The 26^th annual National Colorectal Cancer Roundtable Annual Meeting took place Nov. 16-18 in Baltimore, MD, bringing together nationally known experts, thought leaders, and decision makers on colorectal cancer screening research, policy, and delivery.

NCCRT’s first in-person meeting since 2019 boasted record attendance (240 participants) and drew record-breaking sponsorships ($120,000), a clear testament to the energy and momentum behind the NCCRT’s 80% in Every Community campaign, which aims to increase colorectal cancer screening rates to 80% and higher.

Meeting highlights included analyses on the latest colorectal cancer screening data, updates on progress toward reaching average-risk individuals for screening at age 45, and a moving and action-oriented discussion on implicit bias and the impact on patients and survivors.

“The palpable energy and enthusiasm of so many passionate and devoted people to meet in person and exchange ideas that will affect positive, and equitable, change in colorectal screening in every community, is what made the 2022 NCCRT Annual Meeting such a success” said NCCRT chair and Professor of Medicine, Oncological Sciences, and Medical Education at the Icahn School of Medicine at Mount Sinai, Dr. Steven Itzkowitz.

Dr. Pascale White, a Co-Founder of the Association of Black Gastroenterologists and Hepatologists and new member of the NCCRT Steering Committee, shared: “The 2022 NCCRT Annual Meeting was such a success due to its diverse group of attendees. It was inspiring to be among survivors, practitioners, and advocates who share the mission of amplifying CRC screening and promoting health equity. “

Meeting slides and select session recordings will be available on the NCCRT website, in the next couple weeks. Meanwhile, the highlight of the meeting, an “armchair conversation” on implicit bias between a primary care physician and a colon cancer survivor that experienced significant bias that delayed her diagnosis is available to view now.

We’re proud to share we saw robust engagement on our social channels (Twitter and LinkedIn), with 352 uses of our event hashtag, #NCCRT2022. Visit our channels to find additional meeting highlights and photos.

Thank you to all of our valued members, speakers, and sponsors for making the meeting such a success. We look forward to our continued work together as we relentlessly strive toward 80% in every community.

December 5, 2022 – Authors: Emily Bell, MPH and Kaitlin Sylvester, MPA

The 26^th annual National Colorectal Cancer Roundtable Annual Meeting took place Nov. 16-18 in Baltimore, MD, bringing together nationally known experts, thought leaders, and decision makers on colorectal cancer screening research, policy, and delivery.

NCCRT’s first in-person meeting since 2019 boasted record attendance (240 participants) and drew record-breaking sponsorships ($120,000), a clear testament to the energy and momentum behind the NCCRT’s 80% in Every Community campaign, which aims to increase colorectal cancer screening rates to 80% and higher.

Meeting highlights included analyses on the latest colorectal cancer screening data, updates on progress toward reaching average-risk individuals for screening at age 45, and a moving and action-oriented discussion on implicit bias and the impact on patients and survivors.

“The palpable energy and enthusiasm of so many passionate and devoted people to meet in person and exchange ideas that will affect positive, and equitable, change in colorectal screening in every community, is what made the 2022 NCCRT Annual Meeting such a success” said NCCRT chair and Professor of Medicine, Oncological Sciences, and Medical Education at the Icahn School of Medicine at Mount Sinai, Dr. Steven Itzkowitz.

Dr. Pascale White, a Co-Founder of the Association of Black Gastroenterologists and Hepatologists and new member of the NCCRT Steering Committee, shared: “The 2022 NCCRT Annual Meeting was such a success due to its diverse group of attendees. It was inspiring to be among survivors, practitioners, and advocates who share the mission of amplifying CRC screening and promoting health equity. ”

Meeting slides and select session recordings will be available on the NCCRT website, in the next couple weeks. Meanwhile, the highlight of the meeting, an “armchair conversation” on implicit bias between a primary care physician and a colon cancer survivor that experienced significant bias that delayed her diagnosis is available to view now.

We’re proud to share we saw robust engagement on our social channels (Twitter and LinkedIn), with 352 uses of our event hashtag, #NCCRT2022. Visit our channels to find  additional meeting highlights and photos.

Thank you to all of our valued members, speakers, and sponsors for making the meeting such a success. We look forward to our continued work together as we relentlessly strive toward 80% in every community.

August 16, 2022 – Authors: Emily Bell, MPH and Kaitlin Sylvester, MPA

Each summer, the NCCRT steering committee meets at an annual retreat to reflect on the landscape of colorectal cancer screening, to review our current and recent work, and to chart our course for the coming year. We were thrilled to meet in-person with the group–for the first time since 2019!–in Washington, DC last week. 

We’re pleased to share with you the “State of the NCCRT” presentation that we prepared for the steering committee to summarize where we stand with our work toward 80% in Every Community—the collective efforts of the NCCRT membership, our Strategic Priority Teams, and numerous advisory groups.

