Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS...
-
Upload
mitchell-briggs -
Category
Documents
-
view
212 -
download
0
Transcript of Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS...
![Page 1: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/1.jpg)
Colorectal Cancer Screening in Appalachia PA:
a pilot intervention projectWilliam Curry, MD, MS
Dept of Family & Community MedicineM.S.Hershey Medical Center
7 MAY 2008
![Page 2: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/2.jpg)
Colorectal Cancer Screening in Appalachia PA:
a pilot intervention project
Mark Dignan, PhDGene Lengerich, PhD
Alan Adelman, MD, MSBrenda Kluhsman, MS
Marie Graybill, BSN
![Page 3: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/3.jpg)
Colorectal Cancer• Second leading cause of cancer
deaths– 150,000 new cases annually– 57,000 annual deaths
• In Pennsylvania– 8,200 new cases annually– Rates decreasing except in black males
• 75/100,000 black males, 49/100,000 white females
– 3,000 annual deaths• 26/100,000 males, 18/100,000 females
![Page 4: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/4.jpg)
Pennsylvania CountiesParticipating Practices
Hershey Medical Center
![Page 5: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/5.jpg)
Burden of Disease• Union County
– 130 cases per year• 20% more cases in males than expected
– 32 deaths per year• 18/100,000 males, 12/100,000 females
• Northumberland County– 190 cases per year
• 20% more cases in males than expected
– 163 deaths per year• 30/100,000 males, 19/100,000 females
![Page 6: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/6.jpg)
Burden of Disease• Centre County
– 271 cases per year• 7% fewer cases in males than expected
– 93 deaths per year• 20/100,000 males, 14/100,000 females
• Snyder– 137 cases per year
• 32% more cases in females than expected
– 38 deaths per year• 19/100,000 males, 17/100,000 females
![Page 7: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/7.jpg)
Colorectal Cancer Screening• Screening of population is less
than optimal– 53% in US
– 49% in PA
• 44% in Appalachian PA
Only 32% of colorectal cancers are Only 32% of colorectal cancers are found at local stage in rural found at local stage in rural Appalachia.Appalachia.
![Page 8: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/8.jpg)
ACS CRC Screening Guidelines
• Fecal occult blood test (FOBT)*
• or fecal immunochemical test (FIT)* every year**
*For FOBT or FIT, the take-home multiple sample method should be used.
**Colonoscopy should be done if the FOBT or FIT shows blood in the stool
![Page 9: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/9.jpg)
ACS CRC Screening Guidelines
• Flexible sigmoidoscopy every 5 years**
**Colonoscopy should be done if sigmoidoscopy results show a polyp
![Page 10: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/10.jpg)
ACS CRC Screening Guidelines
• an FOBT* or FIT* every year plus flexible sigmoidoscopy every 5 years**
(Of these first 3 options, the combination of FOBT or FIT every year plus flexible sigmoidoscopy every 5 years is preferable.)
**Colonoscopy should be done if the FOBT or FIT shows blood in the stool or sigmoidoscopy results show a polyp
![Page 11: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/11.jpg)
ACS CRC Screening Guidelines
• Double-contrast barium enema every 5 years**
**Colonoscopy should be done if DCBE shows a polyp
![Page 12: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/12.jpg)
ACS CRC Screening Guidelines
• Colonoscopy every 10 years **
**If possible, polyps should be removed during the colonoscopy.
![Page 13: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/13.jpg)
ACS CRC Screening Guidelines
• Other alternatives– Stool DNA– CT Colonography (virtual colonoscopy)
![Page 14: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/14.jpg)
Colorectal Cancer Screening
• Interventions– Audit & Feedback– CME– Provider reminders
• Despite these efforts, CRC screening Despite these efforts, CRC screening rates remain lower than breast, rates remain lower than breast, cervical and prostate cancer cervical and prostate cancer screenings.screenings.
