Improving Cancer Screening Through Patient Navigation and Partnerships

Sustainability of Patient Navigation in Preventive Screening: A Toolkit to Help Guide the Way

Author:

Andrea Dwyer (Presenter)
University of Colorado Cancer Center

Public Health Statement: Patient Navigation in cancer prevention is noted as an evidence-based strategy which reduces barriers and aids in access to care; particularly focused towards those who are medically underserved. However, paying for and sustaining patient navigation-particularly for preventive screening remains elusive.

Purpose: In order to address the issue of sustaining patient navigation for cancer prevention, the American Cancer Society’s National Colorectal Cancer Roundtable commissioned The Colorado School of Public Health to develop a Toolkit to tackle paying for and sustaining patient navigation.

Methods/Approach: The Toolkit focused on the primary domains: Evidence, Implementation in the Field, Quality and Accreditation Measures, Funding Strategies, Cost Effectiveness, and Evaluation, per the recommendation of the planning committee and advisory team. The direct evaluation strategy of the Toolkit is to access overall satisfaction with the tool, impact and utilization three months and one year after download. Several forums have allowed the introduction of the Toolkit. Overall satisfaction with the presentation and the perceived utility of the Toolkit and its components have been evaluated.

Results: The Toolkit was introduced 11/16, with an average rating of 4.8 of 5.0 with overall satisfaction of the content. The Toolkit formally launched 01/17, and 75–80% strongly agreed or agreed they had learned new approaches and strategies to pay for screening navigation and specific policy resources and 87% noted they learned of the importance and strategies to evaluate patient navigation. 75% of the attendees noted they planned to use the new Toolkit in their work in the next program year and also share the resources with their colleagues. The evaluation of the components of the Toolkit will begin in May of 2017, for those who downloaded the Toolkit in January.

Conclusions/Implications: The initial vetting of the Toolkit and response to the forums in which it is presented, notes a considerable need and interest. The full evaluation of the Toolkit will begin in the spring and allow opportunities to assess the implementation and in the next year, the opportunity to further ensure there is impact in making progress towards sustainability.

New Hampshire Colorectal Cancer Screening Program (NHCRCSP) Patient Navigation (PN) Model for Increasing Colonoscopy Quality and Completion

Authors:

Lynn Butterly (Presenter)
Dartmouth-Hitchcock; Geisel School of Medicine; New Hampshire Colorectal Cancer Screening Program (NHCRCSP)

Joanne Gersten, Dartmouth-Hitchcock
Gail Sullivan, NHCRCSP

Public Health Statement: Interventions that increase high quality colorectal cancer (CRC) screening are essential to the national goal of decreasing CRC. Using a highly effective statewide PN model, a replication manual was created to disseminate this intervention.

Purpose: Evaluate the effectiveness of a PN colonoscopy protocol by comparing outcomes for navigated vs. non-navigated patients in a community health clinic.

Methods/Approach: A subset of NHCRCSP navigated patients were compared to a similar subset of non-navigated patients at the same clinic. Prevalence and prevalence odds ratios to measure the association between PN and each study outcome were measured. Based on the results of this study, NHCRCSP and CDC developed a replication manual for dissemination of the NHCRCSP PN model, including steps for successful implementation and detailed description of the data necessary to evaluate outcomes.

Results: Navigated patients were 11.2 times more likely to complete a colonoscopy than non-navigated patients, and 5.9 times more likely to have an adequate bowel preparation. In addition, navigated patients had no missed appointments compared to 15.6% of non-navigated patients and were 24.8 times more likely not to have a cancellation less than 24 hours prior to their appointment. All navigated patients and their primary care providers received test results, and all follow-up recommendations were consistent with clinical guidelines as compared to 82.4% of non-navigated patients.

Conclusions/Implications: PN is a highly effective intervention for improving CRC screening completion and quality in the disparate populations most in need of intervention. These results provide evidence for effectiveness of PN and highlight its value for public health, leading to the development and dissemination of the PN Replication Manual.

Partnerships with Idaho Community Health Centers to Increase Colorectal Cancer Screening Rates

Authors:

Megan Mackey (Presenter)
Idaho Department of Health and Welfare

Charlene Cariou, Idaho Department of Health and Welfare

Public Health Statement: Colorectal cancer is the second leading cancer killer among men and women in Idaho.