We hope you will take a look at the exciting work completed or teed up for the remainder of 2022 and join us in the feeling of immense pride and gratitude for all that we are able to accomplish when we work together to achieve bold goals.

We are fortunate to work alongside you as we strive to reach 80% in Every Community. 

Thank you for all that you do!

Emily & Kaitlin

January 12, 2022 – Author: Steven Itzkowitz, MD, FACP, FACG, AGAF

The beginning of a new year is typically a time for optimism, goal-setting, and fresh starts, but clearly the start of 2022 feels different. With the surge of cases brought on by the Omicron variant, and our health care system and workforce stretched to new limits, it is hard to be optimistic. However, as I reflect on 2021 and the work of our colorectal cancer fighting community, I am humbled and hopeful for the future. The relentless passion of our NCCRT members and partners has been an inspiration to me since I first attended an NCCRT meeting in 2003 and is what makes me so excited about working with you in my new role as Chair.

But first, I want to share my immense gratitude with all of you who are working on the frontlines of the pandemic. Your tireless dedication to protecting our communities against COVID-19 and caring for those infected by the virus is invaluable, immeasurable, and has not been acknowledged in ways you truly deserve. I have seen at my own hospital how stretched the doctors, nurses, trainees, and all support staff are, not only from getting COVID themselves, but having to cover other colleagues who are out sick or who have to provide child or elder care.

As I look back on our work in 2021, I am proud to reflect on our adaptability and innovation. While colorectal cancer screening rates lagged even during times that COVID-19 cases improved, you pivoted to provide options for your patients, utilizing at-home, stool-based tests. Then in May when the United States Preventive Services Task Force (USPSTF) changed its colorectal cancer screening recommendation to initiate screening for those at average risk at age 45, you rallied together to adapt your processes, promote the new guideline, and advocate for policy changes to ensure swift adoption for health insurance plans. Then, in November, at the 2021 80% in Every Community Conference & NCCRT Annual Meeting, you demonstrated your steadfast commitment to tackling persistent barriers to screening, presenting on the latest research, promising practices, and policy developments, and engaging in critical discussions to advance our work in addressing the NCCRT’s current three priority areas:

1. On-time screening (as soon as eligible whether average or increased risk)
2. Timely colonoscopy follow-up to abnormal non-colonoscopy test
3. Understanding and addressing the source of disparities

The Annual Meeting was one of the most engaging meetings we have had in recent years, with every topic having direct relevance to our work on the ground.

And 2022 is already bringing some early successes. Most importantly, On January 10^th the Department of Labor issued an FAQ regarding coverage of colonoscopies pursuant to USPSTF recommendations. The FAQ specifies that plans are required to cover without cost-sharing, a follow-up colonoscopy performed to evaluate a positive non-invasive stool-based screening test or direct visualization test. Beginning on or after May 31, 2022, plans must provide coverage without cost sharing for plan or policy years. This is a tremendous success, thanks in no small part to the work of numerous NCCRT members.

I’m also excited to share with you that we have several exciting new resources and opportunities in the pipeline for the coming year:

• We will soon release our new Steps Guide for Increasing Colorectal Cancer Screening in Primary Care Practices, which is being updated to reflect the new guidelines, recent research and best practices, and will now be expanded beyond community health centers to all primary care settings;
• We are working on new market research to better understand how to reach Black and African American adults and adults that are newly or soon-to-be eligible for colorectal cancer screening; and
• We are planning a new webcast series, which we’re calling Blue Star Conversations, in which our Strategic Priority Teams will host virtual meetings featuring an expert speaker on a timely topic, followed by member conversation. Watch for registration for these “meet the expert” sessions coming soon!

I also want to share a reminder that the NCCRT’s 2020 resource, Reigniting Colorectal Cancer Screening As Communities Face And Respond To The COVID-19 Pandemic: A Playbook, remains a vital resource to align NCCRT members and partners in working to reignite screening during the pandemic. We will look for opportunities to update and add to this work this year.

Since our mission is to reach “every community”, we need to redouble our efforts to identify and overcome the CRC screening rates based on disparities related to race, ethnicity, gender-identity, and insurance, in our local communities. Collectively, we have huge talents and expertise to overcome these barriers, and we know, by example, that it can be done.  

While the challenges in our day-to-day lives and in our work remain unprecedented, I am confident that we will continue to find new ways to adapt and innovate to reach more individuals for colorectal cancer screening, and in turn save more lives from this often-preventable disease. I’m in awe of your dedication and proud to work alongside you as we strive to reach 80% in Every Community. 

Thank you for all that you do. Stay safe and well.

