Workshop - smhs.gwu.edu · 80% by 2018 FORUM III Workshop: Increasing Screening in Community Health...
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80% by 2018 FORUM III Workshop: Increasing Screening in Community Health Centers Decatur A
Transcript of Workshop - smhs.gwu.edu · 80% by 2018 FORUM III Workshop: Increasing Screening in Community Health...
80% by 2018 FORUM III Workshop:
Increasing Screening in Community Health Centers
Decatur A
Increasing Screening in Community Health Centers 80 by 2018 CRC State Teams’ Forum September 6, 2017
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Jannette Dupuy, Phd, MS - HRSA Faye Wong, MPH - CDC
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Increasing Screening in Community Health Centers
Welcome & Introductions
Colorectal Cancer Screening Rates in Health Centers: 2016 UDS Data (Jannette Dupuy, Phd, MS)
CDC’s Colorectal Cancer Control Program (Faye Wong, MPH)
Group Activity • Instructions/Discussion • Report back
Wrap up
Objectives • Describe FQHCs and Colorectal
Cancer • Describe CDC’s Colorectal
Cancer Control Program • Discuss activities to increase
colorectal cancer screening
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Faye L. Wong, MPH Chief, Program Services Branch
CDC’s Colorectal Cancer Control Program
September 6, 2017
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Objectives
• To present an overview of…
• CDC’s Colorectal Cancer Control Program (CRCCP)
• CRCCP year 1 findings and some lessons learned
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CDC currently funds 30 CRCCP grantees
23 states 6 universities 1 tribe
CDC DP15-1502 CRCCP Grantees
Presenter
Presentation Notes
Current program funds universities in addition to more traditional state health department grantees.
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The program consists of two distinct components:
Component 2 6 Grantees Only
Provide high quality CRC screening, diagnostic, patient navigation, and other support services to eligible patients. Patient eligibility criteria: • Un- or underinsured • <250% of the federal poverty level • 50-64 years-old
Component 1 All 30 Grantees
Partner with health systems to implement evidence-based interventions (EBIs) and supportive activities (SAs). EBIs: • Patient reminders • Provider reminders • Provider assessment & feedback • Reducing structural barriers
SAs: • Small media • Patient navigation/community health workers • Provider education
What does CRCCP evaluation data tell us so far?
PY1 PY2 PY4 PY3 PY5
We are here
Our data are here
We’ve got a lot of program left to evaluate!
Presenter
Presentation Notes
Baseline and annual clinic screening rates Annual health systems’ survey Cost study Case studies
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In Program Year 1, CRCCP grantees have partnered with a number of health systems and clinics.
413 Clinics
140 Health
Systems
3,438 Providers
706,128 Patients,
aged 50 to 75
Presenter
Presentation Notes
MOUs required Grantees can continuously add health systems clinic partners
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CRCCP grantees are partnering with the right clinics.
413 CRCCP Clinics
72% are Federally-
Qualified Health Centers (FQHCs)
46% serve high
percentages of uninsured patients
(≥10%)
53% use FOBT/FIT tests as the primary CRC screening test type
A closer look at CRCCP partner clinics:
Presenter
Presentation Notes
Why do thieves rob banks? 33% used colonoscopy as the primary test
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CRCCP clinics across the US: Grantees are primarily working with FQHCs.
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Source: Clinic data submission, Component 1 only, all 30 reporting, April 2017
Presenter
Presentation Notes
Grantees are primarily working with FQHCs (70%) Health system (14%) Private (6%) Other (6%) Tribal health (5%) Health dept (0.4%)
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In Program Year 1, grantees implemented or enhanced a variety of EBIs and SAs.
