Do You Want to Increase Cancer Screening? You’ll Want These Tested Methods in Your Cache!

Using Process Maps to Understand and Improve the Implementation of Evidence-Based Strategies to Increase Colorectal Cancer Screening

Authors:

Cynthia Calef (Presenter)
University of South Carolina

Pamela Gillam, University of South Carolina
Hiluv Johnson, University of South Carolina
Jay Whitmore, University of South Carolina
Casey Childers, Core for Applied Research and Evaluation
Lauren Workman, University of South Carolina
Heather Brandt, University of South Carolina

Public Health Statement: Continuous improvement (CI) tools are increasingly being used in the healthcare sector to enhance patient care. The Colorectal Cancer Screening Program in South Carolina is using process maps, a CI tool, to improve implementation of evidence-based strategies to increase colorectal cancer screening (CRCS) with federally-qualified health centers (FQHCs).

Purpose: The purpose was to 1) provide a visual tool to understand key steps of each evidence-based strategy; 2) identify appropriate technical assistance (TA) opportunities; and 3) solve implementation issues that could inhibit increased CRCS.

Methods/Approach: During implementation site visits, FQHCs described detailed plans for implementing selected evidence-based strategies. A process map for each strategy in each FQHC was developed using Visio software. FQHCs provided feedback on process map drafts for accuracy. Maps were used to monitor implementation processes and identify opportunities for TA.

Results: A total of 13 process maps were developed (2 client reminder, 4 provider assessment and feedback, 7 provider reminder). Process maps have provided FQHCs the ability to clearly communicate the implementation process to their staff and helped them identify and solve implementation issues. Implementation support has been provided based on identified needs elucidated by the process maps.

Conclusions/Implications: Process maps are an effective tool to assist in implementation of evidence-based strategies to increase CRCS. CRCS in FQHCs and associated process maps will be evaluated to identify processes that are more effective than others and may lead to higher CRCS rates. Identifying effective processes to implement evidence-based strategies for CRCS may accelerate implementation efforts among similar programs

A Demonstration Project to Improve Cancer Screening Rates in New York State Federally Qualified Health Centers (FQHCs)

Authors:

Margaret Gates (Presenter)
New York State Department of Health

Erin Shortt, New York State Department of Health
Gina O’Sullivan, New York State Department of Health
Heather Dacus, New York State Department of Health
Ian Brissette, New York State Department of Health
Katherine Pfisterer, New York State Department of Health

Public Health Statement: The project aims to increase cancer screening rates in FQHCs as the populations served by FQHCs mirrors those with the lowest screening rates.

Purpose: The State Health Department and Primary Care Association developed a quality improvement (QI) initiative that uses an interactive information technology platform and health systems QI coaching to increase cancer screening rates.

Methods/Approach: Project phases include programming standard metrics into a data platform, interfacing electronic health records (EHRs) to the platform, enrolling three cohorts of eleven to twelve FQHCs for QI interventions, validating EHR/platform data, gathering baseline health information tecnology and QI capacity, assessing cancer screening workflow and, through a twelve-month learning collaborative, providing data validation results, workflow recommendations to implement evidence-based interventions, QI coaching and shared learning opportunities. Mixed methods evaluation including regular tracking of screening data, surveys and interviews with FQHC staff, assessed changes in screening rates and clinical practices.

Results: By February 2017, 51 FQHCs representing every region of NYS and nine EHR vendors are interfaced with the data platform. The first 12 FQHCs completed all project phases in 2014 and, as of June 2016, have had relative increases in their aggregate breast, cervical and colorectal cancer screening rates of 11.4%, 13.7% and 83.8% over baseline, respectively.

Conclusions/Implications: Findings suggest the establishment of a planned approach to cancer screening across FQHCs can be supported by an EHR-based registry that includes data quality as a focus as well as coaching focused on evidence-based interventions.