Steven Itzkowitz, MD, FACP, FACG, AGAF
Professor of Medicine, Oncological Sciences and Medical Education
Icahn School of Medicine at Mount Sinai
Chair, NCCRT

October 4, 2021 – Authors: Andrew Van Wieren, MD and Ted Hufstader, MPH

On March 1, Esperanza Health Centers became the recipient of the 2021 80% in Every Community 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 achieve colorectal cancer screening rates of 80% and higher.

Andrew Van Wieren, MD, is Chief Medical Officer, leads our team of over 70 medical and behavioral health providers, and is dedicated to expanding access to high-quality health care to underserved communities. Dr. Van Wieren’s efforts have helped Esperanza receive the National Quality Leader Award four out of the past five years, placing us within the top tier of health centers nationally for our quality of care. He graduated from the Warren Alpert Medical School at Brown University and completed his residency at Brigham and Women’s Hospital Primary Care Internal Medicine Program at Harvard Medical School. Some of his awards and affiliations include the Alpha Omega Alpha Honor Society, Gold Humanism Honor Society, and National Health Service Corps Scholar.

Ted Hufstader, MPH, joined Esperanza Health Centers in January 2018, bringing 12 years of expertise in health research and organizational learning and development to his role. Most recently, Ted was supporting and developing a leadership and succession planning program at Southcentral Foundation (SCF), an Alaska Native primary care system known for its transformational relationship-based care model and a two-time winner of the Malcolm Baldrige National Quality Award. Ted’s philosophy is determining what builds, drives, and sustains an organization’s culture, and he brings this approach to Esperanza’s nationally recognized quality improvement initiatives. Outside of work, you can find Ted running through Chicago’s many neighborhoods, relaxing with his cat Fuzzie Mercury, and searching for Chicago’s best chocolate chip cookie.

Esperanza Health Centers was founded in 2004 with a mission to deliver health and hope for Chicago’s underserved communities. Esperanza serves primarily, but not exclusively, Latin X Mexican-American immigrant populations on the southwest side of Chicago. About 90% of their patients identify as Latin X, and they are committed to DEI efforts (diversity, equity, and inclusion) in their work.

In 2016, Esperanza began applying a team-based care approach to increase colorectal cancer screening rates from a baseline of 43% in 2015. Screening rates climbed to 69% in 2016 and reached 80% in 2017, with rates remaining above 80% through 2019.

In 2018 and 2019, the Health Resources and Services Administration (HRSA) designated Esperanza a National Quality Leader, an honor bestowed on fewer than 5% of federally qualified health centers nationwide. During the COVID-19 pandemic, care teams focused on delivering fecal immunochemical tests (FITs) with prepaid mailers and frequent reminders.

Tell us a little bit about Esperanza Health Centers and how you have been impacted by COVID-19.
We believe in and live our values of caring, quality, and family. We continuously strive to deliver high-quality patient-centered care that meets the needs of the communities we serve. Between 2016 and 2020, our health center population rose from 20,719 to 45,548 patients.

The COVID-19 pandemic disproportionately impacted the communities we serve, with a COVID-19 positive test rate of 75% in some communities. During the pandemic, we focused on the immediate needs of our community by providing health information, testing, clinical evaluation, referrals, and vaccination services.

When and why did Esperanza Health Centers decide to focus on increasing colorectal cancer screening rates?
In 2015, our baseline screening rate was 43%, and we wanted to improve this measure. The NCCRT’s 80% by 2018 goal helped to motivate and focus us on increasing our colorectal cancer screening rates. Once we set the goal for an 80% screening rate, it was hard not to go forward. It took us about four years to reach 80%.

Our approach was to get curious and look at different ways to improve access to screening, especially for our uninsured patients. For example, we incorporated FIT tests into the screening workflow because about 30% of our patients are uninsured.

What clinical practice changes did you implement to support colorectal cancer screening?
We adopted a team-based care model with a care coordinator role. In this model, every patient works with a dedicated three-person team – care coordinator, medical assistant, and provider – with each team member’s skills leveraged to reach the best patient outcomes. The care coordinators really helped by working with lists of patients, doing patient education around FIT tests, and following up on abnormal test results.

We did a lot of training to make sure that everyone felt that they were part of the team. We built the team by starting at the point of new hiring and welcoming people to the team. Being on a team is about sharing responsibility and designing systems that make it easy for people to be successful at doing the right things.

We changed our electronic health records (EHR) system to one that had strong population health tools that could provide us with monthly dashboard reports. The dashboard data enabled us to identify the care teams that were exceeding their goals and capture and share their best practices. You cannot improve if you do not know where you are and whether your interventions are helping. The dashboard really helped us to see that information.

The EHR system also allowed our care coordinators to directly order FIT tests without a provider being involved. That enabled patients to access FIT testing without needing to come in for a visit. Instead, they received their FIT tests simply because they were on our panel of patients. Providers signed off on FIT tests in batches, and the care coordinators followed up to get the FIT tests back for analysis.

