80% by 2018 Blog
March 21st, 2017 :: Author: Erica Sutton, MD
On February 1, 2017, Surgery on Sunday Louisville, Inc. became an Honoree recipient of the 2017 80% by 2018 National Achievement Awards, a program designed to recognize individuals and organizations who are dedicating their time, talent and expertise to advancing needed initiatives that support the shared goal to regularly screen 80% of adults 50 and over by 2018.
Dr. Sutton is a graduate of Indiana University where she triple majored in psychology, chemistry and mathematics prior to entering the Johns Hopkins University School of Medicine. She completed her residency in general surgery at the University of Maryland followed by a fellowship in minimally invasive surgery also at the University of Maryland. Since coming to the University of Louisville in 2011, Dr. Sutton has served in many leadership roles related to educating the next generation of doctors and surgeons. In 2013, she founded Surgery on Sunday Louisville, Inc., a nonprofit organization whose mission is to provide free surgery and outpatient surgical procedures such as colonoscopy to people who are uninsured or underinsured.
Hi, Dr. Sutton! We’re excited to feature your work on the 80% by 2018 Blog. Can you tell us a little about yourself and how you ended up working on colorectal cancer screening?
I work as a laparoscopic surgeon at the University of Louisville in Kentucky. While colonoscopy and colorectal surgery are just two of many services I provide to my patients, I’m particularly passionate about colorectal cancer screening. In terms of the ability to prevent a cancer, there are few cancers more preventable than colorectal cancer. With routine screening, we’re able to remove cancer in its early stages or even before it has started.
While I’ve been passionate about colorectal cancer screening throughout my career, there was one patient in particular that pushed it to the forefront for me. A few years ago, one of my patients died of colorectal cancer. He was an amazing father with an indomitable spirit. The idea that his cancer could have been prevented never left me, so when I was approached to collaborate on a community-wide initiative to increase screening, it was an easy “yes” for me. This is a fight that I want to be a part of. This is a fight we can win.
Tell us a little bit about Surgery on Sunday Louisville, Inc. (SOSL). How did the organization get started?
SOSL was inspired by a Surgery on Sunday program that started in Lexington, Kentucky in 2005. In 2013, my colleague, Dr. Whitney Jones, founder of the Colon Cancer Prevention Project and gastroenterologist at Midwest Gastroenterology Associates, approached me with the idea to start a similar program in Louisville. However, our focus would be on providing colonoscopy since we had a groundswell of energy around colorectal cancer prevention in the community. We began as a small group wanting to make a difference and do the right thing for the city, but our small group grew quickly.
How does SOSL operate?
The organization is built on a collaborative model in which every hospital in the Louisville area shares a responsibility in providing in-kind services to members of the community who could not otherwise afford care. The focus is colonoscopy, but we also provide all outpatient surgical procedures and some in-patient procedures, including pediatrics, orthopedics, laparoscopy and plastic surgery. Each month, we rotate locations to provide services at a different hospital. Endoscopies are performed every other month, but we hold clinic twice monthly to provide pre-endoscopy consultation, education and follow-up care after the procedure.
Early on, we decided to form a non-profit since it was clear that our work wasn’t going to be at a single hospital or academic institution. Our 501c3 non-profit status has given us enormous flexibility to grow the way we needed to. In our second year, while planning for growth and sustainability, we partnered with a consultant to develop a business strategy.
Who participates in delivering and coordinating screening services?
Most people are surprised to learn that SOSL started with just as many non-health care partners as health care partners. In addition to physicians, nurses, and hospital administrators, we’ve had lawyers, marketing professionals and students at the table from the beginning.
In the early days, the organization consisted of me, Dr. Sam Walling as medical director, and our volunteer board. We quickly learned we needed staff in administrative roles and a medical organizer. We’ve hired two additional employees since then: a program coordinator to support me with the administrative work and a clinical coordinator to support our medical director.
What do you attribute to your success in recruiting so many volunteers?
We are collaborative in the truest sense of the word–we look for partnership with anyone and everyone. Moreover, we don’t say no to help, even when we must work to identify a role for a new volunteer. We believe everyone’s idea is valid and can add to our growth. Recently a student wanted to get involved in SOSL, so we identified a role for them as a grant writer. Only three months into 2017, we’ve already submitted our third grant application!
I think a secret to success in engaging so many partners is that Louisville is truly a caring and compassionate community. We’ve heard from many of our volunteers, especially the clinicians, that they had been looking for a way to give back. If you provide the opportunity, you may be surprised with the untapped potential you’ll find.
Tell us about the impact that your making in the local community.
Since its founding in 2013, Surgery on Sunday Louisville, Inc. has recruited over 500 volunteers to treat more than 270 patients, which led to the treatment of over 125 polyps and two cancers. More critically, the patients we treat are at increased risk; in Kentucky, patients who lack insurance have more than twice the odds of being diagnosed with advanced colorectal cancer.
In addition to our colonoscopy work, other diseases and health concerns we’ve treated include hernias, melanomas, pediatric burns and gallbladder disease.
What have you done to measure the sustainability of the program?
What’s really exciting is that we’re now demonstrating that the program is cost neutral. We conducted a study to test our hypothesis that providing pro bono colonoscopies to uninsured patients at high-risk for colorectal cancer successfully detects early stage disease and is thus cost-effective.
For 12 months, we prospectively collected data from 682 high risk patients (35 to 64 years old) that received free colonoscopy. We then compared the incidence of colorectal cancer within our cohort to a control group of uninsured patients from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program registry, using SEER-Medicare data of health expenditures by colorectal cancer stage to develop a cost model. To compare overall costs between our cohort and the SEER control, the average initial cost of care was weighted by the stage-specific colorectal cancer incidence in each group. We identified nine cancers in the 682 patients, resulting in an overall incidence rate of 1.3%. Compared with the SEER control, our cohort included more early stage cancers and subsequently had a marginally lower per-patient initial cost ($43,126 vs $43,736).
The study is limited since the sample size is small, but it provides proof of concept that providing pro bono care can be cost neutral. More importantly, we’re reducing suffering and saving lives by catching cancers earlier, which we believe is truly invaluable.
I understand you’re now helping other communities to replicate this model.
That’s right. We’re now assisting communities in other states to replicate the SOSL model. In the past few weeks we traveled to Indiana and Boston, Massachusetts to share our successes and lessons learned. We’re also working with the University of Louisville School of Business to develop a replication model. The school identified a team of entrepreneurial students to develop a 12-page blueprint on how to franchise our model.
What lessons learned would you share with others that are interested in forming community partnerships to offer donated screening services?
Stick to the sincerity of your idea and do not stop because someone tells you no. We’ve heard “no” so many times, but over time, we’ve learned to ask different questions. Instead of can I or would you, we ask how can we. We state our goal and then we ask a “how” question for a very specific next step, such as: “We want to provide free colonoscopies to high risk people in our community who don’t have insurance. How can we get your hospital to donate their endoscopy suite? How can we make that a possibility?” Make the ask simple and concrete. It will be hard to say no!
Do you have any final tips for our readers that are working to achieve 80% by 2018?
If you really want to see the rate of deaths and illness from colorectal cancer reduced in your community, show everyone how they share in the responsibility. By showing everyone their role in your vision—physicians, hospital administrators, students, lawyers, your mayor and more—you make it their vision, too.
Thank you for sharing your story with us! We look forward to hearing more about your work and Surgery on Sunday Louisville’s progress in the future.
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February 28th, 2017 :: Author: Andrew Albert, MD
On February 1, 2017, Advocate Illinois Masonic Medical Center became the Grand Prize recipient of the 2017 80% by 2018 National Achievement Awards, a program designed to recognize individuals and organizations who are dedicating their time, talent and expertise to advancing needed initiatives that support the shared goal to regularly screen 80% of adults 50 and over by 2018.
Dr. Andrew Albert is Medical Director of Digestive Health at Advocate Illinois Masonic Medical Center and Advisor to the NCCRT 80% by 2018 Hospital and Health System Initiative. He grew up in Hewlett, New York and attended Brandeis University after high school. He went on to George Washington University School of Medicine to complete his MD and MPH degrees and was subsequently appointed Associate Chief Resident at Boston Medical Center. He went on to complete a Gastroenterology fellowship at Loyola Medical Center and was selected to participate in the University of Chicago’s inflammatory bowel disease program. He is Board Certified in Gastroenterology and has lectured extensively within the community. Connect with Dr. Albert on Twitter at @DrAndrewAlbert.
Hi, Dr. Albert! We’re excited to feature your work on the 80% by 2018 Blog. Can you tell us a little about yourself and how you ended up working on colorectal cancer screening?
I’ve been an attending gastroenterologist for 10 years and have a passion for colorectal cancer screening. As a gastroenterologist, I perform colonoscopies on a daily basis, but there was one day a few years ago when I had to look three patients in the eye and share the news that they were facing colorectal cancer, a disease that in many cases can be caught early, and sometimes even prevented, with routine screening. I wanted to do something about it, so I started providing ongoing education for physicians at my hospital with a lecture series during National Colorectal Cancer Awareness Month. Over time, I started participating in community health fairs and was called on to represent the hospital on TV when we had the opportunity to share a call to action to get screened with the local community. But my role as a colorectal cancer screening advocate really kicked into high gear when we learned about the 80% by 2018 initiative and enthusiastically signed the pledge. This is when our team came together to rally toward this important goal.