Purpose: Colorectal cancer can be prevented with early detection and screening. Idaho’s screening rate is only 60 percent, ranking 44^th in the nation. The purpose of Idaho’s Colorectal Cancer (CRC) Program is to implement evidence-based interventions, including provider reminders, provider assessment and feedback, patient reminders and reducing structural barriers, within Idaho Community Health Centers to increase colorectal cancer screening rates.

Methods/Approach: Community Health Center (CHC) partners were recruited through the Idaho Primary Care Association (IPCA). Evidence-based intervention implementation was measured through work plan progress. Screening rates were measured monthly through a mix of electronic health record and PopIQ data. PopIQ is a data aggregation tool used by IPCA to monitor CHC data on key Healthy People 2020 and Uniform Data System (UDS) measures.

Results: The Idaho CRC Program partnered with five CHCs in 2016. The average baseline CRC screening rate across all partner clinics was 23%. Each CHC implemented at least two evidence-based interventions. All five CHCs implemented patient reminders. Four CHCs implemented strategies to reduce structural barriers. Four CHCs implemented provider assessment and feedback, and two CHCs implemented provider reminders. From January 2016 to June 2016, 29 clinics within the five CHCs were able to screen more than 1,500 patients, an average increase of more than 10 percentage points from baseline. The greatest clinic increase was 29 percentage points.

Conclusions/Implications: The project demonstrated the success in increasing colorectal cancer screening rates within Idaho Community Health Centers. The outcomes align with recommendations that implementing evidence-based interventions within health systems will lead to an increase in screening rates. The Idaho CRC program will replicate this model with other CHCs to increase the spread and impact. Further monitoring of CRC screening rates within the five CHCs is needed to show sustainability and continued increases in CRC screening rates.

Pennsylvania’s 80% by 2018 Strategic Plan: Building a Sustainable Infrastructure for 80% by 2018

Authors:

April Barry (Presenter)
PA Department of Heatlh

Alesia Mitchell-Bailiey, American Cancer Society

Public Health Statement: Pennsylvania’s Comprehensive Cancer Control Program and the Cancer Calition are actively engaged in the “80% Screened by 2018” nationwide initiative by NCCRT to eliminate colorectal cancer (CRC) as a major public health problem and work towards the shared goal of having 80% of adults aged 50 and older screened for CRC by 2018. In early 2016, one statewide 80% by 2018 Strategic Plan was developed for Pennsylvania.

Purpose: The Pennsylvania Department of Health and the Cancer Coalition have signed the NCCRT’s 80% by 2018 Pledge. In order to achieve this goal, we have created 80% by 2018 Strategic Plan with measureable goals and objectives and built a sustainable infrastructure through the Cancer Coalition to implement the 80% by 2018 Strategic Plan.

Methods/Approach: PA was one of 11 States chosen to participate in the CCC National Partners 80 by 2018 Technical Assistance Forum in September 2015 in Atlanta. PA left Atlanta with a preliminary Action Plan to achieve 80% screening rate by 2018. PA then conducted a statewide 80% by 2018 CRC Leadership Summit. There were 169 participants who represented Employers, Federally Qualified Health Centers, Health Plans, Hospitals, and other strategic partners. The Summit’s goal was to inform, engage, and activate key stakeholders around 80% by 2018. The Summit participates helped us synthesize the information from the original action plan with what was learned from the Summit to ultimately create our PA 80% by 2018 Strategic Plan in early 2016.

Results:

1. Statewide Colorectal Cancer Leadership Summit was conducted.
2. A Statewide PA 80% by 2018 Strategic Plan was created with measurable objectives.
3. A main Colorectal Cancer (CRC) workgroup of the Cancer Coalition) was developed as well as four sub-committees (Primary and Specialty Care, Health Plans, Hospitals and Employers).
4. Strategic/Interventions of each of the four subcommittees were identified.
5. The membership of the Cancer Coalition has increased 63 percent (over 60 members) as a result of the addition of the CRC workgroup and four subcommittees associated with the 80% by 2018 initiative. CCCP and the Cancer Coalition are engaging and activating key stakeholddrs around 80% by 2018.
6. Planning Phase has moved to the implementation phase for projects.

Conclusions/Implications: In order to achieve our outcomes of the 80% by 2018 Strategic Plan in Pennsylvania, collaboration with key stakeholders is essential and a sustainable, organized infrastructure through Comprehensive Cancer Coalition is crucial for implementation.