![Page 15: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/15.jpg)
Colorectal Cancer Screening• Academic Detailing
– One-on-One interaction between provider and trained educator
• Interactive information presentation
– Evidence for Academic Detailing?• Reduced inappropriate and over-prescribing• Tobacco cessation• Improved rural diabetes care• Increased mammography use• Decreased inappropriate PSA ordering
![Page 16: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/16.jpg)
Colorectal Cancer Screening• Academic Detailing
– One study that showed improved follow-up of positive FOBT1
– Mixed evidence about effectiveness with CRC screening
• Physician recommendation is an important factor in patient willingness to be screened
![Page 17: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/17.jpg)
Colorectal Cancer Screening• Study Design
– Baseline Provider Survey• Screening practices• Follow-up practices• Referral patterns
– Practice Assessment• Key informant interviews• Assess current screening practices
![Page 18: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/18.jpg)
Colorectal Cancer Screening• Study Design
– Medical Record Abstraction• Patients 50 and older• Seen in practice in the previous 2 months• Estimate number of patients offered
screening and who had screening completed– Exclusion criteria
» History of colon cancer, polyps» Symptoms of colon cancer» Acute visit
![Page 19: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/19.jpg)
Colorectal Cancer Screening• Study Design
– Academic Detailing• Visit 1 – Lunch and Learn• Visit 2 & 3 – Tailored intervention based on
practice assessment and Visit 1• Visit 4 – Follow-up and final physician
assessment
– Post-intervention Provider survey– Post-intervention medical record
abstraction
![Page 20: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/20.jpg)
Colorectal Cancer Screening• Study Design
– Post-intervention Key-informant interviews
• Qualitative assessment
![Page 21: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/21.jpg)
Colorectal Cancer Screening• Data Collection with caBIG
– Working with Univ of Minnesota, capturing chart abstraction via web to NCI database
• caBIG™ Goal: To create a virtual web of interconnected data, individuals, and organizations redefining how research is conducted, care is provided, and patients/ participants interact with the biomedical research enterprise
– CDEs - Completed– Output is an Excel datafile to research
team
![Page 22: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/22.jpg)
![Page 23: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/23.jpg)
![Page 24: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/24.jpg)
![Page 25: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/25.jpg)
![Page 26: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/26.jpg)
![Page 27: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/27.jpg)
Results• Four practices
– Initial 3 visits completed– Initial provider surveys collected– Record review
• 280 patient records abstracted– 105 entered into CaBIG
» 64 completed– Initial Datafile returned from CaBIG
– 45% screening rate (preliminary)• Patient factors• Physician/system factors
![Page 28: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/28.jpg)
Lunch and Learn Lessons• Providers and staff engaged
• Each practice has different outlook– Wall Charts– Handouts– Engaging staff
• Story telling
• Want information on their performance
![Page 29: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/29.jpg)
Acknowledgements
• National Cancer Institute
• ACTION Health
• The four practice sites
• Research Team
![Page 30: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/30.jpg)
References1. Myers RE , Turner B , Weinberg D , et al. Impact of a
physician-oriented intervention on follow-up in colorectal cancer screening Preventive Medicine, 2004 ;38(4):375-381
2. Soumerai SB, McLaughlin TJ, Gurwitz JH, Guadagnoli E, Hauptman PJ, Borbas C, et al. Effect of local medical opinion leaders on quality of care for acute myocardial infarction: a randomized controlled trial. JAMA 1998;279(17):1358-63.
![Page 31: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/31.jpg)
References3. Centers for Medicare and Medicaid Services. Colon
Cancer Screening. 2008. Available at: http://www.cms.hhs.gov/ColorectalCancerScreening. Accessed January 31, 2008.
4. American Cancer Society. Detailed Guide: Colon and Rectum Cancer. 2008. Available at: http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=10.
![Page 32: Colorectal Cancer Screening in Appalachia PA: a pilot intervention project William Curry, MD, MS Dept of Family & Community Medicine M.S.Hershey Medical.](https://reader030.fdocuments.us/reader030/viewer/2022032607/56649ec05503460f94bcac02/html5/thumbnails/32.jpg)
Colorectal Cancer Screening
Questions?Questions?