Tell us a little bit about Advocate Illinois Masonic Medical Center.
Advocate Illinois Masonic Medical Center, located on Chicago’s North Side, is one of the state’s largest nonprofit medical centers. The hospital is part of Advocate Health Care’s 13-hospital network, which serves 3.4 million patients at over 250 sites of care. Advocate Illinois Masonic is a 408-bed teaching hospital, and our 900 physicians conduct over 180,000 outpatient visits each year. We’re a city hospital, which means we treat everyone that walks through the door–regardless of insurance status. Our patient population is incredibly diverse: the communities we serve range from wealthy residents along Chicago’s lakefront to areas where over 20% of the population is living below the poverty level. Advocate Illinois Masonic is surrounded by academic medical centers in all directions, but we’ve been able to compete and succeed in this competitive landscape. We’re proud to share that our cancer treatment program has been accredited by the
American College of Surgeons Commission on Cancer and that we’ve been ranked one of Chicago’s Best Hospitals by U.S. News & World Report for the past five years.
When and why did Advocate Illinois Masonic Medical Center decide to focus on increasing colorectal cancer screening?
Our hospital had been increasing our focus on colorectal cancer screening for some time, but starting in 2014 a number of factors came together to push this focus to the next level. First, we learned that Advocate Illinois Masonic was not meeting the standards for screening set under our new structure as an accountable care organization (ACO). Our screening rate in 2014 was approximately 25%. Not only were we not meeting the ACO standards, we were not meeting the needs of our community. At that time, Advocate Illinois Masonic had recently created a service line leadership infrastructure to progress the goals of the Center for Digestive Health we have today. This includes an Administrative Director, Lab Manager, Medical Director, Surgical Director, and RN navigator. With the help of Jessica Smith and Meg Fischer of the American Cancer Society in Chicago, we began implementing changes to increase our rates. Then, in 2015, Jessica brought the 80% by 2018 initiative to our attention. We enthusiastically signed the pledge, and were so fortunate to have Dr. Richard Wender, Chief Cancer Control Officer of ACS and Chair of the NCCRT, come and speak to staff from across the 13-hospital network. This is when the hospital truly embraced a focus on colorectal cancer screening, from administrative staff all the way up to senior level leadership, and we doubled down on our efforts.
What activities and systems changes did you implement, and how did you choose them?
We started looking closely at things we could do to not only increase our patients’ willingness to get screened, but to also make sure they were well supported from the moment they were recommended screening and through all necessary appointments and diagnostic workups. We decided to build a fully navigated Direct Access Screening Colonoscopy (DASC) program. We mobilized partners from surgery, gastroenterology, hospital administration and other departments to design the program, which allows primary care and specialty providers to refer patients directly for colonoscopy to the hospital, creating seamless access to screenings. Patients can also contact the program directly. As part of the program, nurse navigators schedule exams, review instructions with the patients, and follow up with patients to share the results. This helps minimize confusion and gives patients a point person to go to with questions. We also started offering appointments on Saturdays to make it easier for patients that have trouble taking off work during the week. Our focus has been on reducing barriers and identifying patients who have not been screened in the past.
More recently, we secured grant funding to offer fecal immunochemical tests (FITs) to patients who would otherwise be unable to afford screening. We are distributing the FITs to local Federally Qualified Health Centers (FQHCs), and Advocate Illinois Masonic’s charity care program provides follow up colonoscopies for the patients that get a positive result. We also continue to speak at community events and health fairs focused on our LGBTQ and Latino populations through our HispanoCare Program.
Watch this short video to see Digestive Health doctors and staff address patient concerns to break down barriers to screening.
What success have you seen? How did you measure that success?
In less than three years, we’ve increased our mid-year screening rate from 25% to 60% in our 50-65-year-old patients, and from 17% to 70% among patients ages 65 and older. What’s truly exciting: our end of the year rates are nearing 80% among patients ages 65 and older! While the DASC program improved our screening rate, it has also brought additional benefits, including: colonoscopy wait time shrunk from over two months to two weeks, we’ve decreased loss to follow up, our adenoma detection rate has improved and patients are happier with the more efficient, streamlined and patient-centered care. In just one and a half years, we’ve navigated 800 patients through the program, resulting in the diagnosis of seven unanticipated cancers. We’re finding cancers that might otherwise have gone undiagnosed until a later stage.
And our providers are happier, too. Our cross-disciplinary approach to designing the DASC program broke down some of the silos that you often see between departments. We’re all invested in the cause and share in the satisfaction that we’re taking better care of our patients.
Are there plans to implement these changes across the Advocate Health Care system?
Our work began as an Advocate Illinois Masonic initiative, but we’re now working across Advocate Health Care’s 13-hospital system to implement changes system-wide. We have the full support of Advocate Health Care’s executive team, and they’re even going so far as to raise the system wide goal toward 80%. My team is being asked to share lessons learned across the hospital network, codifying Advocate Illinois Masonic’s success as the model for the entire system. Dr. Joaquin Estrada, a colorectal surgeon and Digestive Health Surgical Director, will often say: “We’re going to figure it out and we’re going to do it well; it just has to be done. Let’s take the impossible and make it possible.”
But we don’t want to stop there. We’re also helping others; whether hospitals or health systems to strive for 80% and identify strategies that are unique to their individual populations. Our Administrative Director, Jequeatta Upton Smith will often say, “A rising tides floats all boats.” We want to do everything we can to help others succeed. By working together, we can stomp out this disease.
What lessons learned would you share with others that are working to increase colorectal cancer screening in hospital settings?
Results don’t come overnight. It takes a lot of patience, ongoing communication, and engagement from all stakeholders to be a true success. Dream big and engage as many people as possible in your efforts, and never be afraid to think outside the box to try something you’ve never done before. Every day we love going to work because we feel like we’re doing the right thing. You never know what will become a wildfire and spread.
Were there tools, trainings or resources that you found helpful?
Working together with Dr. Wender, Jessica and Meg from ACS has been a huge help. They helped us identify places where we could make early gains, which helped us get buy-in to devote more staff and resources to the effort. They’ve spoken at hospital meetings and have continually brought new ideas to the table. This personal engagement from ACS has been one of our most important tools.
I’m now serving on an NCCRT advisory work group to develop a handbook of best practices to increase colorectal cancer screening for hospitals and health systems. We’re excited to share what we’ve learned with other hospitals that are just starting their efforts.
Do you have any final tips for our readers that are working to achieve 80% by 2018?
Anyone can do this. You just need to get the right people together. And never lose sight of what you’re working to achieve. Stay the course no matter how hard it may be, because in the end, everybody wins.
Thank you for sharing your story with us! We look forward to hearing more about your work and Advocate Illinois Masonic Medical Center’s progress in the future.
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February 17th, 2017 :: Author: Danielle Ripley-Burgess
Danielle Ripley-Burgess is a two-time colon cancer survivor first diagnosed at age 17. She has Lynch syndrome and is currently in remission. She works as the Director of Communications for Fight Colorectal Cancer.
Colorectal Cancer Awareness Month is like a second holiday season for me and my colleagues at Fight Colorectal Cancer (Fight CRC). And it’s not just because I’m a colon cancer survivor (although all of the blue does add special meaning for me).
I love it when the big cancer spotlight turns on colorectal cancer and the world starts seeing what we think about and work on all year long.
The stories of strong survivors. The passion of researchers and doctors. The quest to find and remove polyps before they become cancer. The information about prevention with the hopes that someone’s life will be spared a cancer diagnosis.
It’s what we live for, it’s what I love, and March is when it all comes together.
Kicking off March 2017
As March 2017 nears, I’m very excited that our team at Fight CRC is partnering with NCCRT, the American Cancer Society, Mayo Clinic and Exact Sciences to present the Countdown to 2018 – an event that will broadcast from Times Square the afternoon of March 1.
Together as a nation we’ll come together and commit to seeing fewer cancer cases and more screenings. The live broadcast is sure to inspire and encourage. To register and for details, go to CRCcountown.org.
Share your Screening Story!
In addition to our live broadcast, we’re launching a social media project for March called Screening Stories. We want to take away the mystery about screening! We know those who have not been screened may be afraid of the test itself or may not appreciate the life-saving potential of screening. Hearing from you about screening success stories can help! The best way to do that? Social media, of course!
If you’re in the fight against colorectal cancer, join us in March and make plans to post a Screening Story.
Here’s how to participate:
HOW TO SUBMIT A STORY
Starting now and throughout March, please share your screening stories on social media. Organizations can also participate by sharing any public service announcements that they have created that talk about the benefits of screening. We’ll choose some to highlight in the lead up to our Countdown to 2018 live stream that we’re broadcasting to hundreds of thousands of followers!
Here’s how to share your screening story:
1. Come up with your story idea. Ideas:
- What led you (or a patient) to get screened
- How screening saved your life, or someone else’s life
- Tips for getting screened
- Explain your role in prevention
- Successes in your state, region or organization
- Use an existing video or public service announcement if you or your organization has one!