Communication is important for patients and follow-up because patients don’t always return the FIT tests on time. For example, our care coordinators sometimes call patients a number of times before getting the FIT test back. Our normal policy is to do two phone calls and a letter, but sometimes messages alone are not good enough. Some people require more help to return their FIT test because of health literacy or social determinants of health factors. In those cases, a persistent care coordinator can make a big difference.

Benchmarking our measures helped to motivate the teams through competition and improvement. We used data dashboards and business intelligence to do some visualization of the data. When the data told a story, it enabled people to discuss how they wanted to respond. We revised the designs of the dashboards based on team member feedback. For example, some people wanted a comparison report showing how they were doing compared to the previous year. The data visualizations from the EHR helped us to get new perspectives.

One of our strategic goals is to be in the first quartile for all the Uniform Data System (UDS) measures. The competition aspect keeps the teams motivated to improve their thinking about how to make screening accessible and how to accompany patients through the screening journey. We also have a quality subcommittee of our board, and we try to build an open culture for curiosity and new ideas. We are saying, doing, and living our values, which is very important.

What advice would you offer to other health centers that would like to implement a team-based care approach to colorectal cancer screening?
We recommend that health centers find an EHR system that facilitates their team-based population health approach. Find an EHR that provides informative dashboards, monthly reports, and lists of patients to work from.

Additionally, set SMART (specific, measurable, achievable, realistic, timely) but audacious goals for motivation, and then work on step-by-step incremental achievements toward the big goals. Keep yourself accountable for those incremental achievements and keep pushing toward them.

Finally, ensure that you have institutional buy-in and investment. Reaching big goals does not happen magically; people must be hired, and money must be spent. We have built a brand of quality for our system, and that’s the #1 advertisement that you can have. Our reputation is behind a lot of the growth success that we have had.

What success have you seen? How did you measure that success?
We look at success measures at both the team level and across the whole clinic. We share the team dashboard results with teams every month, and the Practice Transformation Associates work with teams to understand the data and set new goals.

We like FIT tests because, as a quality measure, the model of colorectal cancer screening with a FIT test is easy to explain, and it’s a workflow that people can understand and operate successfully. When the teams see their team data, they get motivated, and the teams set their own goals.

Our colorectal cancer screening rate has fallen below 80% for now because the pandemic caused our rate to drop. But the current rate is still a large improvement over our 2015 baseline rate. Our goal for this year is 70% because many patients won’t come into the health center because of the pandemic.

Were there tools, trainings, or resources that you found helpful?
The 80% by 2018 national goal was helpful and was very encouraging along the way. Our local American Cancer Society representative, Emmanuel Zambrano, was also a great cheerleader and very supportive.

Do you have any final tips for our readers who are working to achieve 80% in Every Community?
Invest in making small incremental steps toward your big impact goals. That way, people won’t get overwhelmed – they can start smiling and growing fast. Perfect!

Thank you for sharing your story with us! We look forward to hearing more about your work and the Esperanza Health Center’s progress in the future.

September 1, 2021 – Authors: Donald A. Balasa, JD, MBA and Nikki Hochschild, MBA

On March 1, the AAMA became the recipient of the 2021 80% in Every Community 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 achieve colorectal cancer screening rates of 80% and higher.

Donald A. Balasa, JD, MBA, serves as the CEO and legal counsel of the American Association of Medical Assistants®. His areas of legal specialization include not-for-profit governance, professional credentialing and regulation, and antitrust principles applicable to certifying and accrediting bodies.

Balasa served as chair of the National Commission for Certifying Agencies (NCCA) and as vice chair of the committee to update the Institute for Credential Excellence (I.C.E.) publication ICE 1100:2019—Standard for Assessment-Based Certificate Programs, which is an American National Standard. He was elected to the board of directors of the Commission on Accreditation of Allied Health Education Programs (CAAHEP) in 2018 and as president of CAAHEP in 2021.

Balasa received both his baccalaureate and law degrees from Northwestern University and his MBA in economics from the University of Chicago. He was awarded the Certified Association Executive (CAE) credential from the American Society of Association Executives. Balasa has taught a course on association management at the DePaul University Kellstadt Graduate School of Business and teaches constitutional law evening courses at Trinity International University.

Nikki Hochschild, MBA, serves as the chief operating officer (COO) of the AAMA. Before her role as COO, Hochschild was the director of information technology and operations. She has played a key role in implementing the AAMA’s first ever e-commerce integrated website, improving operational efficiencies, and coordinating our partnerships with health care organizations like the NCCRT. Hochschild graduated with a Master of Business Administration from Northern Illinois University.

