable (LCCRT)’s data and access task groups’ preliminary examination of the location and distribution of gastroenterologists (GIs) indicated that large areas of the Louisiana have no GI colonoscopy provider. In addition, we called GIs listed as providers on LA Medicaid’s website, and found that over a quarter did not accept Medicaid. In order to further explore and understand GI acceptance of Medicaid in LA, we developed an online survey of GIs.

Methods/Approach: In March/April 2017 will be conducting and online survey of GIs via Survey Gizmo. The survey will be send out by via email by the Louisiana Governor of American College of Gastroenterology (ACG) (and Past President of the Louisiana Gastroenterology Society) to members of the American College of Gastroenterology located in the state. He send a reminder email one week after the initial email. The questionnaire will ask GIs if they are aware of Medicaid expansion, if they accept Medicaid, and their reasons for accepting or not accepting Medicaid. The data will use descriptive statistics, as well as review and categorize respondents’ comments.

Results: The results will be analyzed in April and be ready by May. LCCRT will present the results to LA Medicaid, ACG, and other stakeholders. They will inform the work of LCCRT, and its members, including the Centers for Disease Control and Prevention-funded Louisiana Colorectal Health Project.

Conclusions/Implications: The results of the survey will be valuable for the cancer control community in Louisiana. They will inform future policy and programmatic work of LCCRT partners by providing further information on capacity issue, including geographic distribution of GIs who accept Medicaid and reasons for not accepting Medicaid that we can work to address. We recognize that there are non-GI colonoscopy providers in LA, and are planning additional research on those providers.

Community of Practice: Hospitals Working Together to Create Healthier Environments

Authors:

Michelle Moreau (Presenter)
WI Comprehensive Cancer Control Program

Sheri Scott, Scott Consulting
Noelle LoConte, University of Wisconsin Carbone Cancer Center

Public Health Statement: The environment that people live and work in can significantly influence their ability to make healthier choices. Hospitals are in a unique situation with an opportunity to not only impact their patients, but also employees, visitors and the community.

Purpose: The purpose of the WI Healthy Hospitals’ Community of Practice is to create a supportive group that encourages participating hospitals to identify opportunities for change by assessing their environment, using the Centers for Disease Control and Prevention’s Healthy Hospital Food & Beverage Environment Scan, and supporting their efforts to make small changes with big impacts.

Methods/Approach: Participating hospitals completed the Centers for Disease Control and Prevention’s Healthy Hospital Food & Beverage Environment Scan at the beginning of the project to help identify opportunities for change. They received support throughout the yearlong project including in person meetings, field trips to WI hospitals, online networking, conference calls and other technical assistance. At the conclusion of the project, hospitals reported on successes/challenges and completed a post environment scan.

Results: Hospitals reported numerous successes including eliminating bottled soda and reducing sugar-sweetened beverage options at the fountain, offering more fruits and vegetables, eliminating free refills, promoting hydration, and creative promotion of healthier items.

Conclusions/Implications: Participants commented on four main factors that drove success—accountability, momentum, support and idea sharing. They achieved successes that would not have occurred without the WI Healthy Hospitals’ Community of Practice.

Leveraging Electronic Health Records to Enhance Systems of Care for Increased Colorectal Cancer Screening

Authors:

Cecil Pollard (Presenter)
West Virginia University

Adam Baus, West Virginia University
Stephenie Kennedy, West Virginia University
Mary Ellen Conn, West Virginia University
Susan Eason, West Virginia University
Dannell Boatman, West Virginia University
Taylor Daugherty, West Virginia University

Public Health Statement: Colorectal cancer (CRC) in West Virginia (WV) is a significant health problem. It is the second leading cause of cancer-related deaths. During 2009–2013, 50% of CRC cases were diagnosed late stage. Increased screening facilitates early detection, leading to more effective treatment and improved survival.

Purpose: The WV Program to Increase Colorectal Cancer Screening (WVPICCS) is designed to better equip primary care with skills and resources necessary to revise and sustain systems-level changes for increased CRC screening rates.

Methods/Approach: WVPICCS collaborated with 13 health systems to support enhanced use of electronic health records (EHRs) for bolstered CRC screening rates. A combination of on-site and web-based assessment with each site identified strengths, resources, and needs, shaping the training and coaching. Site-level trainings focused on: enhanced use of EHR data for identification of at-risk patients; office flow redesign for team-based care and use of EHR data; and increased skills in using EHR data for patient care and population-level health.

Results: 27 EHR data support sessions and 18 practice facilitations were provided to date. Overall, improved EHR use helped facilitate an increase in mean screening rates from 28% (baseline) to 51% after one year of implementation.

Conclusions/Implications: WVPICCS is helping to remedy longstanding issues in using EHRs for CRC screening in particular and preventive screenings broadly. A hands-on, collaborative approach is proving effective in increasing screening rates in a way which is sustainable and beneficial to the health systems and patients served.

Increasing Adolescent HPV Vaccination Rates in Federally Qualified Health Centers Through an Integrated Quality Improvement Framework

Authors:

Marcie Fisher-Borne (Presenter)
American Cancer Society

Sandy Preiss, American Cancer Society
Molly Black, American Cancer Society
Debbie Saslow, American Cancer Society

Public Health Statement: The HPV vaccine is cancer prevention. It prevents infection by high risk types of human papillomavirus, or HPV, that cause the majority of cervical, vaginal, vulvar, anal, penile, and throat cancers and genital warts. While slightly more than half of boys and girls in the U.S. get at least the first dose of HPV vaccine, too many are not vaccinated and are missing the protection against cancer it could provide.

Purpose: Federally qualified health centers (FQHCs) serve patients at disproportionate risk of HPV-related cancers and are the nation’s largest primary care network, serving over 23 million uninsured and underinsured patients in over 9,000 communities. The HPV Vaccinate Adolescents against Cancers (VACs) Project, an initiative of the American Cancer Society (ACS), set out to increase HPV vaccination rates for adolescents ages 11–12 in select FQHCs through system-wide quality improvement interventions. Strategies employed include clinician training, EHR modification, provider assessment and feedback, standing orders, provider prompts, and parent reminder interventions.

Methods/Approach: At project initiation, FQHC systems completed a HPV vaccination inventory that included setting baseline rates for all HPV doses and Meningococcal and Tdap and assessing system opportunities for vaccine uptake. ACS Primary Care staff provided on-site quality improvement coaching and assistance to partner sites throughout the pilot. Additionally, system and clinic-level rate data were collected at month six and month twelve of the pilot. Core project outcomes include changes in HPV vaccination rates, separated by dose, among 11–12 year-olds in partner FQHC systems. Partners calculated vaccination rates using a variety of methods, including EHRs, immunization registries, population management systems, and chart review.

Results: In the first 12 months of the interventions, FQHC systems (n=22) increased HPV vaccination initiation rates among 11–12 year-olds (n=24,521) by an average of 13.4 percentage points. Second dose rates increased by 7.6 percentage points, and series completion rates increased by 2.7 percentage points. Additionally, 82% of pilot partners reported increased capacity through the intervention to use data generated in quality improvement efforts.

Conclusions/Implications: Integrating multiple evidence-based intervention strategies through a quality improvement framework can lead to significant increases in HPV vaccination rates. For the VACs pilot, this approach was most promising for vaccine initiation.