2. Decide how to tell your story on social media. Ideas:
- Write a blog post (If you want to guest blog for Fight CRC contact us!)
- Make a video and post it on YouTube or use an existing video or public service announcement
- Do a Facebook Live or Periscope video
- Post a series of photos on Instagram or go live
3. Share and hashtag your story
- Share your story or public service announcement on social media – we recommend Facebook and Twitter!
- Hashtag your post with #80by2018 and #ScreeningStory
- Search for other posts with the hashtag and share
We’ll be watching for your screening stories! Let’s create conversations and save lives together!
4. Spread the Word about March 1
On March 1 celebrities, experts and survivors will kick off Colorectal Cancer Awareness Month during the Countdown to 2018. We have one year left to reach our goals and see 80% of people screened by 2018!
To let people know to tune in, please add this call-to-action to the end of your story if you post before March 1:
Don’t miss it! Tune in on March 1 to watch the nation kick off Colorectal Cancer Awareness Month from Times Square! Get details: CRCcountdown.org
5. Be part of the chorus!
Additionally, Stand Up To Cancer co-founder, Katie Couric, will be posting a celebrity “get screened” video-of-the-day throughout March on Instagram. At the same time, this content will be available on SU2C’s YouTube channel.
We’re fortunate there are more than 31 of these videos, so during the month, others will be posted at SU2C’s Facebook, Twitter and Instagram channels.
We’re looking forward to you following and sharing these celebrity “get screened” videos on social media all month-long for important colon cancer screening info.
Share Your Screening Story is a great way for us to join in this March chorus about the life saving benefit of screening and ensure that our families and friends can’t miss this message during the month of March.
Saving Lives One Screening at a Time
This March, I will be one of the over 1 million survivors posting about screening in hopes that others won’t face the same diagnosis I did. I hope you’ll join us and do the same. I’ve got my blue out and my stories ready, and I am ready to ring in another March and celebrate Colorectal Cancer Awareness Month!
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January 6, 2017 – Authors: Mary Doroshenk, Emily Bell and Dionne Christopher
Happy new year everyone! As we embark on 2017, we want to take the time to reflect on highlights from NCCRT’s 2016 Annual Meeting, which took place last November. While collaborative work is at the core of our shared goal to reach 80% by 2018, there were three speakers in particular who reminded us of the remarkable power we as individuals have to save lives from colorectal cancer. Many of us have looked to these individuals for inspiration and leadership, and we see three leaders who are honest, humble and brave.
Honesty. Sometimes in our lives, we hear something we need to hear, exactly when we need to hear it. That was the feeling in the room when Dr. Edward Partridge, MD, director, UAB Comprehensive Cancer Center of the University of Alabama at Birmingham spoke Thursday morning. Dr. Partridge, who has made social justice a cornerstone of his research, started his talk with a candid look at his own history growing up in the segregated South, culminating with his witness to the Freedom Marchers walking in one direction toward Selma, and the Klan headed toward Selma from the other. The weight of those challenges were in the room, as Dr. Partridge described his current work, serving the residents of the Mississippi Delta and Alabama Black Belt, where nearly two-thirds of African Americans live in poverty. Dr. Partridge inspired us all to look honestly at our challenges and at our past. It is only by looking at issues of trust, bias and power, can we move forward. Honesty.
Humility. Early the next day, Dr. Sidney Winawer, Paul Sherlock chair in medicine at Memorial Sloan Kettering Cancer Center in New York and American Cancer Society Medal of Honor recipient, was recognized with the NCCRT award for Distinguished National Leadership.
Dr. Winawer’s work on the National Polyp Study served as the catalyst for including colonoscopy in national screening recommendations, but perhaps equally important, Dr. Winawer set the tone for our efforts, acting as a true public servant, always putting the mission before his own self-regard. We all repeat Dr. Winawer’s words often, the best test is the one that gets done, and this simple statement is a gentle, constant reminder to us as a community to put aside competition, and work toward what is right. Humility.
Bravery. The meeting culminated with a heroic appearance from colon cancer survivor and Broadway actress Karen Walsh, who has turned her chemo treatments into opportunities for humor, creativity and awareness. She has undergone over 25 rounds of chemotherapy, each time photographed with friends in full costume embodying everyone from Princess Leia to Rosie the Riveter. As Ms. Walsh relayed, “It’s about changing the narrative of what’s actually happening and trying to transform that into something productive.” Ms. Walsh recently became NCCRT’s 80% by 2018 champion and received the American Cancer Society’s Mothers of the Year honor in October 2016, for using her platform to promote screening. She embodies why we do what we do. Ms. Walsh could have hidden her experience from the world. Instead, she pulls herself forward in an open and inspiring way, and thereby pulls us each forward, too. Bravery.
Each of these incredible leaders illustrate the power of what one person can do in the fight against colorectal cancer. We’re humbled by the incredible work that they’ve accomplished, and will reflect back on their stories for inspiration as we turn the corner toward 80% by 2018.
Happy new year from the NCCRT team!
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September 22, 2016 – Author: Andrea (Andi) Dwyer and Tamar Wallace
The Roundtable’s work would not be possible without the invaluable expertise offered by the volunteers that comprise its seven Task Groups: Community Health Centers, Evaluation and Measurement, Family History and Early Onset, Policy Action, Professional Education and Practice, Public Awareness and Social Media and Quality Assurance. In this series, we’ll hear from the co-chairs that lead the work of these groups. Today we will talk with the Evaluation and Measurement Task Group co-chairs, Andrea (Andi) Dwyer and Tamar Wallace, to learn about the exciting work that this group is tackling to advance colorectal cancer screening. Learn more about how the Roundtable works.
Andrea (Andi) Dwyer is a public health practitioner from the University of Colorado Cancer Center and Colorado School of Public Health. Also serving in a dual appointment with Fight Colorectal Cancer, as director of Health Promotion. Andi brings nearly ten years’ experience in colorectal cancer prevention and cancer survivorship. As one of her biggest accomplishments, serving as the Co-Director of the statewide colorectal screening program in Colorado and one of the largest screening patient navigation programs in the country.
Tamar Wallace is director of Strategy, Education, and Outreach in the Division of Gastroenterology at NYU Langone Medical Center. Tamar specializes in medical writing, editing, and education for health professionals, patients and families, and the public. She is co-chair of the Evaluation and Measurement Task Group for the National Colorectal Cancer Roundtable; a member of the steering committee of the New York Citywide Colon Cancer Control Coalition (C5); and a member of the American Congress of Obstetricians and Gynecologists’ Task Force on Colorectal Cancer.
Hi, Andi and Tamar! We’re happy to talk with you on the 80% by 2018 Blog. Can you tell us a little about your interest in colorectal cancer screening and how you ended up working with the Roundtable?
[Andi] I completely agree. I became active in the Roundtable in 2010 when the Colorado Colorectal Screening Program began making connections with Roundtable members and using Roundtable resources. I quickly became engaged in the Roundtable’s evaluation work, which has brought a lot of value to our efforts to evaluate our screening program here in Colorado. The Roundtable is perhaps the only place I can go to find resources that address the multi-faceted range of issues that comprise colorectal cancer screening. It’s also provided me with invaluable opportunities to network with colleagues working on similar issues, and fosters a spirit of collaboration that allows us to cross pollinate what’s working in our programs.
[Tamar] When we look at colorectal cancer—we see a cancer that is the second-leading cause of malignancy-related death in the US and yet a cancer for which screening is available and a cancer that is highly preventable with that screening. With the Roundtable being so dedicated to increasing colorectal cancer screening—and having such a vast and diverse collaboration of members committed to this effort—it was an easy decision for us to apply for Roundtable membership in 2003 and we were honored to be accepted.
Why is evaluation and measurement a critical topic to address in our efforts to increase colorectal cancer screening?
[Tamar] With our shared national goal to reach 80% screening in men and women aged 50 and older by 2018, we need to know where we are now, and where we are along the way, so we can plan how we’re going to get to 80%. It’s important for the Roundtable as a whole to be able to gauge the effectiveness of our national campaign—and also critical for individual members, partners, and collaborators to be able to determine how effective their efforts to increase screening are. And with this knowledge—we can work to increase successful efforts, improve our programs over time, and when needed, correct course. Plus, it’s just really fun to see the needle move—to know that together we are making progress and lives are being saved.
What are some of the issues and topics the Evaluation and Measurement Task Group has addressed over the years?
[Andi] In addition to creating the Toolkit, we hosted an Evaluation 101 webinar series covering topics such as colorectal cancer screening data sets, systems change and social media. Visit the NCCRT Webinar Archive webpage to find these and other webinar archives. The Evaluation and Measurement Task Group also provided input in developing the annual 80% by 2018 Partner Survey, which launched in the fall of 2015 and is just wrapping up this year. Finally, members of the task group provided input to task group member Ann G. Zauber, PhD, researcher at Memorial Sloan Kettering, on a poster describing 80% by 2018 progress to date presented at the annual Digestive Disease Week Conference in San Diego in May 2016.
