for Cancer Prevention New England Colorectal Cancer Screening - - PowerPoint PPT Presentation

Building Community Health Center Capacity for Cancer Prevention

New England Colorectal Cancer Screening Learning Collaborative

Randy Schwartz, MSPH Morgan Daven, MA Lynn Basilio, MS

10th Annual Conference on the Science of Dissemination and Implementation in Health December 2017

• 600+ staff specializing in health systems partnerships
• Six regional leadership teams
• Partnerships to implement public health strategies and

interventions

• Focus on 3 system types:

American Cancer Society

Health Systems Workforce

• Hospital systems
• CoC cancer centers
• Integrated delivery systems
• State-based systems
• CDC, state health departments
• Health plans
• Primary Care systems
• FQHCs, PCAs, NACHC, HRSA

American Cancer Society

Primary Care Strategy

• Build CHC capacity to

help more patients and provide quality care

• Collaborative
• Team-based
• Patient-centered
• Evidence-based
• Efficient
• Sustainable
• Relevant & appropriate

Adapting Evidence and Bringing to Scale

Adapting Evidence and Bringing to Scale

Adapting Evidence and Bringing to Scale

Quality Improvement Coaching

ACS staff provide Quality Improvement coaching to ensure clinic policies, practices, and work-flows improve patient outcomes for cancer-related priorities.

• Focus on interventions that have the greatest impact on ACS

mission outcomes and are also aligned with CHC’s priorities.

• Align interventions and support to PCMH standards.
• Help develop Medical

Neighborhood models (coordination of care).

• Work with CHC QI staff to

develop patient registries and implement rapid cycle improvement (PDSA cycles).

American Cancer Society Objectives

• Advance the national 80% by 2018

Colorectal Cancer Screening campaign in New England with primary care partners

• Engage multiple Health System partners in

new Division-wide initiative

• Build Primary Care, Health Systems staff

capacity in quality improvement activities through pilot project

8

Colorectal Cancer Screening Learning Collaborative

• 18-month pilot project involving 11 CHCs, 5 statewide partners,

and ACS to increase CRC screening rates at CHCs

• Collaborative members met monthly (in-person or webinar) to

learn, share, and discuss evidence-based interventions, quality improvement processes, and progress to goal

• Proposed evidence-based interventions – client reminder and

recall systems; provider reminder and recall systems; and, provider assessment and feedback

• Baseline CRC screenings rates of 11 CHCs ranged from 34-60%
• CHCs reported data monthly; key measure included UDS CRC

screening rate

Collaborative Members

Community Health Centers

• Charter Oak Health Center, CT
• Edward M Kennedy CHC, MA
• Fair Haven CHC, CT
• Generations Family Health Center, CT
• Goodwin Community Health, NH
• HealthReach CHC, ME
• Manchester CHC, NH
• Nasson Health Care, ME
• Penobscot CHC, ME
• Southwest CHC, CT
• WellOne Primary Medical & Dental

Care, RI

Statewide Partners

• Community Health Center Association
• f Connecticut
• Maine Primary Care Association
• Massachusetts Department of Public

Health

• Massachusetts League of Community

Health Centers

• New Hampshire Colorectal Cancer

Screening Program

10

Model for Improvement

• Always ask….
• What can we do by

next Tuesday?

Aim

To increase colorectal cancer screening rates in the participating New England community health centers toward the national goal of 80% screening in the population age 50 and

• ver by June 2016.

Increase colorectal cancer screening rates to 80%

• r more

among health center patients ages 50 and

• lder by

June, 2016

Primary Drivers Changes Prepared team Patient Identifica- tion Shared decision on screen type Overcome barriers, resistance, ambivalence Referral and follow up

Support patient with care navigation, care coordination Decide follow up vehicle (text, phone, face to face, etc.) with patient Communicate with specialists Improve relationships for referrals for GI specialists Communicate with colonoscopy providers Connect patients who need treatment with appropriate providers Identify clinical champion to lead Clarify roles of care team Develop staff competency Establish team time, data collection Hold daily or 2x day huddles Look forward in schedule, identify who is due each week Use reminders for those overdue Flag those due, bring to huddle Use IT to identify patients Work down backlog Offer patients a choice based on risk Use risk guide first

Aim Step 1: Make a Plan Step 2: Assemble a Team Step 4: Coordinate Care Across Continuum Step 3: Get Patients Screened *Steps

*As outlined in Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Community Health Centers, ACS & National Colorectal Cancer Roundtable

Negotiate and set goal with patient Use Motivational Interviewing Use teach back for education Share gut check videos

Act

Adapt? Adopt ? Abandon? Next cycle?

Plan

Objective Questions and predictions (why) Plan to carry out the cycle (who, what, where, when) Next cycle?

Study

Complete the analysis of the data Compare data to predictions Summarize what was learned

Do

Carry out the plan (on a small scale) Document problems and unexpected

• bservations

Begin analysis

The PDSA Cycle for Learning and Improvement

W.E.Deming referred to this as the Shewhart Cycle

CRC Screening Progress

May '15 Aug Sep Oct Nov Dec Jan '16 Feb Mar Apr May Median Rate 49.9 45.55 47.2 47 50 51.7 53.6 53.2 55 56 57.95 Baseline Median 47.1 47.1 47.1 47.1 Adjusted Median 53.4 53.4 53.4 53.4 53.4 53.4 53.4

25 30 35 40 45 50 55 60 65 70 75

Median Rate

Month

NE Colorectal Cancer Screening Learning Collaborative Aggregate Median CRC Screening Rates (N=11 health centers) May 2015-May 2016

Breakthroughs

• Improved EHR/tracking system
• Provider reports/feedback
• Planning and team huddles
• Expanded FIT/FOBT testing

Barriers

• Lack of clinical champion/leadership
• EMR limitations and reporting issues
• Documentation
• Colonoscopy access and capacity
• Transient population

Lessons Learned

• Engage senior leadership and ensure a clinical champion

participates actively on the improvement team

• Combining adaptations can build a scalable program
• Promote evidence-based practices and provide tailored

support for testing and implementation

• Evidence-based models and tools can be adapted and

utilized to scale

• Engage external champions and program developers
• Seek more input on data collection and reporting from

CHC quality improvement staff

Building on the Collaborative

• ACS Cancer Control considering this model

and scaling up in other regions

• ACS connecting with HRSA, NACHC, and
• ther national partners to leverage

resources and support for CHCs

• Exploring next Northeast Learning

Collaborative – screening/disease area, geography, membership, staff capacity

Questions

Thank you!