ANNUAL OCT. 31-NOV. 2, 2017 MEETING ARLINGTON, VA Patient-Cen enter ered ed Strateg egies es t to Improve H e Health h and Health O Outcomes f for V Vulnerable P Populations November 1, 2017 #PCORI2017
ANNUAL MEETING | #PCORI2017 Welcome & Introductions • Mod oderator: or: C Cheryl Peg egus us, MD, MPH, Clinical Professor of Population Health, New York University Lagone Health November 15, 2017 2
ANNUAL MEETING | #PCORI2017 Increasing CRC Screening among Hispanic Primary Care Patients • Princ ncipa pal I Inves estigator: R Ron Myers, PhD, Professor and Director of the Division of Population Science, Thomas Jefferson University • Patien ent/Stakeho eholder der P Partner: M Myra P Piña, MD, Executive Director, Fé Foundation of the Hispanic Chamber of Commerce of the Lehigh Valley November 15, 2017 3
ANNUAL MEETING | #PCORI2017 Patient-Centered Trauma Treatment for PTSD and Substance Abuse: Is It an Effective Treatment Option • Princ ncipa pal I Inves estigator: A Annette C e Crisanti, PhD, Research Associate Professor of Psychiatry and Behavioral Sciences, University of New Mexico • Patien ent/Stakeho eholder der P Partner: G Gina na J James es, Research Assistant, Division of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, University of New Mexico November 15, 2017 4
ANNUAL MEETING | #PCORI2017 Lowering the Risk of Heart Problems for People in Appalachian Kentucky • Principal I Investigator: De or: Debra M Mos oser, PhD, RN, FAAN, Professor, University of Kentucky College of Nursing November 15, 2017 5
ANNUAL OCT. 31-NOV. 2, 2017 MEETING ARLINGTON, VA Incr creasing C Colorect ctal Cance cer ( (CRC) Scr creening among H Hispanic P c Primary C Care Patients Ronald E. Myers, PhD and Myra D. Piña Professor Executive Director of the Fé Foundation November 1, 2017 #PCORI2017
ANNUAL MEETING | #PCORI2017 Ronald E. Myers, PhD and Myra D. Piña • Have nothing to disclose. November 15, 2017 7
ANNUAL MEETING | #PCORI2017 Objectives At the c conclusio ion o of this a activ ivit ity, t the p part rtic icip ipant s should ld b be able to to: • Des escribe i e inter ervention i impact o on n over erall s scree eening adher herenc ence • Des escribe i e inter ervention i impact o on n tes est-spec pecific s screeni ening ng adher herenc ence • Des escribe i e inter ervention i impact o on n screen ening dec decisi sion stage ge November 15, 2017 8
ANNUAL MEETING | #PCORI2017 Colorectal C Cance cer a and Scr creening in the US H Hispanic/L c/Latino P Population Incidenc dence: e: 12,400 400 Deaths: hs: 3,800 00 Localized d ed disea ease: e: 38% 38% Screen eening non on-adher dherenc ence: 50% 50% • 80% 80% by 2018 2018 C Campaign Go Goal: o Increase the n e number a and % % of f non-adher erer ers w who s screen een 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 November 15, 2017 9
ANNUAL MEETING | #PCORI2017 Study P Participants Patien ents f s from 5 Lehigh V h Valley ey H Health N h Net etwork ( (LVHN) Primary Care P e Practices es, S Southea heastern P n PA • Hi Hispanic m men en a and women aged 5 50-75 y yea ears o of a age ge • Visited ed p practice w e within p previous 2 2 yea ears • No f o fam amil ily y histor ory o y of C CRC o or c colon olon p polyp lyps • No p o personal h al history o of CRC, c colon olon p polyp lyps, o or i inflam lammatory bow owel l disea ease • Scree eening n g nonadher erence o 80% 80% b by 2018 2018 Campaign Goal i in LVHN VHN : 30% adherers + [70% nonadherers (71%)] November 15, 2017 10