[Tamar] When the task group first formed, we turned to the Community Guide to learn which interventions have a strong body of evidence to show they are effective in increasing colorectal cancer screening. We found that there were interventions, like the use of small media, that were recommended for efforts to increase screening for colorectal cancer. And there were other interventions for which there was not enough evidence in the literature to recommend them. We knew a lot of our members and colleagues who were doing great work, but it wasn’t being published. So we surveyed our members, and they overwhelmingly indicated that they could benefit from an Evaluation Toolkit for their projects to increase colorectal cancer screening. And thanks to the hard work of the Roundtable leadership and our task group members, the Evaluation Toolkit became a reality. People can now use this Toolkit to walk them through how to develop an evidence-based program, how to collect and analyze outcomes—and hopefully allow for increased publishing and sharing of this information. We continue to make updates to the Toolkit as needed, with the latest version slated to be released later this fall.
What is the Evaluation and Measurement Task Group currently working on?
[Tamar] As we mentioned before, we are in the middle of updating the Evaluation Toolkit. The original version focused on how to conduct evaluation of initiatives that increase the community demand for screening. We know that these days, our members are doing a much broader array of work, such as conducting practice change, systems change and policy work. The revised version will do more to explain how to evaluate these types of interventions. Additionally, we’ll provide more guidance on the existing colorectal cancer measurement sets and how to access them. Finally, we’re providing more concrete guidance on how to evaluate use of the tested health messages we recommend to our members. Even though these messages were based on market research, it’s important that our members continue to evaluate their use and how they are being received within the context of their own programs, interventions and communities.
In addition, the task group is providing strategic direction in NCCRT’s plans to build a searchable web repository of successful programs and evaluation tools to help support our collective efforts to reach 80% by 2018. This new web repository would allow partners to access materials from interventions that are being implemented in a real time community setting, coupled with evaluation tools that will help them assess that work. Stay tuned for more news on this project, as the Roundtable will be eager to hear from partners about the strategies and interventions that are working in your communities.
[Andi] Finally, several members of the Evaluation and Measurement Task Group are participating in a strategic planning session on evaluation and measurement of the 80% by 2018 effort. We’re taking a comprehensive look at all the data sources that will help us evaluate the initiative now and in 2018. We’re also looking at how we can capture the qualitative, anecdotal successes that really paint the picture of the remarkable work that’s coming out of this collective effort. One recent success we’re excited about is the jump we’ve seen in the UDS (Uniform Data System) screening rate among federally qualified health centers (FQHCs), also called community health centers. The UDS colorectal cancer screening rate has climbed two percentage points each year for the past three years. But in 2015, the rate jumped by nearly four points. This increase represents an additional 279,990 FQHC patients were screened for colorectal in 2015 as compared to 2014. It feels great to begin to see such promising gains in one of the key measures we use to evaluate our efforts.
What advice would you like to share with our readers as they evaluate and measure their own programs?
[Tamar] For some, evaluation is a scary word, but it doesn’t have to be. Evaluation is not pass/fail; it’s about helping you develop and improve your program. The Toolkit will help you put the steps in place to assess your progress and deliver on its promise.
[Andi] Don’t be intimidated. Everyone has to start somewhere, so don’t be daunted if you are new to the process. Even if you have no experience in evaluation, the Evaluation Toolkit can help you get started.
Are there key evaluation and measurement resources you recommend readers use?
[Andi] First and foremost, I recommend checking out the Evaluation Toolkit!
It’s organized in such a way that there’s something for everyone—newcomers and seasoned experts alike. We also recommend downloading the four Evaluation 101 learning models available on the same webpage, and visiting the NCCRT Webinar Archive to find the most recent webinars addressing evaluation topics. The webinar on Colorectal Cancer Screening Data Sets is a great place to start. In addition, if you’re not using it already, the 80% by 2018 Communications Guidebook and corresponding Hispanics/Latinos and Colorectal Cancer Companion Guide include tested messages that have been show to resonate with the unscreened. The Community Guide is also a great resource to use, especially if you’re interesting in learning more about the evidence base for public health interventions that address topics other than colorectal cancer.
Do you have any final tips for our readers that are working to achieve 80% by 2018?
[Tamar] We know that if we reach 80% by 2018, 277,000 cases and 203,000 deaths from colorectal cancer will be prevented by 2030. But it isn’t going to take until 2018 to start saving lives, we’re doing it all along the way. For everyone who has joined in the 80% by 2018 initiative, it’s an honor to be a part of this effort with you.
Thank you for sharing your story with us! We look forward to hearing more about the work of the Evaluation and Measurement Task Group in the future.
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May 11th, 2016 :: Author: David Dubin
David Dubin co-founded AliveAndKickn with Robin Dubin in 2012. David is MLH1 Lynch Syndrome positive and is a three-time cancer survivor (colon x2, kidney). He is currently the Director of Sales in the Genetics and Genomics Department at the Icahn School of Medicine at Mount Sinai Hospital in New York. David is a frequent speaker and has been an active advocate for many years, having been honored with the 2013 Sapphire Visionary Award from the Colon Cancer Alliance as well as being named Mr. January in the 2012 Colondar. Robin Beth Dubin is Executive Director of AliveAndKickn. David’s grandfather, father and older brother all have had colon cancer, some multiple times. David and Robin have three sons, who are all active in AliveAndKickn as well.
Hi, David! We’re happy to connect with you to learn about the work you’re doing. Can you tell us a little about yourself and how you ended up founding an organization to address Lynch Syndrome?
I was diagnosed with colorectal cancer at age 29, which made me the youngest but not the only one in my family to receive this diagnosis. Every Dubin male for the past three generations has had colon cancer, sometimes more than once. I inherited Lynch Syndrome, a genetic mutation that increases a person’s risk for certain cancers. It is the most common inherited cause of colorectal cancer. Many individuals with a Lynch mutation develop related cancers at very early ages, much younger than the general population.
I wanted to do something to make life better for individuals and families affected by Lynch Syndrome, so I founded AliveAndKickn with my wife Robin in 2012. AliveAndKickn’s mission is to improve the lives of individuals and families affected by Lynch Syndrome and associated cancers through research, education, and screening. We’re fortunate to have the partnership of numerous colorectal cancer-focus organizations, which has allowed us to make an incredible amount of progress in our first four years.
We understand you’ve launched a new resource called the HEROIC Registry. Tell us a little bit about it.
We launched The HEROIC Registry, Hereditary Cancer Research Champions, just over two months ago in March 2016. It’s a first of its kind patient-centric genetic database that enables patients to take an active role in furthering research into Lynch Syndrome genetic mutations. The Heroic Registry allows patients to contribute medical information and their experiences living with Lynch Syndrome and its associated cancers to help researchers develop new treatments, understand the various Lynch genetic mutations, write medical papers and conduct further studies and clinical trials. Patient data can shape the types of research studies to be conducted that are most beneficial to the patient.
We’ve seen an incredible response since our launch. Close to 60 people have registered so far, half of which are “previvors,” which is how we refer to individuals with Lynch Syndrome who have not yet been diagnosed with a cancer. And of those who have signed up, almost all have been willing to share data for research purposes. We’re looking forward to seeing the numbers climb over time as we continue to share information about the new site on social media and with our partners.
Why is the registry needed?
Simply put, because nothing like this existed. As far as we know it’s the first of its kind. There are registries based in individual academic medical centers, but nothing existed outside the bounds of an institution. And the need of it is clear. According to the American Gastroenterological Association, statistically, one in every 440 Americans has Lynch syndrome, but as much as 95% of these people have not been diagnosed. Many individuals with a Lynch mutation develop related cancers at very early ages, much younger than the general population. If you have a parent with a Lynch mutation you have a 50% likelihood of inheriting that mutation. Knowing your family cancer history can help determine if you are at risk, even if it was NOT necessarily colon cancer.
With today’s technology, patients are no longer passive bystanders in managing their condition. They can now play an active role in the research process, sharing insights, experiences and valuable health information about Lynch Syndrome and its associated cancers that can lead to new discoveries. The social aspect of sharing information can be just as important as the medical aspect.
How does the HEROIC Registry address privacy concerns?
Patients can share as much of your health information as they want, when they want, and with whom they want. They control who views it, what information they would like to share and which research studies they are willing to participate in. Ensuring that their medical data remains secure is our top priority. We protect patient privacy with cutting-edge technology.
What are the research goals for the HEROIC Registry?
Patient medical data is incredibly valuable. By aggregating large amounts of data from thousands of patients living with Lynch, researchers are able to analyze the conditions relevant to specific mutations and help answer questions most important to patients. Patient data can shape the types of research studies to be conducted that are most beneficial to the patient. Survivors and previvors, hospitals, laboratories, physicians, providers, and insurance companies can feel comfortable with the security provided by the HEROIC Registry.
The HEROIC Registry will be a valuable resource for patients, clinicians and researchers, and AliveAndKickn welcomes partners who are interested in collaborating on this project.
What can our readers do to help get the word out about the HEROIC Registry?
We can all play a part in encouraging individuals and families affected by Lynch to get involved. If you are a clinician or work in a medical setting, make sure the providers that work with colorectal cancer patients and survivors are aware of this new tool. And if you work with colorectal cancer patients or survivors outside the medical setting, you can share the tool in your newsletters, social media and in conferences or community events.
