Interview with Oklahoma City Indian Clinic—Grand Prize Recipient of the 2018 80% by 2018 National Achievement Award
March 6, 2018 – Author: Kelli Guinn, DON, RN, BSN & Jessica Deaton, Care Manager, RN, BSN
On February 26, 2018, Oklahoma City Indian Clinic (OKCIC) became the Grand Prize recipient of the 2018 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.
Kelli Guinn, DON, RN, BSN is a proud member of the Chickasaw Nation tribe with over 11 years of nursing experience in working with underprivileged populations. She currently works as the Director of Nursing at the OKCIC. She graduated with her Bachelors in the Science of Nursing from Langston University, in 2006. She has been collaborating with the American Cancer Society on several projects which are centered on cancer prevention and improving patient outcomes since 2014.
Jessica Deaton, RN, BSN has six years of nursing experience. She graduated with her Bachelors in the Science of Nursing in 2011 from the University of Oklahoma. She has an extensive background in cardiac care, then went on to work as an RN Care Manager at OKCIC. In 2016, she helped develop and coordinate a colorectal cancer screening program while continuing to work towards increasing colorectal cancer screening rates. She has presented on a webinar for the NCCRT about colorectal cancer screening in the American Indian population as well as presented an abstract at the American Nurses Association Conference on quality improvement.
Hi, Kelli and Jessica! 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?
First and foremost, we are so honored and humbled to have been chosen as the 2018 Grand Prize recipient of the 2018 80% by 2018 National Achievement Award. It has been a long and rewarding adventure to say the least. Colorectal cancer screening has always been an important focus to our clinic including our CEO having a personal connection, which has been an influential driving force and support system.
[Kelli] I started at the Oklahoma City Indian Clinic (OKCIC) in 2014 and was one of the founding members of the internal Colorectal Cancer Quality Improvement Committee (CRC QI). As the Director of Nursing, I have been a longstanding advocate for improving cancer screening rates, removing patient barriers, and am passionate about leading my nursing staff efficiently to provide compassionate quality care to all patients.
[Jessica] I started at the OKCIC in 2015 as an RN Care Manager. At the beginning of 2016, I accepted the assignment of spearheading a grant application for colorectal cancer funding. This opportunity led me to research evidence-based practice that could be implemented and utilized to further increase colorectal screening rates at the OKCIC. Shortly after, I began to chair the CRC QI Committee, which led to being accepted as members of the NCCRT as well as signing the 80% Pledge.
Tell us a little bit about Oklahoma City Indian Clinic.
Oklahoma City Indian Clinic (OKCIC) is a 501(c)(3) nonprofit clinic that provides services to nearly 20,000 American Indians in central Oklahoma from over 200 federally recognized tribes every year. We have implemented many practice changes to increase colorectal cancer screening rates. We are small but mighty in the sense that we attempt to offer a comprehensive visit during each patient encounter. We accomplish this by offering a variety of onsite services in addition to primary care which include: CT and other radiology services, mammography, laboratory services, behavioral health, public heath to include cancer navigation, onsite pharmacy, along with multiple other services. We continue to grow and expand services in order to meet the needs of our patients while adapting treatment plans based on disparities in order to provide holistic care. We are currently discussing potential implementation of internally screening patients earlier than the recommended age of 50 due to the high incidence of colorectal cancer and increased mortality rates within the American Indian population.
In addition to improving screening rates, we also screen each patient for insurance during the registration process. All of our Patient Relations Representatives interview each patient to identify eligibility for alternate resources. We are currently exploring the possibility of starting an Insurance Sponsorship program for selected patients to pay insurance premiums and provide a marketplace Blue Cross Blue Shield plan. These steps aid in reducing patient transportation barriers, since being insured means that patients can complete colorectal cancer screening and diagnostic testing locally rather than traveling to another Indian Health Services (IHS) facility (approximately a three-hour round trip).
What activities and systems changes did you implement, and how did you choose them?
A defining moment that ultimately led to our process changes was when we began our colorectal cancer partnership with the American Cancer Society (ACS). Our ACS Primary Care Health Systems Manager, Meagan Carter, was our educator and biggest advocate. She introduced us to the holy grail of colorectal cancer screening, Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Community Health Centers. Armed with this tool, we implemented initiatives that affected change and created sustaining processes that could be seen through data. Activities included forming a quality improvement committee that meets quarterly to analyze and review evidence-based practices and current initiatives, systematizing patient and provider reminders, improving tracking in the electronic health record, offering incentives for completing screening at health fairs, creating an oncology case manager position within public health to provide navigation to patients and eliminating gaps in care, and improving access to screenings by offering a Flu-FIT (fecal immunochemical test) clinic in the fall. As a result, OKCIC has increased colorectal cancer screening rates among age-eligible patients from 14% in 2007 to 64% in 2017, while patient volume increased by 27%. The chart below illustrates our yearly screening rates as compared to OKCIC’s screening goal and the area target, the goal for Oklahoma as a state.