113
58
113 110
153
36
70
100
189
139
155
109
132
12
111
138
0
50
100
150
200
250
300
PatientReminders
ProviderReminders
ProviderAssessment and
Feedback
ReducingStructuralBarriers
Small Media CommunityHealth Workers
PatientNavigation
ProviderEducation
# of
clin
ics
Implemented new activity
Enhanced existing activity
Supporting Activities Priority EBIs
Presenter
Presentation Notes
Enhanced existing activity: activity was in place at baseline BEFORE CRCCP activities started in the clinic and clinics used CRCCP resources (e.g., funds, staff time, materials, contracts) during the program year to contribute to planning, developing, implementing, monitoring/evaluating or improving the activity. Implementing new activities: activity was NOT in place at baseline before CRCCP activities started in the clinic and clinics used CRCCP resources (e.g., funds, staff time, materials, contracts) during the program year to contribute to planning, developing, implementing, monitoring/evaluating or improving the activity. Implementing enhanced activities: During the first program year, most clinics enhanced existing EBIs and supporting activities. This makes sense because most of the clinics already had many EBIs and SAs in place at baseline before CRCCP activities started so they used CRCCP resources to enhance/improve them during this first year.
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CRCCP grantees’ also worked with a variety of non-health system partners.
Partner Activities The five most frequently reported activities were: 1. Provider education and
professional development. 2. Quality improvement. 3. Health information technology to
improve electronic health record systems.
4. Patient reminders. 5. Small media.
Grantees’ five most common partners:
Presenter
Presentation Notes
Many grantees partnered with non-health system partners. Most worked with ACS and State PCAs (Primary Care Associations). ACS: 25 grantees partnered with ACS. 7/25 used CRCCP funds to partner. State PCA: 16 grantees partnered with State PCAs. 9/16 used CRCCP funds to partner. Paid/Unpaid Partners Paid: Top activities were professional development/provider education, small media, quality improvement, patient reminders, and health IT. Unpaid: Top activities were professional development/provider education, quality improvement, patient reminders, health IT, and small media.
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What did CRCCP achieve in Year 1?
6% INCREASE
IN CRC SCREENING
RATES
413 Clinics
140 Health
Systems
3,438 Providers
706,128 Patients,
aged 50 to 75
Presenter
Presentation Notes
Note: 6 percent point increase is unweighted. Clinic Average Baseline Screening Rate = 33% PY1 Annual Screening Rate = 39% PY2 Target Screening Rate = 50%
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Year 1 findings:
• Increases in CRC screening was higher in:
• Urban and Metro clinics vs rural clinics
• Medium size clinics vs small and large clinics
• Clinic using FIT vs colonoscopy or FOBT
• Clinics with an internal CRC screening champion vs no champion
• Clinics with a written CRC screening policy vs no policy
• Most clinics received monthly implementation support
Presenter
Presentation Notes
Urban and Metro clinics vs rural clinics (+6.3 vs +6.1 vs +4.8) Medium size clinics vs small and large clinics (+8.9 vs +4.7 vs +4.1) Clinic using FIT vs colonoscopy or FOBT (+9.7 vs +4.2 vs +3.4; also, test type “varies” was +8.2 and unknown was +4.8) Clinics with an internal CRC screening champion vs no champion (+6.6 vs +4.0) Clinics with a written CRC screening policy vs no policy (+7.2 vs +2.7)
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Lessons Learned (so far):
Grantees successfully launched this evidence-based, public health model for increasing CRC screening rates in clinics serving high-need populations.
Grantees are targeting clinics with low screening rates and implementing EBIs and Supportive Activities.
Baseline data suggest potential for significant reach and impact as grantees recruit more clinics to participate.
Measurement and evaluation is important.
Funded and non-funded partners are critical to successful implementation.
Obtaining accurate screening rate data from EHRs is challenging.