Email us at firstname.lastname@example.org to discuss partnership opportunities, registration, or to request brochures. Visit our website, aliveandkickn.org, and connect with us on social media at @AliveAndKicknDD with hashtag #IAmAliveAndKickn and on Facebook at facebook.com/AliveAndKickn/. And if you’re planning to go to Digestive Diseases Week in San Diego, CA on May 22nd to 24th, be sure to stop by our booth!
Thank you for sharing your story with us! We look forward to hearing more about your work and the HEROIC Registry in the future.
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April 28th, 2016 :: Author: Mark B. Pochapin, MD
Mark B. Pochapin, MD is the Sholtz-Leeds Professor of Gastroenterology, Director of the Division of Gastroenterology, and Vice Chair of Clinical Affairs in the Department of Medicine at NYU Langone Medical Center. Dr. Pochapin’s clinical focus is in advanced gastrointestinal endoscopy and the prevention, early detection, and treatment of gastrointestinal cancers, such as colorectal cancer. He is currently Secretary of the American College of Gastroenterology, a member of several medical and gastroenterology professional organizations, and the author of What Your Doctor May Not Tell You About Colorectal Cancer. Dr. Pochapin graduated from the University of Pennsylvania with a Bachelor of Science and Engineering degree, and received his medical degree from Cornell University Medical College. He completed his residency in internal medicine at NewYork-Presbyterian /Weill Cornell Medical Center and his fellowship in gastroenterology at the Albert Einstein College of Medicine.
As endoscopists, we have had the privilege of being on the front lines of the fight against colorectal cancer for over two decades—helping our patients not only to find and treat cancer early, but to prevent it altogether. I know it has been an honor for every one of us to be of service in this way. There is nothing more rewarding than being able to give a patient the “good news” that he or she had a suspicious polyp and it’s been successfully removed. And I know for all of us, it has been tremendously fulfilling to see those colorectal cancer mortality and incidence rates on the decline.
Now, more than ever, it’s time to double down and come together to do all we can to achieve our shared national goal of 80% by 2018—an 80% screening rate in men and women age 50 and older. Often, by the time we see a patient, he or she has already been referred by his or her primary care physician for a screening appointment. As endoscopists, we dedicate ourselves to providing a high-quality procedure, hitting quality benchmarks, and finding every potentially premalignant or malignant polyp we can. This is the most important role we play in the fight to end this disease. And yet, there are other things we can do to increase the screening rates and quality of our screening efforts.
One important step is to take advantage of the respected role we play in the community by serving as a clinical champion who can bring expertise to local efforts to increase colorectal cancer screening. We can make ourselves available as medical experts in getting the message out about screening to our communities. We can do this in a number of ways, including working through the communications or media department of our institutions, working with professional societies, partnering with advocacy groups, or serving as champions in local, state, and national coalitions. When we provide this type of public health message, it’s important to have prepared quick sound-bites with accurate information on the screening recommendations and benefits of colonoscopy. I believe it’s also important to make it clear that people have options and there are other colorectal cancer screening tests available. Finally, we know that the personal stories are what move people to action. I have found it can be very helpful to keep a HIPAA-compliant list of patients who have expressed interest in potentially serving as spokespersons for future media spots or other efforts to promote screening to the public.
The Roundtable’s new guide,What can gastroenterologists and endoscopists do to advance 80% by 2018? (1689), is a wonderful resource that provides many more practical tips on how endoscopists can help achieve our goal of 80% by 2018. It is endorsed by the American College of Gastroenterology (ACG), American College of Surgeons (ACS), American Gastroenterological Association (AGA), and American Society for Gastrointestinal Endoscopy (ASGE).
I hope you will utilize this important resource—as well as those available from the ACG, ACS, AGA, ASGE, and GIQuIC (a quality benchmarking registry)—as a guide to achieving increased screening rates and optimal quality in endoscopy. Because, in the case of colorectal cancer screening, we know that more screening based on our recommended national guidelines means more lives saved. And that’s why making our national goal of an 80% screening rate by 2018 is so important. More screening, more quality, more prevention.
Together, we are saving lives. And together, we can save more.
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April 14, 2016 – Author: Michael Sarap MD, FACS
On March 1, 2016, the Tina Kiser Cancer Concern Coalition became an Honoree recipient of the 80% by 2018 National Achievement Awards, a program designed to recognize individuals and organizations who are dedicating their time, talent and expertise to advancing needed initiatives that support the shared goal to regularly screen 80% of adults 50 and over by 2018.
Michael Sarap, MD is senior partner in a four-person independent surgical group providing general, vascular, trauma and endoscopic surgical services for patients in Southeastern Ohio. Dr. Sarap is an active member of multiple professional organizations. He currently serves as a Governor of the American College of Surgeons and is editor of the Governors Newsletter, a member of the American College of Surgeons Advisory Council on Rural Surgery and served as President of the American College of Surgeons Ohio Chapter. Dr. Sarap is Chairman of the Department of Surgery and Cancer Committees and Director of the Breast Care and Colorectal Cancer Teams at Southeastern Med. Dr. Sarap is the Commission on Cancer Physician Liaison Program State Co-Chair for Ohio. He also is a board member of the East-Central Division of the American Cancer Society.
Hi, Dr. Sarap! Congratulations! We’re excited to feature your work on the 80% by 2018 Blog. Can you tell us a little about yourself and how you ended up working on colorectal cancer screening?
The Tina Kiser Cancer Concern Coalition (TKC3) is very excited and honored by the 80% by 2018 recognition and the opportunity to talk about our work. As a long-term Commission on Cancer (CoC) Physician Liaison for my local hospital and now the CoC State Co-Chair in Ohio, I have always had an interest in cancer prevention, detection and treatment. As a general surgeon in a small community, I have provided colonoscopy screening services and cancer-related surgical services for decades. This has allowed me to be intimately involved in cancer patient care and to realize the many benefits of prevention and early detection gained by effective colorectal cancer screening. We have been long term proponents of educating primary care providers and the public about the benefits of screening and our efforts have been reinforced by the 80% by 2018 initiative and by the progress we have made in our own community. TKC3 would like to thank our American Cancer Society (ACS) representative Amy Magorien for nominating our group for the award.
Tell us a little bit about the Tina Kiser Cancer Concern Coalition (TKC3). When and why did TKC3 begin working to increase colorectal cancer screening?
In 2005, the Ohio Department of Health’s (ODH’s) Ohio Cancer Incidence Surveillance System identified the counties in Ohio with the highest percentages of late stage diagnosis of colon and rectal cancer between 1999-2003. Guernsey County had a late stage rate of nearly 60%, the second highest rate in any county in Ohio! The ODH and the ACS met with taskforces from each of these 23 counties in early 2005 to investigate ways to increase screening and earlier diagnoses in their communities. Hospital administrators and local physicians made significant commitments to improve our local rates.
We launched the Guernsey County Colorectal Taskforce in 2006 (later renamed the Tina Kiser Colorectal Cancer Coalition in honor of a member of the group that lost her long battle with Stage IV colon cancer in 2008). Our vision was to decrease colorectal cancer incidence and mortality in Southeastern Ohio and improve the quality of life for all colorectal cancer survivors. We developed the slogan: “Face the Bear Facts: Colon Screenings Save Lives”. We later renamed the coalition the Tina Kiser Cancer Concern Coalition to allow expansion of our efforts to other types of cancers.
Who has been involved in your local collaborative?
From the beginning, team members have included the Cancer Registrar and Cancer Program Administrator, representatives from ACS and the local health department, local nurses, physicians and surgeons, representatives from local businesses, a marketing specialist and a cancer survivor. The taskforce also included the CEO and the VP of Medical Affairs of the local hospital, Southeastern Med, signifying the importance placed on the initiative by local health care providers.
What have been the main focal points of your coalition activity?
TKC3 concentrated its efforts in four areas: physician education, community education, legislative advocacy and low/no-cost screening services for patients with financial need. We visited primary care offices to encourage screening test conversations between physicians and patients and distributed ACS screening guidelines, posters and pamphlets. Community education efforts included billboards, radio spots, direct postcard mailings to 10,500 households, newspaper articles and informational ads, and a video of the hospital CEO undergoing a colonoscopy. We also provided presentations at all local service clubs, placed displays in local National City Bank lobbies, distributed brochures through the local Meals on Wheels program, and placed an ad in a movie theater, which reached 130,000 patrons in 12 months. We also designed and ordered an inflatable walk-through colon, dubbed “The Supercolon,” that is used for public education events in Ohio and neighboring states.
These initiatives have prompted hundreds of calls to our cancer program administrator, and have allowed us to serve individuals from 16 counties in Ohio, including 500 colonoscopies, most provided at no cost to patients. TKC3’s activities have been made possible through excellent community support in the form of donated time and services, as well as grants from ACS, Walmart, the Kiwanis Foundation, National City Bank, ODH and The Ohio State University.
Do you have data that supports what you have been doing?
The late stage rate in Guernsey County has dropped from 60% of cases 10 years ago to 12% in 2014, making Guernsey County one of the counties with the lowest rates in all of Ohio, and this rate continues to improve over time. The total number of cases of colorectal cancer diagnosed rose nearly 50% in one year (27 cases in 2005 versus 40 cases in 2006) with more than double the previous number of Stage I cases found in 2006. After nearly 10 years of these efforts, we have seen a decrease in the total number of colon cancer cases with 16 total cases in 2014 and only two late stage cases. The average late-stage rate in Ohio is 51%.
