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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
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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!
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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
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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:
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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
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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
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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
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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:
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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
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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
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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
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)
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)
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%
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%
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%
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
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
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