Tell us a little bit about the AAMA.
The American Association of Medical Assistants®, the only organization in the world devoted exclusively to the medical assisting profession, was established in 1956 and serves the interests of more than 92,000 medical assisting professionals. The American Association of Medical Assistants provides quality resources and educational opportunities for medical assistants by offering CMA (AAMA)® certification, advocacy for quality patient-centered health care, credential acknowledgment, and scope-of-practice protection.

When and why did AAMA decide to focus on informing and equipping medical assistants to educate patients about the importance of colorectal cancer screening?
The AAMA decided to focus on educating patients about the importance of colorectal cancer (CRC) screening because our leaders and members in certain parts of the United States were encountering a lot of patients with colorectal cancer who could have been helped by earlier detection. As important public health issues arise, the AAMA focuses on initiatives that impact our members in their professional and personal lives. For example, in addition to CRC screening, the AAMA has also played a prominent role in the efforts by the Centers for Disease Control and Prevention (CDC) to prevent fetal alcohol spectrum disorders (FASDs).

The focus also stemmed from the AAMA’s engagement as an NCCRT member starting in 2017. AAMA staff who attended NCCRT’s annual meetings in 2017, 2018, and 2019 were inspired by the energy and enthusiasm for reaching screening rates of 80%. They then shared the best practices and evidence-based strategies to increase CRC screening that they learned about at the meeting with their colleagues and the idea for a partnership with NCCRT was born.   

What activities did you implement, and how did you choose them?
Throughout 2020, the AAMA implemented activities that best inform and equip medical assistants in educating patients about the importance of CRC screening and helping patients overcome barriers in the screening process. Those activities were established in support of the goal to achieve colorectal cancer screening rates of 80% and higher.

AAMA continuing education courses and articles from our bimonthly publication, CMA Today, were geared toward empowering medical assistants to be more effective advocates for CRC screening. This focus was amplified during National Colorectal Cancer Awareness Month in March and Medical Assistants Recognition Week October 19–23. Emily Butler Bell, NCCRT co-director, contributed an article on the importance of CRC screening, the critical role of medical assistants in delivery timely, quality CRC screening, and to highlight the AAMA and NCCRT’s collaboration to place a special focus on the opportunity to save more lives from this disease.  

To broaden our CRC education outreach to medical assistants, the AAMA created social media posts about CRC courses and programs offered by the NCCRT and other reputable CRC screening providers. The AAMA posted on Facebook, Instagram, LinkedIn, and Twitter, which resulted in approximately 183,613 impressions.

What success have you seen? How did you measure that success?
One of the centerpieces of the AAMA’s CRC education initiative was the new course entitled Medical Assistants’ Roles in Improving Colorectal Cancer Screening Rates: Getting to 80% by Durado Brooks, MD, MPH, former vice president of cancer control interventions of the American Cancer Society. This course was marketed by e-blasts and social media posts throughout the year, and the price of the course was discounted during National Colorectal Cancer Awareness Month and Medical Assistants Recognition Week. 3,964 individuals—including medical assistants and other health professionals—completed the course successfully and were awarded AAMA continuing education credit.

What tips would you offer to other professional organizations that would like to support and empower their members to focus on colorectal cancer screening?
Get your regional, state, and local affiliates involved, as well as educators in academic programs in your profession. The AAMA state societies and local chapters and academic programs “caught the vision” and created their own CRC educational events. This amplified the impact of the AAMA initiative in countless ways!

Our organization constantly shared informational messaging with medical assistants about the importance of CRC screening to empower them to communicate with patients. We went 100% virtual during the pandemic, which required us to rely heavily on digital sources, such as social media, websites, and online learning courses for disseminating information about CRC screening to medical assistants.

Do you have any final tips for our readers that are working to achieve 80% in Every Community?
The American Cancer Society and NCCRT staff have been instrumental in creating CRC screening resources. For those who are looking to achieve 80% in Every Community, I highly recommend you reach out to them as they are incredibly receptive to ideas you may have, and they have been so great to collaborate with.

Don’t underestimate the generosity and commitment of health professionals! We witnessed the bravery and sacrifices of health care heroes during the COVID-19 pandemic. The AAMA observed the same traits in our medical assistants throughout the United States as they strove to help patients overcome fears of CRC screening.

July 27, 2021 – Author: Folasade May, MD, PhD, MPhil

On March 1, UCLA Health became the Grand Prize recipient of the 2021 80% in Every Community 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 achieve colorectal cancer screening rates of 80% and higher.

My name is Fola May. I am a Gastroenterologist and health services researcher at UCLA Health and focus on colorectal cancer prevention and health care disparities. I am also the Director of Quality Improvement for Digestive Diseases. In that capacity I help run health system efforts to improve quality of care for patients with gastrointestinal and liver diseases.