What challenges remain?
Our main challenge at this moment is to maintain our momentum and find ways to reach people that do not have primary care providers. In analyzing the data from 2015, we have been discouraged to see several late stage cases in 60 and 70-year-old patients who had never been screened before. We need to find a way to capture the attention of people who traditionally avoid the health care system.
A second challenge is the issue of no-shows (patients that do not show up for a scheduled screening test). We have been very fortunate to have a relatively low no-show rate, which may be due to the fact that all colonoscopy patients are provided with a free prep kit, but we’d like to see improvements to this rate.
What lessons learned would you share with others that are just getting started with their colorectal cancer coalitions?
I would say that it is vitally important to find at least one community champion who is well known and respected by both clinicians and the public. Also, another goal would be to recruit community coalition members from a broad variety of organizations to bring a wealth of varied resources to the table. Patient stories in the local media about the value of screening are also very valuable.
Are there specific components of your program that make your group particularly proud?
We are proud of the incredible response we’ve received from the primary care community and the public. The educational component to any screening program must be complemented by competent care during the screening process and state-of-the-art treatment for those individuals that receive a cancer diagnosis as a result of the program. We are fortunate that our cancer program exceeds quality benchmarks and has earned American College of Surgeons Commission on Cancer Accreditation for over 20 years. Our CoC benchmarks, such as our adenoma detection rate, regularly exceed local, state and national levels. This focus on quality care has resulted in a local five-year survival rate for all stage colon cancer patients that is equal to or better than all other CoC facilities, and a resounding 96% of all colon cancer patients choose to remain in our community for their care.
We are also proud that our efforts and results have been recognized at local, state and national gatherings, such as the CoC National Meeting, the Community Cancer Control in Appalachia Conference, and the Prevent Cancer Foundation national meeting. We received an American Hospital Association Charitable Services Award of Excellence, recognition from the NCCRT Blue Star Award program, and we’ve received the sole Excellence in Mission Award from the ACS East-Central Division for the last three years.
Clearly, in our small community there has been a definite improvement in awareness of colorectal cancer screening and real progress in decreasing late stage diagnoses. These improvements have been accomplished by fostering relationships with primary care providers, the ACS and other partners, all with minimal resources and without government funding. Our hope is that these modest efforts inspire the work of other state and national initiatives.
Thank you for sharing your story with us! We look forward to hearing more about your work and TKC3’s progress in the future.
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March 31, 2016 – Author: Chastity Dolbec and Deb Kasanke
On March 1, 2016, Coal Country Community Health Center became the first Grand Prize recipient of the 80% by 2018 National Achievement Awards, a program designed to recognize individuals and organizations who are dedicating their time, talent and expertise to advancing needed initiatives that support the shared goal to regularly screen 80% of adults 50 and over by 2018.
Chastity Dolbec, RN, BSN, (pictured at right) is the Director of Patient Care & Innovation at Coal Country. She has over 25 years of combined nursing experience in the areas of long term care; home-health and hospice; acute and primary care; patient-centered medical home; population health and care coordination.
Deb Kasanke, RN, (pictured at left) is the Charge Nurse/Quality Coordinator at Coal Country. She has over 30 years of combined nursing experience in the areas of long term care; home-health and hospice, acute and primary care, and care coordination.
Hi, Chastity and Deb! Congratulations! We’re excited to feature your work on the 80% by 2018 Blog. Can you tell us a little about yourself and how you ended up working on colorectal cancer screening?
We have each worked for Coal Country Community Health Center for several years (Chastity for six and Deb for 11) and have been part of an extraordinary team focusing on improving population health through the development of a patient-centered medical neighborhood. Under the direction of Dr. Aaron Garman, Medical Director, our delivery of healthcare has transformed from an acute care model, where we largely focused on sick visits, to a prevention and wellness model, where we are pro-actively working to keep our patients well.
Tell us a little bit about Coal Country Community Health Center.
Coal Country is a federally qualified health center located in rural west central North Dakota with clinics in Beulah, Center, and Killdeer, where staff provide comprehensive health services to our patients throughout their lives, including basic primary care, diagnostic and screening services, health education, disease management, care coordination, and behavioral health services. Coal Country provided 31,227 visits to 7,867 patients through its patient-centered medical neighborhood in 2015.
When and why did Coal Country decide to focus on increasing colorectal cancer screening?
In 2012, HRSA (Heath Resources and Services Administration) updated its core clinical measures (Uniform Data System or UDS) to include colorectal cancer screening. As a result, Coal Country began tracking colorectal cancer screening rates. We realized we were at 29% and wanted to do better. By focusing on quality improvement and doing what we know works, we knew our colorectal cancer screening rates could improve to reflect the type of quality care we strive to deliver to our patients. With the strong support of Coal Country’s executive leadership team, we implemented a quality improvement plan for increasing colorectal cancer screening rates in addition to breast and cervical cancer screening rates. Through ongoing collaboration and implementation efforts associated with our patient-centered medical neighborhood, our clinic developed innovative approaches to improving our overall rates.
Coal Country has obtained National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) Level 3 recognition, the highest level of recognition. That’s impressive. How does that inform the type of changes you made to support colorectal cancer screening?
A key element of the patient centered medical home model is implementing a team-based approach to care delivery, so our providers lead care coordination for our patients in close concert with our chronic care coordinators (CCCs).
For us this meant implementing evidence-based clinical guidelines and standing orders, under the direction of our medical director. Colorectal cancer screening has become a routine screening at all visits with age appropriate patients. Our registered nurse CCCs complete pre-visit planning for all patients, communicating recommended screenings to our medical home teams. All care teams frequently send reminders and recalls to patients who are not up to date with colorectal cancer screening. Colorectal cancer screening rates improve when the whole team is working toward that improvement and everyone understands his or her role.
Additionally, we had the freedom and support to try innovative programs. Through our population health committee and collaborative relationships, Coal Country facilitated our first annual flu-FIT campaign in 2015 working together with our local public health unit and rural health clinic. We screened 289 patients for colorectal cancer screening during our two community wide flu clinics. This was a very successful event which we plan to continue on an annual basis.
What success have you seen? How did you measure that success?
Coal Country has increased its colorectal cancer screening rate from 29% in 2012 to 70% in January 2016 through the implementation of several innovative quality improvement projects. Our patients have become accustomed to our comprehensive health screening questionnaire as part of their visit, which includes a question about colorectal cancer screening. Increased education and communication with our patients has been received through positive feedback on our patient satisfaction surveys.
Coal Country measures all screenings through a report writing software included with our electronic medical record as well as through a population management software product through Blue Cross Blue Shield of North Dakota. Every six months we review 100% of all age-eligible patient records for colorectal cancer screening and send recalls and reminders to patients on the importance of completing screening. Patients have shared their stories with the local media highlighting the importance of completing colorectal cancer screening within their medical neighborhood.
We understand your clinicians can get competitive with one another in trying to improve screening rates?
Yes, when we started this process, we shared with our providers their individual baseline screening rates. One of our physician’s assistants was at 19%. He didn’t like that! But that knowledge served as a motivation to do better. In just six months, he improved his rates to become one of the highest performers around colorectal cancer screening in the clinic.
What lessons learned would you share with others that are working to increase colorectal cancer screening in primary care settings?
Development of clinical guidelines and standing orders by our medical director was the beginning of our success. Strengthening our collaboration with the local critical access hospital (Sakakawea Medical Center) through the delivery of a medical neighborhood has also been key to our clinic’s ongoing success. We do not have access issues for colonoscopy thanks to our relationship with Sakakawea Medical Center. Whether being able to offer FIT cards at the clinic visit through screening protocols by the medical home provider and team; or with offering further colonoscopy screening options at Sakakawea Medical Center through general surgeons, Coal Country has increased its colorectal cancer screening rates through comprehensive care coordination.
Coal Country has a unique arrangement with Sakakawea Medical Center. Can you tell us about it?
Yes. Our CEO also serves as the CEO of Sakakawea Medical Center. This is an unusual arrangement that had to be approved by the Health Resources Services Administration (HRSA) and the National Association of Community Health Centers (NACHC). It may be unusual, but it has served us and our patients well, creating a true partnership between Coal Country and our critical access hospital. The partnership helps us provide a continuum of care for our patients.
Were there tools, trainings or resources that you found helpful?
Coal Country participated in the North Dakota Colorectal Cancer Roundtable, a statewide coalition of organizations dedication to 80% by 2018, in 2015, which provided us with additional education and resources from the American Cancer Society and the North Dakota Department of Health. Dr. Richard Wender, NCCRT chair, provided an engaging keynote presentation, which facilitated and engaged our team to become more motivated to continue our local efforts to increase colorectal cancer screening rates. Our local American Cancer Society representative, Shannon Bacon, has also been instrumental in assisting our organization through the delivery of additional resources. For instance, the ACS flu-FIT toolkit and www.flufit.org website were very important resources for us as we implemented the flu-FIT campaign in 2015. Deb Kasanke continues to be an active member of the North Dakota Colorectal Cancer Roundtable, which was most recently tasked with the deployment of a unified message to patients for national Colorectal Cancer Awareness Month.
