DP17-1701: National Breast and Cervical Cancer Early...

CAPT Jacqueline W. Miller, MDMedical DirectorNational Breast and Cervical Cancer Early Detection ProgramProgram Services Branch

DP17-1701:National Breast and Cervical Cancer Early Detection Program (NBCCEDP)

Reviewer TrainingMarch 16, 2017

RELIABLE TRUSTED SCIENTIFIC DCPC

Training Objectives

• Understand background and purpose of FOA• Identify expected outcomes for the NBCCEDP• Identify strategies that applicants are expected to implement• Understand criteria and points for evaluating applications

Background


Breast and Cervical Cancer Burden

• Breast Cancer• >210,000 women diagnosed each

year• >40,000 women die each year• Screening detects cancer at early

stages when treatment most effective

• Cervical Cancer• >12,000 women diagnosed each

year• >4,000 women die each year• Screening to find precancerous

lesions and prevent development of invasive cancer


Program Purpose• Authorized by the Breast and Cervical Cancer Mortality

Prevention Act of 1990• Provide breast and cervical cancer screening and

diagnostic services to low-income women• Eligibility criteria

• Income ≤ 250% federal poverty level• Uninsured or underinsured• Ages 40-64 years old for breast cancer• Ages 21-64 years old for cervical cancer

• Referral to treatment services for those diagnosed with cancer (Breast and Cervical Cancer Treatment Act)


Program Requirements

• Comprehensive program providing…• Screening / diagnostic tests• Case management / patient navigation• Quality assurance / quality improvement• Public education and targeted outreach• Professional development• Partnerships• Data management and use• Program monitoring and evaluation


Breast and Cervical Cancer Screening

• Breast Cancer (average risk)• 40 to 49 years - decision to start

screening should be an individual one by a woman and her physician regarding the potential benefits versus potential harms

• 50 to 74 years - mammography every 2 years

• Cervical Cancer (average risk)• 21 to 29 years - Pap testing every 3

years • 30 to 65 years - Pap testing every 3

years or a combination of Pap and human papillomavirus (HPV) testing every 5 years

U.S. Preventive Services Task Force


Program History

• Since program inception in 1991• Served >5 million women

• Diagnosed >60,000 invasive breast cancers; >21,000 in situ breast lesions; >3,800 invasive cervical cancers; >175,000 precancerous cervical lesions

• Current 5-year funding cycle ending 6/29/2017 funded 67 programs

• All states and DC

• 11 tribes

• 5 territories


Program Performance and Reach

• Meets program quality standards for cancer screening and diagnostic services

• Completion of services

• Timeliness of diagnostic services

• Timeliness to treatment

• Limited Reach• ~10% of all women in the US are eligible for the program

• 11% of women eligible for breast screening are served

• 7% of women eligible for cervical screening are served

Expanded Program Focus


Expanded Focus

• Expand population-based approaches• Work within health systems clinics and communities• Expand implementation of evidenced-based interventions• Address barriers to screening faced by all women• More aggressive outreach to find hard-to-reach women• Put more focus reducing disparities


Expanded Focus with New Program Look

• Old program components not emphasized separately••••••••

• All components still important and fit under new strategies• Key focus is that completing the component itself is not the end result


Expanded Focus with New Program Look

• Must screen women as per legislative authority• Focus in three strategic areas

• Patients

• Health systems

• Communities

• All end points of strategies implemented should be women getting screened, receipt of diagnostic services, and referral to treatment, if needed

Program Strategies and Activities


NBCCEDP Grantee Strategies

• Primary strategies (Logic Model #4, 5, and 6)• Specific activities to increase appropriate breast and cervical cancer

screening

• All three primary strategies are required and must be included in application

• Cross-cutting strategies (Logic Model #1, 2, 3, 7, and program management)

• Activities that must be done along with all the primary strategies to achieve outcomes


Primary vs Cross-Cutting Strategies

Primary Strategies• Environmental approaches for

sustainable cancer control

• Community-clinical linkages to aid patient support

• Health systems changes

Cross-Cutting Strategies• Program collaboration

• External partnerships

• Cancer data and surveillance

• Program monitoring and evaluation

• Program management


Primary Strategy Activities

• Environmental approaches for sustainable cancer control• Work with community-based organizations and employers to

provide education on policies that increase availability of screening services to low-income women