 

Tell us a little bit about UCLA Health and the organization’s colorectal cancer screening program.
UCLA Health is a large, integrated tertiary care medical center in Southern California with over 55 primary care sites and approximately 390,000 primary care enrollees. We also have five endoscopy procedure units that perform about 15,000 screening colonoscopies per year. The health system leadership designated colorectal cancer screening a high priority area in 2018 and since then has committed several resources to our quality improvement program and awareness campaign.

When and why did UCLA Health decide to focus on increasing colorectal cancer screening?
We recognized several years ago that colorectal cancer screening and early detection were areas where we could have much more impact. Our screening rates were quite low at the time—at round 50%. There were also several changes in our health system around that time that supported this new focus: health system leadership embraced the opportunity to improve our screening rates, we extended our capacity for screening colonoscopy by adding endoscopy units, and we started using more stool-based screening tests like the fecal immunochemical test (FIT). We also implemented a new electronic health record (EHR) system at around that time, and that platform allowed us to improve documentation of screening utilization. All of these changes resulted in an ideal environment with the tools, resources, and leadership needed to launch our first systemwide cancer awareness program focusing on colorectal cancer.

What activities and systems changes did you implement, and how did you choose them?
We had three major goals of the campaign. First, we wanted to increase awareness about colorectal cancer risk and screening utilization among UCLA patients, staff, and faculty. Second, we aimed to establish a formal quality improvement program to continuously track and improve care processes related to the screening and early detection of colorectal cancer. Third, we aimed to engage and support community partners throughout Los Angeles County to address colorectal cancer disparities.

We knew very early that we wanted a campaign that addressed patients, providers, our own staff, and beyond. To raise awareness among the patients we serve, we hosted several public events, often using the massive inflatable colon to engage patients walking to or from appointments on campus. We also identified patients with insightful personal stories about getting screened, receiving colorectal cancer care, and survivorship. We have continuously shared these patient stories on social media, and it has become a major means to bring people into the conversation about colorectal cancer.

There were also a few activities we did specifically for UCLA Health staff and providers. We held multiple Dress in Blue Days to raise awareness about colorectal cancer. Employees were also invited to lunchtime lectures about colorectal cancer screening, prevention through nutrition, and overall wellness.

One of our larger public-facing efforts was an informational social media campaign for which we had help from several advocates and influencers, including Kareem Abdul-Jabbar, Tyra Banks, and Maria Menounos. Through social media, we were able to share content—educational videos, webinars, infographics—to reach a broader audience. Several UCLA Health providers participated in radio show interviews, editorials, local television commercials, and information sessions that were geared towards both patients and providers who wanted to learn more about colorectal cancer. Many of these resources are available on our patient resource page.

I understand you took a multifaceted approach to your campaign. How did this work?
Our Colorectal Cancer Workgroup is the force behind our quality improvement efforts, which is a major component of the campaign. The workgroup is a multidisciplinary team with representation from gastroenterology, primary care, population health, quality improvement, family medicine, geriatrics, oncology, and surgery. So we have champions in many of our clinical divisions and departments to help us improve care processes related to getting patients screened. In addition, we work very closely with UCLA marketing and media. A lot of the success of our quality efforts and annual campaign comes from having this diverse representation of expertise at the table.

What success have you seen? How did you measure that success?
We try to measure success several different ways. For our first goal to increase colorectal cancer screening rates, we have been actively measuring screening rates and screening modalities for our health system. Despite the COVID-19 pandemic, we’ve been able to maintain a 10 percent increase in colorectal cancer screening for our system. Using more FIT during the COVID-19 pandemic was instrumental.

Other markers of success for the quality improvement program include our FIT mailing program, FIT navigation program, and several additional interventions that we’ve used at the provider and patient levels to increase screening rates. We’ve been able to not only roll those programs out, but also evaluate them and publish the results. I think that’s how we measure the success of the QI part of the campaign.

It is a bit more challenging to measure the impact of our efforts on the broader community and county, but we remain encouraged that we have been able to engage so many people through our website and social media efforts. We have travelled with the inflatable colon to two safety net hospital affiliates that see a larger proportion of medically underserved people of color and non-English speakers. I’m most proud of that community engagement and value that we have been able extend the campaign beyond UCLA.

What tips would you offer to others that are working to increase colorectal cancer screening in hospitals and health systems?
My first tip is that it takes a village. You really need to have the right people in the room to do this work in a large health system, and you need to have health system leadership support. I have enjoyed working with my partners in primary care, quality improvement, and population health. And the only reason why any of this work happens is because we embedded our programs in primary care where most colorectal cancer screening originates.

One other tip is to set very specific goals. It was easy for us to stay on task because we had three specific goals. We knew we wanted to increase awareness, increase screening, and implement a QI program. And we focused only on activities related directly to those goals. So having very specific, realistic goals and the infrastructure and resources to achieve them was essential.