Do you have any final tips for our readers that are working to achieve 80% by 2018?
Our most important tip for others would be to develop and strengthen collaborative relationships through the development of a patient-centered medical neighborhood model of care delivery. Comprehensive care coordination is at the heart of improving patient outcomes, decreasing overall healthcare costs, and improving patient satisfaction. Our clinicians know that if a cancer is detected in the screening process, the patient’s follow up care will be assured.
Thank you for sharing your story with us! We look forward to hearing more about your work and Coal Country’s progress in the future.
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March 1st, 2016 :: Author: Mary Doroshenk, MA
March is here! Those of you who have been involved in colon cancer screening efforts for a while will agree that each March, National Colorectal Cancer Awareness Month, is special. It’s special as a way to renew our passion and commitment toward saving lives from this preventable disease, but also special as we mark the passage of time and see our progress evolve. This year, we are marking the third year of the 80% by 2018 effort.
Looking back, I saw March 2014 as the Year of “The Launch.” I won’t soon forget the incredible array of national leaders gathered despite a snowstorm in Washington, DC to launch the 80% by 2018 effort. We set a goal to have 50 organizations sign the 80% by 2018 pledge, and we celebrated new data showing that fewer people were dying of colorectal cancer in large part thanks to screening.
March 2015 was a year of building and learning. We brought together dozens of stakeholders to tackle important issues. We released new tools to help define the role each of us can play in this life saving effort. We learned that we could save 203,000 lives if we were to reach our goal. And spectacular things began to happen: Niagara Falls turned blue; the Health Care Service Corporation building in Chicago shined with “80% by 2018” in lights; state colorectal cancer roundtables began to form all over the country; and rather than counting our 80% by 2018 pledges by the tens, we started to count them by the hundreds.
And yet, this March, I have the feeling that our real success is just beginning. The White House proclaimed March National Colorectal Cancer Awareness month for the third year in a row. We now have over 700 organizations that have pledged their commitment, but what’s even more exciting are the 80% by 2018 success stories that are starting to trickle in each day.
We’re hearing about coalitions rallying to pool talent and resources to create life-saving change; physician practices that are systematically working to get every patient screened; health plans removing screening barriers for their patients; hospitals becoming anchors in the community to support screening; and community health centers, clinics that serve the most in need in the community, hitting screening rates that rival those in private practice.
And with that I’m very pleased to announce some of the top success stories we received in our first 80% by 2018 National Achievement Awards, a program designed to recognize individuals and organizations who are dedicating their time, talent and expertise to advancing needed initiatives that support the shared goal to regularly screen 80% of adults 50 and over by 2018. We received a rich array of nominations, many more than we could possibly honor. We are grateful to everyone who is doing such important, life-saving work, but please join me in congratulating our 2016 honorees whose accomplishments truly stand out:
- Grand Prize: Coal Country Community Health Centers of North Dakota, whose screening rate jumped from 29% to 70% in three years.
- Phoebe Putney Health System of Albany, Georgia, which became an anchor in their community supporting screening;
- Premier Medical Associates of Pennsylvania, who were relentless in their pursuit to ensure that each and every age appropriate patient got screened;
- South Carolina Public Employee Benefit Authority, which tackled cost issues on behalf of their members; and
- Tina Kiser Cancer Concern Coalition of Ohio, which was so successful in their community efforts to increase screening that the percent of late stage cases in Guernsey County dropped from 60% to 12% over the last 10 years.
We thank these honorees for their diligence, passion and creativity in working toward our shared, life-saving goal. Their efforts are truly inspiring.
You can learn more about them during our annual 80% by 2018 Live Broadcast on March 8th from 2:00-3:00pm EST when we’ll mark the beginning of the third year of the 80% by 2018 effort, profile these success stories and otherwise highlight the progress we’ve made in the past year.
I know we all have a busy month ahead, which will precede a busy year, but I look forward to learning and celebrating and progressing with all of you. Please check out the new resources we’ve posted on our 80% by 2018 webpage, particularly our new 80% by 2018 Resource Packet. It’s a tool to reference throughout the year, and a resource to share with partners who are new to the initiative.
Thank you for your tremendous efforts to reach 80% by 2018, and best wishes for March 2016, The Year of Success.
We are grateful for you and the work that you do.
Mary Doroshenk, MA
American Cancer Society, Inc.
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February 17th, 2016 :: Author: Jennifer Weiss, MD, MS
P.O. Box 930302
Verona, WI 53593
Dr. Jennifer Weiss, MD, MS, is an Assistant Professor in the Department of Medicine-Gastroenterology at University of Wisconsin-Madison. Her research focuses on colorectal cancer screening for both average-risk and high-risk populations. Dr. Weiss has served as a physician leader of the UW Health Colon Cancer Prevention Initiative, which developed and implemented multiple complex system-wide colorectal cancer screening interventions that assisted in increasing screening rates from 61% to 81% over the past six years. She has a five-year career development award from the American Cancer Society to identify patient, provider, and system barriers to colorectal cancer screening and optimize interventions that target these barriers. Dr. Weiss is also the Director of the UW Gastroenterology Genetics Clinic where she cares for patients at high-risk for developing colorectal cancer. Dr. Weiss recently presented on UW Health’s journey to reach an 80% screening rate at NCCRT’s 2015 Annual Meeting. We are thrilled to welcome her back to share her story with our readers.
Dr. Weiss! We’re happy to reconnect and to feature you on the 80% by 2018 Blog. Can you tell us a little about yourself and how you ended up working on systems changes to increase colorectal cancer screening?
During both my internal medicine training and my practice as a gastroenterologist, I have seen many patients diagnosed with a colorectal cancer (CRC) that could have been prevented with appropriate screening. CRC is preventable! I tell all my patients that the purpose of CRC screening is to identify and remove the pre-cancerous lesions (adenomas) and preventprogression to colorectal cancer. CRC screening is an amazing process, however, it is also complex with multiple steps and potential barriers. Many barriers exist at the level of the healthcare system (e.g. lack of capacity to perform screening exams, problems with easily identifying patients who are overdue for screening exams, and lack of a reliable follow-up process for ordered exams). I believe that if we can overcome these barriers, we can help save close to 50,000 lives each year.
Tell us a little bit about UW Health Clinics.
UW Health is one of the 12 largest multispecialty physician groups in the United States and provides 2.4 million outpatient visits per year. It is comprised of both multispecialty and community-based primary care clinics, with nearly 400 primary care providers in 50 primary care clinic sites across south central Wisconsin. The patient population we serve is approximately 90% white, 4% African American, 3% Hispanic or Latino, and 3% Asian or Pacific Islander. Approximately 70% have commercial insurance, 20% are covered by Medicare, and the remainder have Medicaid or are uninsured.
How did UW Health decide to focus on increasing colorectal cancer screening?
UW Health is a member of the Wisconsin Collaborative for Healthcare Quality (WCHQ) – a voluntary association of provider groups and health systems across Wisconsin that develop, collect, and report data on their performance measures. UW Health has been reporting CRC screening data since 2005. In 2008, we were surprised to find that we were not among the top health systems in Wisconsin with respect to our CRC screening rates, which was around 61% at the that time. We were above the national average, but our leaders knew we could do better and made it a strategic priority to increase UW Health CRC screening rates. To address this priority, the UW Health Colorectal Cancer Prevention Initiative (CCPI) was formed. CCPI is a multidisciplinary group with members from primary care, gastroenterology, radiology, quality improvement, clinic management, and academic research with the main goal of making CRC screening easier, more accessible, and more appealing for patients and providers.
What did you learn about screening variation among providers?
The first step of CCPI was to determine our current CRC screening rates and practices. We decided to dive deeper and examine the degree of variation in CRC screening rates within our system. We found that there was substantial variation across primary care clinics (range of 42-80% CRC screening rates), as well as between primary care providers within the same clinics (range 38-87% CRC screening rates). Unintended variation can undermine the quality of care we deliver to our patients, so we administered a survey to all UW Health primary care providers to help understand the variation in CRC screening rates. We were able to identify predictors of CRC screening variation at multiple levels of the healthcare system (patient, provider, and healthcare organization) and concluded that interventions to increase CRC screening rates need to be directed at all levels of the system.
What were your next steps?
The primary care provider survey included questions about CRC screening barriers at the patient, provider, and system levels. We used the survey results to design and implement interventions to directly address these barriers (some examples are listed below):
We are happy to report that through the hard work of the CCPI, we have seen an increase in UW Health’s CRC screening rates from 61% to 81% and the 81% has been sustained over the past three years. Our next steps are to further evaluate the interventions that were implemented and determine which ones gave us the “biggest bang for the buck”.
What lessons learned would you share with others that are working to increase colorectal cancer screening in primary care settings?
The most important lessons that we learned are:
- Start by gathering your data and design a process for continual assessment
- Have buy-in from institutional leaders
- Organize the process to increase CRC screening from the start
- Target multiple levels of the healthcare system: patients, providers, and the healthcare organization
Were there tools, trainings or resources that you found helpful?