ANNUAL MEETING | #PCORI2017 Patien ent t and S Stakeh eholder er Advi dvisory ry Co Committee (PA PASAC) PASAC Function/Feeling PASAC Structure • Members provided input on study materials, • 12 members came from community groups, intervention methods, and strategies for religious organizations, health support groups, reaching the population. primary care practices, and include LVHN health • Members were part of the research team, with system primary care provider, specialist, and the role of advising the staff on realities of administrator representatives. working with the population and the health • Project staff and members met 3 X a year at a system. convenient health system location • Members felt an additional role was to learn and • Members included veterans, clergy, patient educate members of the Hispanic community support, housewives, nurses, and a diabetes about cancer screening. support group president. • Members viewed themselves as an extension of • Meetings were facilitated by a bilingual the community, with a duty to share their moderator and were conducted in both English knowledge to guide research and to improve the and Spanish. community health. November 15, 2017 11
ANNUAL MEETING | #PCORI2017 Study D Design gn Consented, Surveyed, and Randomized (N=400) Standard Decision Support and Intervention Navigation Intervention (n=203) (n=197) Endpoint Survey Endpoint Survey (n = 123) (n = 123) and Chart Audit and Chart Audit (n = 203) (n = 197) November 15, 2017 12
ANNUAL MEETING | #PCORI2017 Standard I Inter erven enti tion ( (SI) Patient Reminder Patient Education • Send informational • Send reminder booklet, FIT kit, and colonoscopy scheduling instructions Dec ecision S Support t and N Navigati tion Inter erven enti tion ( (DSNI) I) Provider Engagement Patient Education Support & Navigation Patient Reminder • Send informational • Identify preferred test • Send patient’s • Send reminder booklet, FIT kit, and screening plan to • Determine likelihood of practice colonoscopy screening and barriers to scheduling • Send screening status adherence instructions report and encourage • Develop screening plan follow-up as needed and navigate through adherence November 15, 2017 13
ANNUAL MEETING | #PCORI2017 Hypotheses • H1: O Over erall s screen eening g adher eren ence i e in DSNI Group > SI G Group • H2 H2: T Tes est-spec ecific a adher eren ence i e in DSNI Group > > SI G Group • H3: S Screen eening d g decision stage i in DSNI G Group > > SI Group November 15, 2017 14
ANNUAL MEETING | #PCORI2017 Table 1 1. B Baseline Survey Data (N (N=400) Char arac acter eristic N (%) %) Age ge < 60 Y 60 Years 277 277 (69) 69) > 60 Y 60 Years 123 123 (31) 31) Race ce White te 133 133 (33) 33) Black ck 118 118 (30) 30) Other/Unknown 149 149 (37) 37) Gender Fe Female 235 235 (59) 59) Ma Male le 165 165 (41) 41) November 15, 2017 15
ANNUAL MEETING | #PCORI2017 Table 1 1. B Baseline Survey y Data ( a (continued) Char arac acter eristic N (%) %) Marit Ma ital S l Status Ma Marrie ied o or Livin ing a g as Ma Marrie ied 192 192 (48) 48) Not Ma Marrie ied 208 208 (52) 52) Language Spoken a at H Home Spanis ish 331 331 (83) 83) Both S Spanish a and E Engli glish 41 41 (10) 10) Englis glish 28 28 (7) 7) Insuran ance Sta tatus Insu In sured 281 281 (70) 70) Not Insured o or Unsure 119 119 (30) 30) November 15, 2017 16
ANNUAL MEETING | #PCORI2017 Table 1 1. Baseline Survey D y Data ( a (continued) Te Test Prefer eren ence N N (%) Pr Prefer C Colon onos oscop opy 39 39 (10) 0) Equa qual P Prefer eren ence 275 275 (69) 69) Prefer er F Fecal I Immun unochem emical 86 86 (21) 1) Bl Blood T Test ( t (FIT) To Total 400 400 (10 100) November 15, 2017 17
ANNUAL MEETING | #PCORI2017 Findings • Over erall C CRC s scree eening a adh dherence w e was s almost 5 5 times es grea eater er i in n the D he DSNI Gr Group up t tha han i in n the S he SI Gr Group • FIT s screeni ening ng a and c d colonoscopy scree eeni ning a adher herenc ence wer ere m e more t e tha han 4 4 times s greater a and a almost 9 9 times es grea eater er, r resp espec ectively, i , in n the D he DSNI Gr Group up t tha han i in n the S he SI Gro roup • Forward c cha hange i in n CRC s screen ening dec decisi sion s stage w e was almost 5 5 times m more likely i in the D DSNI G Group than i in the S he SI Gr Group up November 15, 2017 18
ANNUAL MEETING | #PCORI2017 Dissemination a at a LVHN C Community C y Conference November 15, 2017 19
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