Did you leverage any organizational or community partnerships to support your campaign?
We have partnered with the American Cancer Society and with Boston Scientific. Boston Scientific provides our large inflatable colon. We also partner with two local safety net hospitals and an organization of community health workers or promotoras who provide preventive health workshops and trainings in Latino communities in Los Angeles.

Do you have any final tips for our readers who are working to achieve 80% in Every Community?
This work is challenging and time-consuming but also very rewarding and inspiring. I have always loved patient care and my research, but doing this campaign has been an incredible way to work across clinical disciplines in a meaningful way. The stories that confirm the importance of the work are endless.

There was a gentleman we encountered one afternoon when we were out with the inflatable colon. He was walking from the health system to his car with his wife and happened to be leaving from his colonoscopy appointment. They had just left his procedure and they saw the inflatable colon so came by. He proceeded to share pictures from his procedure with all of the other individuals passing by, explaining that he had a polyp and that he was happy that the doctor got it out. He was proud that he had completed his colonoscopy and was telling everyone, “I just got mine. It’s not bad. Go get it done.” It’s moments like those that stick with me—and hopefully with others. We all need to yell from the mountain top that this disease is preventable.

Thank you for sharing your story with us! We look forward to hearing more about your work and UCLA Health’s progress in the future.

February 20, 2020 – Author: Theodore Levin, MD

In February 2019 Kaiser Permanente Northern California 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 achieve colorectal cancer screening rates of 80% and higher.

Dr. Theodore Levin is a gastroenterologist with the Permanente Medical Group in Walnut Creek California. He is clinical lead for CRC screening with TPMG and a research scientist at the KPNC division of research. 

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 12.3 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health.

Tell us a little bit about Kaiser Permanente Northern California and the organization’s colorectal cancer screening program.
Kaiser Permanente Northern California serves 4.3 million members, with a focus on prevention and total health. Beginning in 2006, Kaiser Permanente developed a population-based colorectal cancer (CRC) screening program to systematically deliver screening to age-eligible patients. We use a combination of Fecal Immunochemical Test (FIT) kit outreach and colonoscopy to systematically screen Kaiser Permanente Northern California members for CRC. All our members who are eligible for screening are mailed a kit in the year they turn 50. Following the first kit, all average risk members are mailed a FIT kit each year as they become due for screening through age 75. Colonoscopies are available for higher risk members and for those who would prefer to have that screening procedure.

Members coming due for surveillance colonoscopies are tracked using a regional database. We have a robust, multi-modal reminder and tracking system to help ensure that all members who need to be screened for colorectal cancer are encouraged to do so by phone, online through the Kaiser Permanente member portal (called kp.org), and/or by mail.

When and why did Kaiser Permanente decide to focus on increasing colorectal cancer screening?
Colorectal cancer screening has been a focus of Kaiser Permanente Northern California going back to the early 1980s. We published the first case-control study demonstrating the effectiveness of screening for CRC with sigmoidoscopy in 1992. In the mid 1990s, the preferred screening test was flexible sigmoidoscopy.

With the introduction of the Healthcare Effectiveness Data and Information Set (HEDIS) metric for CRC screening, we discovered that our screening rate was lower than we expected. Using the new FIT screening tests that were available, we saw an opportunity to implement mailed outreach to improve our screening rates. As a result of our mailed outreach and automated reminders program, we saw our screening rate increase dramatically, from 40% to over 80%.

What activities and systems changes did you implement, and how did you choose them?
Our program is based on mailed outreach, automated electronic reminders, goal setting, dissemination of best practices, and feedback on performance. A key change was to proactively send out FIT kits through a systemic outreach program. This allowed members to complete their screenings in the privacy of their home in advance of their due date, regardless of whether they were coming in for an office visit. We also have an electronic reminder system that enables all of our clinicians and staff to see when our members are due for CRC screening, which means we remind our members to complete screening during every interaction they have with Kaiser Permanente. Every primary care provider receives updates regarding how many of their members are up to date with their screenings. In addition, leaders at each medical center share best practices for contacting unscreened members to reach screening goals. This includes specific training on culturally responsive approaches for promoting screening. Outreach messages are also tailored to be culturally responsive.

What success have you seen? How did you measure that success?
Over 10 years, our CRC screening rate increased from 40% to over 80% across the Northern California region. We reduced cases of colorectal cancer by 26% and reduced colorectal cancer related deaths by 52% among our members in Northern California. We published these results in Gastroenterology in 2018.

What tips would you offer to others who are working to increase colorectal cancer screening in hospital systems like yours?
Mailing FIT kits to members’ homes is an extremely effective way to increase CRC screenings because members can do the test in the comfort of their own homes; there is no need for an office visit. At the same time, the engagement of clinicians and staff is needed for additional outreach to members, and to emphasize the importance of screening when members come in for office visits.