Primary Strategy Activities

• Community-clinical linkages to aid patient support• Expand use of community and clinic-based health

workers/advisors/educators to address screening, risk factors, preventive health behaviors, and barriers

• Navigate women to clinical resources (e.g., screening, genomics, immunization)

• Work with communities and partners to reach disparate populations using culturally appropriate interventions (finding the hard-to-reach women)


Primary Strategy Activities• Health systems changes

• Provide direct clinical services

Provide screening and diagnostic testing

Provide patient navigation to low-income women

• Improve cancer screening rates and strengthen delivery of clinical services

Implement evidence-based interventions

Implement quality assurance and quality improvement

Conduct provider education

Enhance use of electronic health records


Cross-Cutting Activities

• Program Collaboration • Other CDC-funded programs on prevention, risk reduction, and

health system changes

• Cancer registries to report and use data

• State cancer coalitions for program planning and identifying priority populations

• Partners to inform women about HPV immunization and tobacco cessation with referral to appropriate resources



• External Partnerships• Strategic partners that also work with NBCCEDP priority

populations

• Non-traditional partners such as Department of Transportation, Bureau of Housing and Urban Development, and others

• Establish formal and detailed MOUs with partners so that partnerships are more than “just conversations”



• Cancer data and surveillance• Use state and local level data to identify populations in

need of screening (first step necessary for all strategies)

• Establish baseline and monitor clinic level screening rates to support health systems change activities

• Report patient level data (Minimum Data Elements -MDEs) on women directly screened or served by the program



• Program management• Adequate staffing (minimum of director, data manager, and evaluator)

• Maintain fiscal tracking

• Acquire clinical consultants

• Attend required CDC trainings/meetings



• Program monitoring and evaluation• Maintain a data system for patient data collected on women served

• Track follow-up of abnormal tests to meet CDC performance standards

• Track and report annual clinic screening rate data

• Monitor outcomes of women who only receive navigation services

• Monitor screening and cancer rates among disparate populations

Application Review Criteria & Points


Approach (35 points)• Presents outcomes that are consistent with the project

period outcomes described in the CDC project description and logic model. (0-6 points)

• Established community partnerships that support increased breast and cervical cancer screening

• Established health system partnerships with broad reach • Measurement and use of high quality data• Reduced barriers and increased access to breast and cervical

cancer and diagnostic screening for priority populations• Increased use of and implementation of multiple evidence-

based interventions & support strategies within health systems• Increased adherence to appropriate screening and diagnostic

follow-up


Approach (35 points)

• Describes an overall strategy and activities consistent with the CDC Project Description and logic model. (0-3 points)

• Health-systems change strategies using evidence-based interventions and direct screening/patient navigation services

• Environmental approach activities

• Community-clinical linkage activities



• Describes strategies and activities that are achievable, appropriate to achieve the outcomes of the project, and evidence-based (to the degree practicable). (0-10 points)

• Describes a defined target population using data to justify target population• Describes focus to reduce health disparities among defined population• Describes identification of and interventions for hard-to-reach women• Describes activities to provide screening and diagnostic services to

program-eligible women• Activities are achievable• Activities are evidence-based• Describes collaborative activities with other programs to achieve project

outcomes• Describes activities with external partners, especially non-traditional

partners



• Shows that proposed allocation of resources is an efficient and effective way to achieve their expected outcomes. (0-2 points)


Approach (35 points)• Presents a work plan that is aligned with the strategies/activities,

outcomes, and performance measures in the approach and is consistent with the content and format proposed by CDC. (0-10 points)

• Objectives are SMART (Specific, Measurable, Achievable, Realistic, Time-phased)

• Objectives listed for each primary strategy environmental approaches health-systems changes community-clinical linkages

• Show use of data sources with baseline data • Identifies person responsible for monitoring objectives and activities • Includes cross-cutting strategies (collaboration, partnerships, and

evaluation) under each primary strategy


Approach (35 points)• Provides letters of support stating organization’s role

in helping applicant to achieve the FOA activities and outcomes. Letter must be dated within 30 days of the application. (0-4 points)

• Letters are signed

• Letters are dated within 30 days

• Letters state organization’s role


Evaluation/Performance Measurement (25 points)

