Summary Report on Links of Care Pilot to Increase Colorectal Cancer Screening for Underserved Patients

The newly released report, Report on a Pilot Project to Increase Colorectal Cancer Screening Rates and Ensure Access to Specialty Care for Underserved Patients, provides an overview of the Links of Care pilot project (2015-2017), which implemented evidence-based strategies to increase screening rates and timely access to specialists after abnormal screenings in three Federally Qualified Health Centers (FQHCs). Participating FQHCs successfully increased CRC screening rates by 8-28 percentage points, secured low- or no-cost colonoscopies from specialty care providers, and implemented patient navigation to ensure timely follow-up to diagnostic services. The report outlines key facilitators to success.

Congratulations to the evaluators and authors that contributed to this publication, Lesley Watson, Kara Riehman, Mary Doroshenk, Rentonia Williams, Vonda Evans, Lynn Basilio, Maryanne Goss, and Roshan Paudel, as well as the numerous individuals that contributed to the pilot projects’ success.

The NCCRT Resources Center also includes two webinars that feature findings from the Links of Care pilot projects, including a 2017 webinar and a 2015 webinar

2019 Colorectal Cancer Screening Messaging Guidebook: Recommended Messages to Reach the Unscreened

In 2018, the NCCRT and the American Cancer Society researched screened and unscreened populations to better understand and address screening disparities. The goals of the market research were to:

  • Measure general awareness of colorectal cancer screening methods.
  • Understand the rationale, attitudes, and motivations for being screened or not.
  • Analyze priority populations such as adults aged 50-54, rural dwellers, and the marketplace insured.
  • Identify logical and emotional drivers that could encourage screening.
  • Use the drivers to create and test messages that would motivate unscreened individuals.

This guidebook shares the findings and recommendations gathered from that research and is further designed to help in the education, empowerment, and mobilization of those who are not getting screened for colorectal cancer. Our hope is that our partners can take this research and the recommended messaging provided to strengthen your own communications campaigns, creating resources that resonate with the target audiences even more by using your own creativity, innovation and spokespersons.

The NCCRT would like to thank the Public Awareness and Social Media Task Group members who participated in the conceptualization of this Guidebook’s research and content. Also, a very special thank you to the 80% in Every Community Market Research Advisory Group for their participation, expertise, and oversight. 

Other Guides and Resources: 

The Hispanics/Latinos and Colorectal Cancer Companion Guide and Asian Americans and Colorectal Cancer Companion Guide introduce market research about the unscreened from these populations and include tested messages in Spanish and several Asian languages. The 2017 Communications Guidebook is also still a useful resource for developing your messaging campaigns. 

2019 Messaging Guidebook – Table of Contents (Section Downloads Below)

Other tools were developed during the 80% by 2018 campaign and can still help you promote and evaluate your communications:

More communications tools and resources will be coming soon!

 

80% in Every Community 2019 Messaging Guidebook: Recommended Messages to Reaching the Unscreened – July 16, 2019

This webinar provided an introduction to the 2019 80% in Every Community Messaging Guidebook: Recommended messages to reach the unscreened. The guidebook serves as a resource to both better understand the motivations, attitudes, and barriers of key unscreened populations, while it also recommends market tested messages that can educate and motivate these key audiences on the importance of colorectal cancer screening. The 2019 update to this NCCRT resource includes new findings, new population profiles, and message delivery insights that will better inform our efforts to improve colorectal cancer screening rates to 80% in Every Community. 

Speakers:

  • Michelle Aubertine, KS&R
  • Bill Willard, American Cancer Society

 

Innovative Ways To Increase Colorectal Cancer Screening Among The Underserved – February 20, 2018

This webinar was a repeat of one of our most highly rated workshops from the NCCRT meeting last month. The purpose of the webinar was to move beyond describing the challenges of reaching the underserved to showcasing innovative solutions, including using systems change to increase colorectal cancer screening in a multi-ethnic community; providing an example of how local health departments can team up with academics on community engagement; and partnering with emergency departments to reach rural residents who don’t have a primary care provider.

Speakers:

  • Joseph Ravenell, MD, MS, Assistant Professor of Population Health and Medicine; Associate Dean for Diversity Affairs and Inclusion at NYU School of Medicine; NCCRT Steering Committee (Presenter/Moderator)
  • Karen E. Kim, MD, Professor of Medicine, Dean, Faculty Affairs, Associate Director, Cancer Disparities, the University of Chicago Medicine Comprehensive Cancer Center
  • Jenna Hatcher, RN, PhD, MPH, Director of Diversity and Inclusion, University of Kentucky, College of Nursing

HSRA Community Health Center Program Data

Each year, Health Resources and Services Administration (HRSA) funded Health Centers (HC) are required to report a core set of information that includes data on patient demographics, services provided, clinical indicators, utilization rates, costs, and revenues. Since 2012, colorectal cancer screening has been included as a clinical quality measure (CQM).

HRSA’s Health Center Data website allows users to explore the UDS colorectal cancer screening rate at the national, the state, and at the HC level. The UDS Mapper allows users to view UDS measures by zip code, create custom maps by adding graphics and text, and export maps. Free registration is required to use the UDS Mapper.

Evaluation: The specification for HRSA’s CQMs are aligned with Centers for Medicare and Medicaid Services (CMS) electronic-specified clinical quality measures (e-CQMS) to ensure measure alignment across the Department of Health and Human Services (HHS). HRSA is also modernizing the UDS reporting process to increase data standardization across national programs, reduce reporting burden, increase data quality, and expand data use to improve clinical care and operations. Rigorous reporting requirements ensure accurate reporting of quality data.