Use of Multiple Criteria Decision Analysis Tools for Cancer Screening Outreach Prioritization

Authors:

Charlene Cariou (Presenter)
Idaho Department of Health and Welfare

Christopher Johnson, Cancer Data Registry of Idaho
Megan Mackey, Idaho Department of Health and Welfare

Public Health Statement: Prioritization of cancer screening efforts are necessary to ensure the greatest impact on decreasing the cancer burden in Idaho.

Purpose: The purpose of the multiple criteria decision analysis process is to identify priority areas for cancer screening outreach efforts.

Methods/Approach: In order to most effectively utilize resources to increase screening, additional data methodology was needed to include various measures known to increase cancer risk or decrease utilization of screening services, as well as to prioritize geographic areas. The Idaho Comprehensive Cancer Control Program (ICCCP) and the Cancer Data Registry of Idaho (CDRI) collaborated to develop and implement Multiple Criteria Decision Analysis (MCDA) techniques and process to prioritize counties within Idaho where the greatest opportunity to impact cancer burden exists (specifically breast, cervical, and colorectal cancer). The MCDA process is a general framework, rooted in operational research, that allows for the use of multiple criteria to solve a decision problem. The ICCCP and CDRI utilized ArcMap software with the free MCDA4ArcMap add-in to apply the MCDA process to impact the cancer burden in Idaho. We used a multi-step MCDA process that involved selecting criteria to be included in the decision, using an expert group to weight the criteria, and deriving a solution based on the weights. The criteria were each measured at the county level, and data from the Behavioral Risk Factor Surveillance System, CDRI and Census were utilized.

Results: MCDA results stratified counties by very high, high, moderate, low and very low priority for health system impact potential and greatest risk for breast, cervical, and colorectal cancer screening efforts.

Conclusions/Implications: Counties identified as very high priority for health systems impact have the greatest potential for reach and impact on cancer screening. The data will be used to inform funding and resource allocation, policy, system and environmental change, and education and outreach efforts. For counties identified as very high priority for greatest risk for breast, cervical, or colorectal cancer, additional research is needed to understand the barriers and disparities related to cancer screening and burden.

Medicaid Enrollees’ Beliefs and Perceptions on Colorectal Cancer Screening

Authors:

Margaret Gates (Presenter)
New York State Department of Health

Elise Collins, New York State Department of Health
Sharon Bisner, New York State Department of Health
Kevin Malloy, New York State Department of Health
Jacqueline Matson, New York State Department of Health
Wei Jing, New York State Department of Health
Heather Dacus, New York State Department of Health
Courtney Matatia, New York State Department of Health
Victoria Wagner, New York State Department of Health

Public Health Statement: Rates of colorectal cancer (CRC) screening in New York’s Medicaid managed care (MMC) population have consistently lagged behind the commercially insured population.

Purpose: To address this disparity and promote CRC screening, the New York State Department of Health partnered with two MMC health plans to mail reminder letters to age-eligible MMC enrollees residing in ten rural northeastern counties who were not up-to-date with screening. Reminders were followed by a mail survey designed to collect information on MMC members’ beliefs, barriers, experiences and perceived value of CRC screening.

Methods/Approach: Medicaid eligibility, demographics, claim and encounter data were used to identify 6,000 MMC members in need of CRC screening. Members were mailed a screening reminder and informational brochure. The survey sample was composed of 320 MMC members who were screened after the reminder was mailed and 2,180 randomly selected letter recipients who did not get screened. The survey questionnaire included 15 questions.

Results: A total of 771 members completed the survey, yielding a response rate of 32% (50.3% of screened sample vs. 27.9% of unscreened sample). Less than half of respondents (43.7%) recalled receiving the reminder. The proportion who recalled the reminder was higher among those who were screened (50.3% vs. 42.0%, p-value = .06). Less than half of respondents (49.3%) considered CRC screening “Very Important” (70.2% in screened vs. 43.8% in unscreened group, p-value <.0001).

Conclusions/Implications: Identifying effective messaging that addresses MMC members’ beliefs and concerns about CRC screening will be essential to improve screening rates in this population.