I understand you took a multidisciplinary approach to provide patients with a FIT test. How did this work?
Although most of the colorectal cancer screening efforts are nursing driven, OKCIC has multi-departmental supporting strategies which are evidence-based and aid in cultivating a medical home atmosphere. A recent notable endeavor was when the pharmacy department collaborated efforts to increase colorectal cancer screening rates. In just three months, screening rates increased by approximately five percentage points by the additional assistance from the dedicated pharmacy team. This further demonstrates the large impact that the clinic has had on screening rates throughout the surrounding Oklahoma City area.
Our cancer screening initiatives also led us to identify a need for one-on-one cancer navigation. In December 2016, OKCIC started providing specialized patient navigation to all oncology patients, including patients with colorectal cancer. There are now over 200 patients in the OKCIC Oncology Patient Registry, of which about 10% have been diagnosed with colorectal cancer. The Oncology Case Manager works diligently to obtain medical records, place referrals, and follow up on comprehensive health care needs. Colorectal cancer treatment can often be complicated and time-sensitive. The Oncology Case Manager insures that patients receive personalized one-one-one education, navigation through the complex treatment process, and approval for their referrals to be paid through the IHS’s Purchased and Referred Care budget.
Without this service, many patients would be overwhelmed and lost to follow up in the complicated health care system or due to the financial burden of treatment. The ability to offer Oncology Case Management Care as well as managing an Oncology Patient Registry makes OKCIC unique in Indian Country, which further contributes to 80% by 2018 attainment and being the national model for American Indian health care.
What success have you seen? How did you measure that success?
In addition to seeing our internal screening rate increase from 14% in 2007 to 64% in 2017, we’ve seen many other notable successes. Colorectal cancer screening has become an expected screening for our age-eligible patients over the past three years. We have noticed an increase in patients requesting FIT kit screening when interacting with different clinic departments. Every March we conduct a FIT kit competition amongst all nursing and provider staff. This healthy competition has created buy-in and in return the nurse with the most returned FIT kits is personally recognized during the annual 5K Strollin’ Colon Run in Oklahoma City and is given free admission to the event. Lastly, we consider being invited to speak on one of the NCCRT webinars along with being selected as the Grand Prize winner of the 2018 80% by 2018 National Achievement Award to be a major success.
Were there tools, trainings or resources that you found helpful?
The relationship that was formed with the ACS was one of our biggest resources that we utilized to develop a sound process map. Along with this relationship, the “CRC News” emails sent out by the NCCRT that provide webinar trainings along with scholarly articles featuring colorectal cancer screening initiatives, and attending the 2016 NCCRT Annual Meeting were a huge asset to our screening success. We were also fortunate to receive one-on-one provider training on how to improve colorectal cancer screening rates and quality with the famously helpful Durado Brooks, MD, MPH, which also helped improve provider buy-in, at the same time igniting passion for improving screening rates.
Other evidence-based interventions that have been implemented include small media, provider assessment and feedback, and client and provider reminder and recall systems. We would encourage all individuals aiming to increase their facility’s colorectal cancer screening rates to tune into NCCRT’s webinars and take the time to read and utilize the scholarly articles in efforts to modify and improve your current process. We have watched many NCCRT webinars ourselves; however, the two that have been most influential are the October 2017 80% by 2018 Progress webinar that featured Dr. Richard Wender, Chair of the NCCRT, and the July 2016 webinar on colorectal cancer screening and the Patient Centered Medical Home.
Do you have any final tips for our readers that are working to achieve 80% by 2018?
Keep striving to succeed! We have been able to affect change and save lives without grant funding in our small partially federally funded facility. If we can achieve increases in colorectal cancer screening rates, any facility can make effective changes and see sustained results as long as they remain dedicated. While our goal is to reach 80% of patients screened by 2018, we know that any increase in completed screenings are ultimately saving the lives of our patients and at the end of the day this is what is important and what matters the most!
Thank you for sharing your story with us! We look forward to hearing more about your work and Oklahoma City Indian Clinic’s progress in the future.