Permissions: Made publicly available online by the Health Resources and Services Administration.

Publication date: Published annually; latest data is for 2016

Post date: October 2, 2017

Contact: Send comments, questions, and suggestions via web form or call 877-974-2742.

Links Of Care Update

Links of Care Update – July 27, 2017

This webinar shared what we’ve learned so far from our Links of Care pilot project. The Links of Care pilots seek to improve colorectal cancer screening and follow up care for uninsured and underinsured patients by strengthening relationships between community health centers and the surrounding medical neighborhood. Speakers provided a brief overview of their specific pilot site, and discussed implementation, workflows, and lessons learned.

Background: In 2012, the Health Resources Service Administration (HRSA) began requiring Federally Qualified Health Centers (FQHCs) to measure and report colorectal cancer screening rates. FQHCs were concerned about securing follow up care for patients with an abnormal diagnosis, as follow-up services are often prohibitively expensive for low-income, uninsured patients. To address this challenge, the American Cancer Society, the Centers for Disease Control and Prevention, and the NCCRT implemented the Links of Care pilot program to promote collaboration between FQHCs serving low-income patients and specialty providers to secure diagnostic services. Goals were to increase timely access to specialists after an abnormal screening, implement evidence-based strategies to increase colorectal cancer screening rates, and assess project implementation.

Speakers:

  • Suzanne Lagarde, MD, MBA, FACP, Chief Executive Officer, Fair Haven Community Health Center, Connecticut
  • Julia Williams, RN, Chief Nursing Officer, Beaufort Jasper Hampton Comprehensive Health Services, Inc., South Carolina
  • Chris Singer, RN, CPHQ, Chief Operating Officer, West Side Community Health Services, Minnesota
  • Kara Riehman, PhD, Strategic Director, Evaluation & Research, American Cancer Society, Inc.

New Hampshire Colorectal Cancer Screening Program Patient Navigation Model Replication Manual

The New Hampshire Colorectal Cancer Screening Program (NHCRCSP) patient navigation model has been highly effective in increasing the completion and quality of colonoscopy screening and surveillance among statewide underserved groups. Patients in this program, all of whom were navigated, were 11 times more likely to complete colonoscopy than non-navigated patients in a comparison group. Given this success, the Centers for Disease Control and Prevention (CDC) and the NHCRCSP worked together to develop a manual to help others replicate the model. The manual includes step-by-step instructions for implementing a screening navigation program, including a detailed navigation protocol, guidance on data collection, navigator training, and sample templates and tools.

Intended Audiences: Any organization that conducts colorectal cancer screening or administers a colonoscopy program may benefit from implementing this intervention. Organizations could include health systems, endoscopy centers, primary care practices (including Federally Qualified Health Centers), universities, state or local health departments, and grantee programs. This manual also may be useful for health care providers, pharmacy staff, and other community partners to clarify their roles in the intervention and how it benefits their patients.

Congratulations to former NCCRT Steering Committee member Dr. Lynn Butterly and to all the others who helped create this resource.

Evaluation: A rigorous evaluation was conducted, including a comparison of NHCRCSP-navigated patients to a similar group of non-navigated patients. Learn more on page 8 and in Appendix D. Evaluation results were also published in the journal Cancer.

Permissions: Made publicly available online through the Centers for Disease Control and Prevention.

Publication date: October 2016

Post date: September 18, 2017

Contact: Send comments, questions, and suggestions to NHPNManual@cdc.gov or NHCRCSP@hitchcock.org.

Study on Medicaid Expansion and Access

A study released by the American Cancer Society Cancer Action Network (ACS CAN) and the NCCRT estimates that in 2017 over 2.7 million low-income men and women aged 50-64 will remain uninsured and continue to lack access to an affordable health care coverage option, including colorectal cancer screening services.

The report, Health Reform and the Implications for Cancer Screening, provides national and state-specific estimates of the number of uninsured men and women in 2017 based on three scenarios: Medicaid expansion decisions as of April 2015, no state Medicaid expansions, and if all states expand Medicaid. Read the ACS CAN report summary.

Many thanks to our partners at ACS CAN for developing the report, and to NCCRT’s Policy Action Task Group members Barry Berger, Joel Brill, Heather Dacus and Holly Wolf for generously sharing their expertise in the review process.

Links Of Care: Improving Access To Specialists For Community Health Center Patients In The Delivery Of Colorectal Cancer Screening

Links of Care: Improving Access to Specialists for Community Health Center Patients in the Delivery of Colorectal Cancer Screening – August 17, 2015

This webinar examined the common features of model programs that have demonstrated success in delivering colorectal cancer screening and follow-up care to uninsured, underinsured, and low-income adults in their respective communities. Hear directly from leaders of the model programs, who describe elements that were crucial to their success in building strong relationships with gastroenterologists, hospitals and other specialists in the delivery of screening.

Speakers:

  • James Hotz, MD, National Association of Community Health Centers
  • Lynn Butterly, MD, Dartmouth – Hitchcock Medical Center
  • Jason Beers, Operation Access

View the July 27, 2017 webinar update on the Links of Care pilots.

Steps For Increasing Colorectal Cancer Screening Rates: A Manual For Community Health Centers

Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Community Health Centers – September 11, 2014

This webinar introduced the new resource, Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Community Health Centers.

Speakers:

  • Richard Wender, MD, American Cancer Society
  • Mary Doroshenk, MA, NCCRT
  • Maria Syl D. del la Cruz, MD, Thomas Jefferson University