Our first step was to learn best practices from successful health systems in Wisconsin and start conversations about the lessons they learned on their journey to increase CRC screening rates. The NCCRT tool, “How to Increase Colorectal Cancer Screening Rates in Practice: A Primary Care Clinician’s Evidence-Based Toolbox and Guide” is a fantastic resource with many relevant and useful templates that can easily be incorporated into practice.
Do you have any final tips for our readers that are working to achieve 80% by 2018?
Start by gathering the necessary people for your team, which can be patients, providers, clinic staff, and system administrators. Next, identify current barriers to reaching this goal and let them inform your interventions. Finally, a strong commitment to this goal is necessary. It can be done and you may even surprise yourselves and reach 80% before 2018!
Thank you for sharing your story with us! We look forward to hearing more about your work and UW Health’s journey in the future.
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February 3rd, 2016 :: Author: Anjelica (“Anjee”) Davis
Anjelica (“Anjee”) Davis serves as President of Fight Colorectal Cancer, a national nonprofit founded in 2005. For over a decade she has focused her work on colorectal cancer research, education and awareness. Ms. Davis co-chairs the Awareness Task Force for the National Colorectal Cancer Roundtable (NCCRT), and is a past member of the steering committee (2009-2012).
Storytelling is the most powerful way to put ideas
into the world today.
I think that sometimes I am too quick to assume that everyone knows someone with cancer. But is that true? It may not be the case.
The American Cancer Society and the National Colorectal Cancer Roundtable’s market research team surveyed some of the 23 million, age-eligible people that need to be screened for colorectal cancer and found that those who didn’t have a personal connection to any type of cancer were those least likely to get screened.
As a public health community, we create beautiful ads with concise messages that have clear calls to action about screening. We share facts that are compelling, like:
- Colorectal cancer is the second-leading cause of cancer deaths for men and women combined
- 1 in 20 Americans will be diagnosed with cancer of the colon or rectum in their lifetime
- Colorectal cancer is preventable
But, the research shows that the facts alone cannot surrogate the power of a personal connection or a story from a survivor or family member who has lived through cancer.
Colorectal cancer survivors and family members have the unique disposition of experience. These are the people who can stop someone in the grocery store, write a blog or post a picture on Facebook and compel others to do the right thing. By sharing their story, their encouragement to prioritize health and get screened will be what inspires others to avoid this very real cancer.
I have had the honor of working with survivors and their families for the last decade and it’s not been merely an intellectual exercise. It’s truly been a cause.
Survivors want to share their stories. They want to humanize the facts and make our awareness efforts personal and emotional. Over the years, I’ve seen them in action in print, on social media and in person connecting with others through their stories. And their stories are powerful. From a mom of three kids who postponed her screening colonoscopy, a grandfather of 20 grandchildren who beat the odds, or a young man who had symptoms but ignored them, the stories are different but all compelling.
As we share these stories, we always hope that someone hearing or reading them will have Oprah’s famous “aha” moment – that point where they finally get it. We want others to say, “Yes! I will make an appointment with my doctor. I will get screened.”
Today, there are over a million survivors living in the United States with these powerful stories and even more family members touched by this disease. We need an army of champions willing to raise the flag for prevention and screening, and we can provide the platform to broadcast them. The patient community is ready and willing to support our national effort of 80% by 2018. Let’s use their powerful voices.
Read and share NCCRT’s new publication, What can survivors and families do to advance 80% by 2018?, to learn more about what you and survivors you know can do to increase colorectal cancer screening. And to read stories and post yours, check out the following NCCRT member websites:
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January 20th, 2016 :: Author: Lisa Richardson :: Leave A Comment
NCCRT Steering Committee member Lisa C. Richardson, MD, MPH, serves as the Director of the Division of Cancer Prevention and Control in the National Center of Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention (CDC).
Following the holidays, winter weather starts to lose a lot of its charm; to keep myself warm on the chilliest of days, I reach for a hat. But a wooly ear flap is not the only hat I wear. Like everyone working on the 80% by 2018 initiative, I wear many hats. As an oncologist, I’ve seen too many times the results of late-stage colorectal cancer. Its devastating results on patients and families drive my commitment to prevent colorectal cancer and to find cancer early, when care and treatment have a higher chance of giving patients a long and healthy life. As a public health professional, I help the Centers for Disease Control and Prevention (CDC) remain committed to improving colorectal cancer screening rates through healthcare provider outreach and training, community screening and partnerships, and a strong focus on educating the public.When I meet with people like yourself, I represent the CDC by working with partners to build stronger communities and maximize our efforts. Finally, I also wear the hat of a newly 50-something (it sneaks up on you when you are busy working) who urges family and friends to take the time for colorectal cancer screening. I remind them that it’s true cancer prevention, and my friends know that I’m happy to explain screening options—and then nag them until they pick one.
We all wear different hats—as a parent, a spouse, a sibling, or a friend—and we’ve been taught to keep these hats separate from our professional life. I urge you to rethink that “lesson” in light of our 80% by 2018 collaboration. The idea behind bringing many “hats” to the table is that we are able to think creatively about new ways to promote colorectal cancer screening across a variety of target audiences.To continue our collaborative efforts, I challenge you to bring your thinking caps! How can we spread the word about colorectal cancer screening to the very communities for whom it’s crucial—but not on the radar? Can we look at lessons learned and build upon those ideas? Can we think creatively and work together to ensure that we are getting our message to those who need it most?
We have made a terrific start in addressing many of these questions, and CDC-supported programs will continue to accelerate the race to 80%. Everyone has a contribution, and your “personal” hat might bring a new perspective. When you take off that hat to sit down at the hairdresser’s, ask if they would like to get involved in promoting colorectal cancer screening with the folks they know. They may have some ideas that just might work. By working together and continuing to promote cancer prevention at every level, we can reach our goal of 80% by 2018. And on that I’ll hang my hat.
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January 7th, 2016 :: Author: Richard Wender :: Leave A Comment
Happy new year, everyone! As the chair of the National Colorectal Cancer Roundtable (NCCRT), I’m excited to welcome you to the NCCRT’s new 80% by 2018 blog. The start of the new year is always a great time to reflect on our hopes and dreams for the coming year, and we share a big one. If we’re going to achieve 80% of adults over 50 years of age regularly screened for colorectal cancer by 2018, we’re going to need to do more to share best practices, tools and resources, and highlight successes to fuel our work. That’s what this blog is all about. Here you will find interviews with leaders in the field, profiles of innovative and successful initiatives, new tools and resources, and commentary on new research and emerging issues.
Thanks in part to the work of many of these leaders we intend to feature, colorectal cancer incidence and mortality rates have dropped by over 30% in the U.S. among adults 50 and older in the last fifteen years, with a substantial fraction of these declines due to screening. This is a major public health success story unfolding before our eyes. Yet, despite the good news, colorectal cancer remains the second-leading cause of cancer death in the U.S. when men and women are combined. To reach our 80% goal, we must reach the 23 million Americans between the ages of 50 and 75 who are not being regularly screened.
The central challenge to our reaching the 80% goal is that those who are still unscreened will be the most difficult to reach. We now need a strong coordinated push to substantially reduce colorectal cancer screening as a major public health problem, to make sure that all Americans are benefitting equally from life-saving technology, and to sustain the progress we make.
Achieving the 80% by 2018 goal will be very difficult, but our work over decades has led us to this moment. We have the plan, the tools and the will to reach this goal. We have an ambitious strategic plan that focuses on moving consumers to action, promoting practice improvement and systems change, bringing down policy barriers and defining accountability. Over 550 organizations – including medical professional societies, academic centers, survivor groups, government agencies, cancer coalitions, cancer centers, payers and many others – have signed a pledge to make this goal a priority. And we are beginning to see progress. We recently conducted an 80% by 2018 partner survey and 72% of respondents engaging in colorectal cancer activities said they launched, expanded or intensified their activities after getting involved in the 80% by 2018 effort. Another 52% are planning additional colorectal cancer activities as a part of their effort to get to 80%. We will be highlighting more of these successes in this blog.
As a first step in celebrating and sharing success, I want to encourage you to get your nominations in for the 2016 80% by 2018 National Achievement Awards, a competitive recognition program that seeks to highlight success stories by recognizing individuals and organizations who are dedicating their time, talent and expertise to advancing needed initiatives that support the shared goal to regularly screen 80% of adults 50 and over by 2018.
Winners (and there are prizes!) will be announced in early March and we’ll profile the awardees’ exemplary work on this blog. Winners will also be profiled during a special 80% by 2018 webcast on March 8th at 2:00pm EST – so save the date! You have just over a week left to submit your nominations before the deadline on January 15, 2016. Visit our 80% by 2018 National Achievement Awards webpage to learn more and submit your nomination (or self-nomination) today.
Finally, one of the great features of the blog format is that it offers a two-way street for communication. We want to hear from you. What do you want to learn about to support your work in 2016? What leader would you like to hear from? I encourage you to share your comments and suggestions.
Thank you for all that you are doing to achieve 80% by 2018, and best wishes for a happy, healthy and productive 2016!
Richard C. Wender, MD
Chief Cancer Control Officer, American Cancer Society, Inc.
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