Decision Support and Navigation to Increase Colon Cancer Screening - - PowerPoint PPT Presentation

Decision Support and Navigation to Increase Colon Cancer Screening and Reduce Disparities (AD-1306-01882) Ronald E. Myers, PhD

Professor, Thomas Jefferson University

Brian Stello, MD

Clinical Associate Professor, Lehigh Valley Health Network September 19, 2019

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Ronald E. Myers, PhD and Brian Stello, MD

• Have nothing to disclose.

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Objectives

• Describe CRC and Hispanic/Latino disparity
• Describe health system learning community to address disparity
• Describe an intervention strategy that can increase CRC screening and

reduce disparity

• Describe intervention strategy impact on overall screening adherence and

test-specific screening adherence

• Describe a health system learning community strategy to support evidence-

based intervention implementation

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Colorectal Cancer and Screening in the US Hispanic/Latino Population

Incidenc dence: e: 12,400 400 Deaths: hs: 3,800 00 Localized d ed disea ease: e: 38% 38% Screen eening non

• n-adher

dherenc ence: 50% 50%

• Increase the n

e number a and % % of f non-adher erer ers who s screen een

• Screening non-adherence:

50% + XX% = 80%

Cancer Facts & Figures for Hispanic/Latinos 2015-2017; National Center for Health Statistics. Health, United States, 2015: With Special Feature on Racial and Ethnic Disparities. Hyattsville, MD, 2016

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Health System Learning Communities

• Learning communities are a collectivity that enables people to

align around a shared purpose and connect organizations to promote cooperation on a common agenda

• Health system learning communities can improve population

health by

• Identifying population health problems and effective evidence-based

interventions, and

• Supporting the adaptation, implementation and scaling of effective

interventions

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Study Participants

Patients from 5 Lehigh Valley Health Network (LVHN) Primary Care Practices, Southeastern PA

• Hispanic men and women aged 50-75 years of age
• Visited practice within previous 2 years
• No family history of CRC or colon polyps
• No personal history of CRC, colon polyps, or inflammatory bowel disease
• Screening nonadherent
• 80% Goal:
• 30% adherers + [70% non-adherers (XX%) = 80%]

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Our Learning Community

Patient and Stakeholder Advisory Committee Members

Awilda Martinez, Wally Vidarrue, Ester Vittini, Luis Sanchez, Carmelo Garcia, Vivian Montes, Elizabeth Charriez, Eddy Aybar, Olga Almadovar, Dagoberto Mosquera, and Myra Piña

Co-Investigators

Brian Stello, MD, Constantine Daskalakis, ScD, Randa Sifri, MD, Evelyn T. González, MA, Melissa DiCarlo, MPH, MS, Melanie B Johnson, MPA, Sarah E. Hegarty, MPhil, Kyle Shaak, MPH, Alicia Rivera, Lucas Gordils-Molina, Anett Petrich, MSN, RN, Beth Careyva, MD, Rosa de-Ortiz, Liselly Diaz

Consultants

Carmen Guerra, MD, MSCE, FACP, Associate Professor of Medicine at the Hospital of the University of Pennsylvania, Abramson Cancer Center, University of Pennsylvania Medical Center; John M. Inadomi, MD, Cyrus E. Rubin Professor

• f Medicine & Head, Division of Gastroenterology, University of Washington School of Medicine; Sally W. Vernon, PhD,

Director of the Division of Health Promotion and Behavioral Sciences at the University of Texas-Houston School of Public Health

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Patient and Stakeholder Advisory Committee (PASAC)

PASAC Structure

• 12 members came from community groups,

religious organizations, health support groups, primary care practices, and include LVHN health system primary care provider, specialist, and administrator representatives.

• Project staff and members met 3 X a year at a

convenient health system location

• Members included veterans, clergy, patient

support, housewives, nurses, and a diabetes support group president.

• Meetings were facilitated by a bilingual

moderator and were conducted in both English and Spanish. PASAC Member Engagement

• Members provided input on study materials,

intervention methods, and strategies for reaching the population.

• Members were part of the research team, with

the role of advising the staff on realities of working with the population and the health system.

• Members felt an additional role was to learn and

educate members of the Hispanic community about cancer screening.