The Big Picture of efforts to increase colorectal cancer
screening
Leveraging Partnerships
NCCRT >1000 80 by 2018 Partner-Signed
Pledges
CDC CRCCP 30 w/health systems
intervention $$
6 w/screening support $$
65 CDC CCC Grantees
33 CRC state teams
CCC National
Partners
A C A Prevention Benefits – covers CRC screening @ no cost
Private Sector • Insurers • Hospitals • GI specialists • Physicians • Venders • Others…
PCAs
HCCNs
PRCs/CPCRNs
Universities
80 by 2018 Screening Goal
ACS • Health Systems
Managers • Media and
Communications
NCI & NCI Cancer
Centers
HRSA FQHCs
9/2015: 11 CRC state teams 7/2017: 11 CRC state teams 9/2017: 11 CRC state teams
Presenter
Presentation Notes
80 by 2018 CRC state teams have a statewide and broad focus CRCCP deep dive interventions with designated health systems clinic partners 9/2015 Forum… 5 teams included 1502/903 CRCCP (CA, FL, MI, NY, SD) 3 teams included 903 CRCCP (AZ, GA, PA 7/18-19/2017 Forum… 5 teams included 1502 CRCCP (AR, DC, ID, RI, U of PR) 1 team included former 903 CRCCP (NE) 9/6-7/2017 Forum… TBD TBD
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 federal source of cancer prevention information:
www.cdc.gov/cancer
@CDC_Cancer Follow DCPC Online!
Colorectal Cancer Screening Rates in Health Centers: 2016 UDS Data
Jannette Dupuy, PhD, MS Team Lead, Accreditation and Patient Centered Medical Home Initiative, Quality Division Office of Quality Improvement (OQI) Bureau of Primary Health Care (BPHC) Health Resources and Services Administration (HRSA)
Health Center Program National Impact
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Source: HRSA 2015 Uniform Data System (UDS)
Presenter
Presentation Notes
UDS overview What is UDS?
Standardized annual (CY) report by health centers includes:
• Patients served • Types of services
provided • Provider Staffing • Clinical Quality
Measures (CQM) • Costs of providing
services • Revenue sources • EHR Capabilities
Clinical Quality Measures
Child/Adolescent BMI & Follow-up
Adult BMI & Follow-up
Childhood Immunization
Tobacco Screening &
Cessation
Asthma & Meds Ischemic Vascular Disease: Therapy
Colorectal Screening Cervical Screening
Coronary Artery Disease: Lipid
Therapy
Early Entry into Prenatal Care Low Birth Weight Hypertension
Control
Diabetes Control Depression Screening
HIV Linkage to Care
Dental Sealants (NEW)
Presenter
Presentation Notes
Section K: Colorectal Cancer Screening (Line 19) Adults age 51 through 74, who had at least one medical visit during the reporting period, are reported on Line 19. For the purposes of this year’s reporting this includes medical patients whose date of birth is between January 1, 1941, and December 31, 1964. • Numerator: Number of patients aged 51 through 74 with appropriate screening for colorectal cancer • Denominator: Number of patients who were aged 51 through 74 at some point during the measurement year, who had at least one medical visit during the reporting year. • a colonoscopy after January 1, 2006, or • a flexible sigmoidoscopy after January 1, 2011, or • a fecal occult blood test (FOBT), including the fecal immunochemical (FIT) test during the measurement year. The following CPT/CPT-II/ICD-9/ICD-10 codes will be useful in identifying meeting the measurement standard: • ICD-9 = 45.22 - 45.25, 45.42 - 45.43, V76.51 • ICD-10 = Z12.11 • CPT = 44150-44158, 44210-44212, 44388 - 44397, 45330 - 45345, 45355, 45378 - 45392, 82270, 82274, • CPT – II = 3017F
CQM: Colorectal Cancer (CRC) Screening
52.1%
30.2% 32.6% 34.5% 38.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
HP2020Baseline
2012 2013 2014 2015
CRC
Goal: 70.5%
Presenter
Presentation Notes
HCs continued to demonstrate improvements in this measure with an increase of 3.9% from 2014 to 2015. This QI is supported by the National Colorectal Cancer Roundtable, which was established by the American Cancer Society (ACS) and CDC in 1997, is a national coalition of: public organizations, private organizations, voluntary organizations, and invited individuals dedicated to reducing the incidence of and mortality from colorectal cancer in the U.S., through coordinated leadership, strategic planning, and advocacy. OQI is engaged in this national partnership. ACS staff supports health centers through practice transformation coaching and learning collaborative. Recently released our 2016 UDS data which revealed 39.9 % CRC screening across health centers
