The Value of Partnerships:Advancing Our Efforts Through Collaboration

ICC Cancer SummitOctober 3-4, 2011

Lorrie Graaf, American Cancer SocietyBobbie Bohnsack, American Cancer Society

Chris Espersen, Primary Health Care, Amy Fletcher, Telligen

Session Objectives

• Gain a better understanding of how to leverage existing partnerships to increase cancer screening rates.

• Receive the tools and resources available for assessing readiness for policy and systems change.

• Identify ways community health centers, health care systems, and providers can implement the cancer screening toolkit in their practices.

What is Collaboration?ProcessIncludes• Exchanging Information

• Enhancing Capacity

• Sharing Resources

• Improving OutcomesCommon Purpose and Mutual Benefit

Collaboration Benefits• Align similar goals and objectives• Coordinate efforts to reach similar populations• Identify common problems and gaps and

opportunities for addressing them • Become effective and efficient • Solve similar problems together• Learn from each other

It’s already happening in many communities!

Collaboration ComponentsPriority Activity

Joint Work Plan

Resource Leverage

Policy Related Activity

Data SharingProgress Tracking and Reporting

In SummaryCollaboration is a:• Process• Way to enhance capacity to achieve common

goals• Means to promote collective thinking and

problem solving• Way to stretch resources while creating greater

impact

The Value of Partnerships:Advancing Our Efforts Through Collaboration

How to Increase Preventive Cancer Screening Rates in Practice

Bobbie Bohnsack, MHADirector, Community Partnerships

American Cancer Society, Health Equity Department

Toolkit Overview

• Developers

• Wide dissemination

• Purpose

• Multiple versions

Make a Recommendation

The primary reason patients say they

are not screened is because a doctor did not advise it..

Develop a Screening PolicyCreate a standardized course of action.

Measure Practice Progress

Establish a baseline screening

rate and set an ambitious practice

goal.

Be Persistent With Reminders

Track test results and follow-up with providers and patients.

Essential Tools: Tools that Save Lives

Essential #1: Make a Recommendation– Assessment of patient readiness– Provide educational materials– Community outreach to underserved

populations

Essential Tools: Tools that Save Lives

Essential #2: The Office Policy/Screening Policy

– Vital component

– Allows for a systematic approach

– Training recommendations

– Examples included in toolkit, multiple options for customizing

Essential Tools: Tools that Save Lives

Essential #3: Office Reminder Systems

– Cues to take action

– Can be directed at patients, clinicians, or both

– Can be simple, or complex, with the more complex systems having the greatest benefit

– Physician and patient reminders are critical

Essential Tools: Tools that Save Lives

Essential #4: Effective Communication System

– Maximizes what little time there is with patients, increasing clear delivery of advice

• Staff Involvement

• Tracking

• Measuring Progress

Well thought out, planned communication strategies save time, resources, and LIVES.

Interactive Web-Based Version

Resources• www.cancer.org

• www.canceriowa.org

• www.cancer.org/webmd

Questions?

Bobbie Bohnsack, MHADirector, Community Partnerships

American Cancer Society, Health Equity Dept.bobbie.bohnsack@cancer.org

Phone: 515-727-0063

The Value of Partnerships: Advancing Our Efforts through Collaboration

Chris Espersen, Primary Health Care Inc

Overview• FQHC• PHC• Goals and Objectives of PHC-ACS Partnership• Using the Toolkit in CHC setting• Outreach efforts

Federally Qualified Health Centers• 1960s War On Poverty• Quality care as a right for all regardless of

ability to pay• Serve 19 million annually• 40% uninsured• 1/3 are children• 1 in 19 people in US rely on an FQHC for

primary care

Primary Health Care, Inc• Four medical clinics (3 in Des Moines, 1 in

Marshalltown)• Pediatrics, OB/GYN, internal medicine, family

practice, HIV, dental, mental health, supportive services, pharmacy

• 25,000 patients, 90K+ visits– ¼ homeless– 53% uninsured– 50% minority (Polk County=19.3%)

– Refugee influx

Goals and Objectives• Baseline data• Increase screening rates• Outreach to 1000 women

Make a Recommendation• Provider knowledge, attitude and beliefs

survey• Training• Tracking plan!

Develop a Screening Protocol• Initial check in

– Providers– Patients

• Documentation• Involving ALL staff

Be Persistent With Reminders• Referral coordinator• Workflow• Tracking referrals

Measure Practice Progress• Monthly chart pulls

– N=70• EMR data collection plan

– universal

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CBEs

Community Outreach• Preventive Care and Medical Home• Care Coordination and Communication outside

the clinic walls• Passion:

– “I really liked the training and I learned a lot. With the information given I think it will give me a great start to be a community outreach worker by having the ability to have a positive effect on the African American community. I think it is important to get the message out.”

The Value of Partnerships: Advancing Screening Efforts Through Participation

Amy Fletcher, TelligenOctober 4, 2011

Background• Colorectal cancer is the most common

malignant cancer diagnosed among Iowans• It is the second leading cause of cancer death• 95% are 50 years of age and older

University of Iowa College of Public Health: State Health Registry 2011 Cancer in Iowa Report

BackgroundGood News• Over the last two decades incidence rates have

decreased 18%• Mortality rates have declined over 30%Bad News• According to the 2008 Iowa BRFSS reports 59.8% of

Iowans 50 years and older were screened by any appropriate method with the proper time frame

University of Iowa College of Public Health: State Health Registry 2011 Cancer in Iowa Report

Partners CollaborateCommon goal to increase CRC screening ratesin primary care practices• Iowa Cancer Consortium – Barriers to

Screening Workgroup• American Cancer Society• Telligen – Quality Improvement Organization

FIT Kit ProjectEach provider site received• 200 Fecal Immunochemical Tests with stamped

envelopes• Reagent• Toolkit with letter template and stamped

envelopes• ACS brochures and instructional DVD• Tracking log• Educational material for staff

Why Focus on Primary Care?• Primary care physicians have it in their power

to improve the screening rates• 80 – 90% of people over age 50 see a

physician each year

MethodThe project was based on the four essentials from the National Colorectal Cancer Roundtable’sHow to Increase Colorectal Cancer Screening Rates:• Physician recommendation• Office screening policy• Patient reminders• Practice progress measurement

Physician Recommendation• The most consistently influential factor in

cancer screening• Participating physicians were asked to discuss

CRC screening with all eligible patients

Office Screening PolicyOffice staff were encouraged to develop processes to increase patient compliance• ACS patient education material reinforced

physician recommendation• Best practice

• Follow up phone calls to patient

Patient Reminders• EHR reports identified patients overdue for

CRC screening• Reminder letters sent• Patients were given a FIT kit or

recommendation for another screening option

Results• Data shows a screening rate increase of 9.8%• Individual provider rates were as high as

16.4%• 57% of FIT kits distributed were returned

Questions?

Thank you for participating in the Cancer Summit 2011!