Were there tools, trainings or resources that you found helpful?
The Community Guide, which is published by the Community Preventative Services Taskforce, was extremely valuable when we were starting our program. We also learned a lot from the United Kingdom’s National Health Service (NHS) Bowel Cancer Screening program.

Do you have any final tips for our readers that are working to achieve 80% in Every Community?
Don’t let perfect be the enemy of good. No matter where you are and what resources you have available, you can always start with some amount of outreach for screening. Be sure to test your materials to make sure they are inclusive of all members of your community, measure your impact, modify your program based on your learnings, and continuously improve.

 

January 16, 2020 – Author: Bryan Green, MD

In February 2019 Dr. Bryan Green 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 achieve colorectal cancer screening rates of 80% and higher.

Dr. Bryan Green is one of five physicians at the Digestive Disease Group in Greenwood, South Carolina. He joined the practice in 2004 after completing his gastroenterology fellowship. Dr. Green is a past President of the South Carolina Gastroenterology Association (SCGA) and has promoted the Colon Cancer Prevention Network, a partnership between the University of South Carolina’s Center for Colon Cancer Research and several SCGA member physicians to perform free colonoscopy screenings to underinsured patients throughout South Carolina. He also has strengthened the relationship between the SCGA and the Medical University of South Carolina Digestive Disease Center through partnerships in meetings, seminars, and research studies. Every March, Dr. Green volunteers at the statehouse as the South Carolina Medical Association doctor of the day in honor of Colon Cancer Awareness Month. Dr. Green has participated in the Digestive Disease National Coalition (DDNC) Legislative Weekend to advocate for colorectal cancer treatment and prevention funding from Congress. He is part of a team of physicians, nurses, and patients that meet with congressional members to encourage funding for digestive health.

Tell us a little bit about your colorectal cancer screening program.
In 2008, my practice of five gastroenterologists in Greenwood, South Carolina, along with two others in a nearby county, partnered with the Center for Colon Cancer Research at the University of South Carolina. Through this partnership, we offered free colonoscopies to the uninsured or underinsured at our endoscopy center. We screened 200 patients and found numerous polyps and two cancers. We realized, however, that this was a challenging group of patients to care for due to various limitations (e.g., limited literacy, transportation, etc.). In 2010, we approached the South Carolina Legislature and BlueCross BlueShield of South Carolina and received a grant to hire patient navigators to help address these challenges. We also spread the word and enlisted other gastroenterologists throughout the state to participate. The program continued to grow to the point that we now have over 80 participating gastroenterologists and have provided free screening colonoscopies to over 3,000 uninsured patients. And we are still growing!

When and why did you decide to focus on increasing colorectal cancer screening?
My practice of five doctors provides all the gastrointestinal care in our five-county area; thus, we see the end result of not screening (i.e., patients showing up in the ER with advanced-stage colorectal cancer and obstructions). Many of these people will suffer and die needlessly. I was so saddened to hear that many of these people knew the benefits of screening but were not able to afford it. I vowed to do everything I could to prevent that from happening in my community.

What makes your program unique compared to other programs?
We began as a grassroots effort by a small group of physicians and researchers without any initial governmental or institutional support. We then realized we could leverage this by obtaining grants to employ patient navigators. We still rely on the generosity of healthcare providers to give their time and use of their independent endoscopy centers to provide this free care. The financial support for the patient navigators from the South Carolina Legislature has allowed us to serve far more people better and save more lives.

What activities and systems changes did you implement, and how did you choose them?
We realized the importance of patient navigators in helping these patients be best prepared and ready for their procedure.

What success have you seen? How did you measure that success?
Our good or excellent prep rate in participating patients went from 60% to nearly 90% after implementing the patient navigator program.

 What tips would you offer to others that are working to increase colorectal cancer screening in medical communities like yours?
Most people go into health care because they want to help others. Bureaucratic red tape, regulatory, and payment issues often stifle this, but most people still have that desire to serve inside them. I gave these providers a way to express that it is truly better to give than to receive.

Were there tools, trainings or resources that you found helpful?
Reaching out to different parties to utilize their unique skills and talents. Myself and my physician colleagues can do colonoscopies and remove the polyps but that is just the final part of the process. I was able to involve survivors, patient advocates, nurses, the media, businesses, corporations and even eventually the legislature to all work towards our goal. We could never have achieved what we did without the participation of all parties. Colorectal cancer is so prevalent that almost everyone knows someone that has been affected by it and most people are glad to help if you just ask.

Do you have any final tips for our readers that are working to achieve 80% in Every Community?
Never doubt the willingness of people to volunteer their time and energy help prevent colorectal cancer in their community. I am continually impressed and humbled by the dedication and unity of so many individuals to help conquer colorectal cancer.