• Shows/affirms the ability to collect data on the process and outcome performance measures specified by CDC in the project description and presented by the applicant in their approach. (0-9 points)

• Describes collection and submission of client-level data in Minimal Data Elements

• Describes submission of annual grantee survey data

• Describes collection and submission of clinic-based data such screening rates and population reach



• Describes clear monitoring and evaluation procedures and how evaluation and performance measurement will be incorporated into planning, implementation, and reporting of project activities. (0-6 points)

• Evaluation plan clearly describes evaluation questions and type of evaluations

• Applicant includes list of stakeholders

• Describes use of program specific logic model

• Describes data collection and analysis plans

• Describes how evaluation findings will inform program planning



• Describes how performance measurement and evaluation findings will be reported, and used to demonstrate the outcomes of the FOA and for continuous program quality improvement. (0-6 points)

• List performance measures

• Describes use of program evaluation data

• Describes dissemination of evaluation findings



• Describes how evaluation and performance measurement will contribute to developing an evidence base for programs that lack a strong effectiveness evidence base. (0-2 points)

• Describes any evaluation studies they are to undertake. Describe in sufficient detail to identify the key evaluation questions, and data sources and analysis methods. (0-2 points)


Organizational Capacity (40 points)

• Demonstrates relevant experience and capacity (management, administrative, and technical) to implement the activities and achieve the project outcomes. (10 points)

• Describes having subject matter expertise to plan and implement strategies

• Experience using population-level data for program planning and assessment

• Experience with implementing systems-level programs to increase cancer screening



• Demonstrates relevant experience and capacity (continued)

• Experience coordinating with at least 2 other chronic disease program and external partners

• Demonstrates access to health system data such as clinic, Medicaid, hospital, etc.

• Demonstrates established or newly built partnerships with health systems, community-based organizations, and other relevant organizations

• Describes ability to use fiscal system to ensure timely reimbursement, for tracking expenditures, and for accurate reporting of expenditures to CDC



• Demonstrates previous experience implementing a breast and cervical cancer screening program. (5 points)

• Demonstrates experience and capacity to implement the evaluation plan. (10 points)

• Program Evaluator has education and experience in evaluation studies, designing evaluations, developing data collection instruments, data collection, data analysis, and creating data reports.



• Provides a staffing plan and project management structure that will be sufficient to achieve the project outcomes and which clearly defines staff roles. (15 points)

• 0.5 FTE Program Manager

• 0.5 FTE Data Manager

• 0.5 FTE Program Evaluator

• Identifies at least one medical advisor with expertise in breast and cervical cancer screening to serve as clinical consultant

• Describes other relevant staff

• Provides an organizational chart

• Provides CVs


Budget (0 points)

• Budget aligns with the proposed workplan• Included required core staff (0.5 FTE Program Manager,

0.5 FTE Data Manager, 0.5 FTE Program Evaluator, Medical Advisor)

• Included travel for one Reverse Site Visit and the 2017 Cancer Conference / DP17-1701 Program Kickoff Meeting

• Submitted a completed Clinical and Non-Clinical Services Budget Breakdown Worksheet is included (may be in Project Narrative)


Budget (0 points)

• Submitted a completed Screening and Diagnostic Worksheet is included (may be in Project Narrative)

• Proposed no more than 10% requested federal funds for administrative expenses

• Documented required Match of $1 for every $3 of federal funding including sources and estimated amounts

• Up to $200,000 of match is waived for Guam, U.S. Virgin Islands, American Samoa and the Commonwealth of the Northern Mariana Islands

• Provided Maintenance of Effort amount• Budgeted for modifications to existing data management

system to support MDE updates, if needed


“The Point Of It All”

• Make sure that women get appropriate breast and cervical services and live healthier lives

• Maintain strategies and activities to fit the changing health care environment.

• Collaboration and partnerships are important because we all can leverage finite resources and have a wider population reach.


Point of Contact

Jennifer WebberGrant Review ManagerCoE/ARM Services

Email: [email protected]: 703.248.2084

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Go to the official source of cancer prevention information: www.cdc.gov/cancer.

@CDC_Cancer

CDC Breast Cancer

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http://www.cdc.gov/cancer

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