• Members viewed themselves as an extension of

the community, with a duty to share their knowledge to guide research and to improve the community health.

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Study Design

(Contacts in Spanish or English as preferred by patient)

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Study Hypotheses

• H1: Overall screening adherence in DSNI Group > SI Group
• H2: Test-specific (stool blood test (SBT) and colonoscopy)

screening adherence in DSNI Group > SI Group

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Table 1. Baseline Survey Data (N=400)

Cha haracteris istic ic N (%) %) Age ge < 60 60 Years 277 277 (69) 69) > 60 60 Years 123 123 (31) 31) Ra Race Wh White 133 133 (33) 33) Black ck 118 118 (30) 30) Other/Unk nkno nown 149 149 (37) 37) Gende nder Fe Female 235 235 (59) 59) Male 165 165 (41) 41)

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Table 1. Baseline Survey Data (continued)

Cha haracteris istic ic N (%) %) Marit ital S Status us Married o

• r L

Livi ving as Married 192 192 (48) 48) No Not Married ed 208 208 (52) 52) Lang ngua uage at H Home me Spa panis nish 331 331 (83) 83) Both Spa pani nish a and E nd Eng nglish 41 41 (10) 10) Engli lish 28 28 (7) 7) Insur uranc nce S Status Insured 281 281 (70) 70) No Not Ins nsured o d or U Uns nsur ure 119 119 (30) 30)

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Table 1. Baseline Survey Data (continued)

Screeni ning ng Dec ecision S Stage N (%)

Dec ecided ed N Not to t to S Screen een 4 ( 1) 1) Not P Planning to g to Screen en 9 ( 2) 2) Undec ecided ed about S Screen eening 47 47 (12) 2) Dec ecided ed to to S Scree een 340 340 (85 85) Tot

• tal

al 400 (100) 00)

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Table 2. Overall and Test-Specific Adherence

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Summary and Publication

• CRC screening adherence was almost 5 times greater in the DSNI

Group than in the SI Group

• SBT screening and colonoscopy screening adherence were more

than 4 times greater and almost 9 times greater, respectively, in the DSNI Group than in the SI Group

• Publication:

Myers RE, Stello B, Daskalakis C, Sifri R, Gonzalez ET, DiCarlo M, Johnson MB, Hegarty SE, Shaak K, Rivera A, Gorkils-Molina L, Petrich A, Careyva B, de-Ortiz R, Diaz L. Decision support and navigation to increase colorectal cancer screening among Hispanic patients. Cancer Epidemiol Biomarkers Prev. 2- 18;28(2):384-391.

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Conclusions

• A patient-centered CRC screening intervention for Hispanic

primary care patients in the LVHN was successful

• DSNI + SI had a significantly greater positive impact on
• verall and test-specific CRC screening adherence than SI

alone

• Health system learning community-based research on the

implementation of the DSNI in health systems and with vulnerable populations is needed.

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Community Conference The community came and we all learned

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Developing a Health System Learning Community

• Patient Centered Outcomes Research Institute (EAIN 2471) & Thomas

Jefferson University support

• Develop a scalable collective impact learning community model for implementing

evidence-based cancer screening interventions in health systems

• Obtain support for using the model to reduce disparities in cancer screening and related
• utcome

Publications:

Myers RE, DiCarlo M, Romney M, Fleisher L, Sifri R, Soleiman J, Lambert, Rosenthal. Using a Health System Learning Community Strategy to Address Disparities. Learning Health Sys, (18) September, 2018; Man L, DiCarlo M, Lambert, Sifri, R, Romney M, Fleisher L, Myers RE. A Learning Community Approach to Identifying Interventions in Health Systems to Reduce Colorectal Cancer Screening Disparities. Prev Med Reports, (12): 227-232,2018.

PADEL Consortium

• Jefferson Health
• Lehigh Valley Health

Network

• Penn State Health
• Christiana Care

Health System

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Learn More

• www.pcori.org
• info@pcori.org
• #PCORI2019

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Thank you. Questions?

Ronald E. Myers, PhD

Professor Thomas Jefferson University ronald.myers@jefferson.edu Brian Stello, MD Clinical Associate Professor Lehigh Valley Health Network brian.stello@lvhn.org