National Colorectal Cancer (CRC) Screening Rates in Health Centers –CY 2016 (39.9% among all 1,367 reporting program grantees)
CRC Screening by Sociodemographic
Patients Best Served in a Language Other than English
38.6% 34.2%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
CRC ScreeningRates
≥ Nat'l Avg <Nat'l Avg
Hispanic Patients Served
37.6% 34.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
CRC ScreeningRates
≥ Nat'l Avg <Nat'l Avg
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* 2015 UDS Nat’l Average: 22.8% *2015 UDS Nat’l Average:35.2%
Presenter
Presentation Notes
Patients Best Served in a Language Other than English 399 HC serving more patients than the national average did better 73.7% were participating in Health Center Controlled Networks 59.4%% Urban HCs 43.9% medium practice; 37.8% large practice by number of patients served Health Center Controlled Networks (HCCNs) bring health centers together for the purpose of strengthening quality of care and improving patient health outcomes by achieving meaningful use of Office of the National Coordinator (ONC)-certified electronic health records (EHRs), adopting technology and quality improvement strategies, and engaging in health information exchange (HIE). % Hispanic Patients Served 402 HCs serving more patients the national average did better 72.6% were participating in Health Center Controlled Networks 55.0% Urban HCs 42.5% medium practice; 40.8 % large practice by number of patients served
CRC Screening by Geography and Practice Size
Geography
35.5% 35.5%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
CRC ScreeningRates
UrbanRural
Patients at 100% and Below FPL Served
34.4% 35.8%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
CRC ScreeningRates
≥ Nat'l Avg <Nat'l Avg
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*2015 UDS Nat’l Average:70.9%
Presenter
Presentation Notes
Not statistically significant for both
CRC Screening by Practice Size
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29.3%
36.9% 38.7%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
CRC Screening Rates
SmallMediumLarge
Presenter
Presentation Notes
Small: TotalPat<=4858 Medium: 4858<TotalPat<22115 Large: >=22115
Modernize Care: PCMH Recognition
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Goal: All health centers are PCMH recognized
Next steps on your journey: • Optimize/enhance your PCMH
• Team based care • Integration of care • Patient engagement
• Engage with the Medical Neighborhood
• Care coordination
• Build Community Partnerships to address social determinants of health Housing Nutrition Education Social Services Aging & Disability Supports Transportation
PCMH & Quality Health centers that receive PCMH recognition generally performed better on clinical measures than health centers without PCMH recognition. http://www.ncbi.nlm.nih.gov/pubmed/27324440
Presenter
Presentation Notes
CRC Screening by PCMH or HCCN
PCMH Recognition Status
38.7% 32.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
CRC ScreeningRates
PCMHNo PCMH
Health Center Controlled Network (HCCN) Participation
35.9% 34.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
CRC ScreeningRates
HCCNNo HCCN
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CRC Screening by PCMH and HCCN
39.0% 37.2% 32.3% 32.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
CRC Screening Rates
PCMH+HCCNPCMH+NoHCCNNoPCMH+HCCNNoPCMH+NoHCCN
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Colorectal Cancer (CRC) Screening
80% by 2018 Public Health Campaign National Colorectal Cancer Roundtable initiative in which more than 1,000 organizations have committed to reducing colorectal cancer (CRC) as a major public health problem for those who are 50 years of age and older.
National PCA Efforts ◦ 30 PCAs committed to supporting colorectal cancer screening efforts through information dissemination, health collaboratives, and training and technical assistance
National Partnerships ◦ National Colorectal Cancer Roundtable ◦ American Cancer Society ◦ Centers for Disease Control and Prevention
Contact Information
Jannette Dupuy, PhD, MS Team Lead, APCMH Team, Quality Division, Office of Quality Improvement Bureau of Primary Health Care (BPHC) Health Resources and Services Administration (HRSA) Email: [email protected] Web: http://bphc.hrsa.gov/index.html Twitter: twitter.com/HRSAgov Facebook: facebook.com/HHS.HRSA
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Group Activity
