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.

September 25, 2019 – Author: Jennifer Redmond Knight, DrPH

In March 2019 Kentucky Cancer Consortium became an Honoree recipient of one 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. Jennifer Redmond Knight is a part-time Assistant Professor in the Department of Health Management and Policy and is a member of the University of Kentucky Markey Cancer Center Cancer Control Program. She serves as the evaluation and sustainability specialist for the Kentucky Cancer Consortium, as co-principal Investigator for the Kentucky LEADS (Lung Cancer, Education, Awareness, Survivorship) Implementation of Quality Lung Cancer Screening Component, and as the principal investigator for a Lung Cancer Health Equity grant focused on workplaces with predominantly male employees. Her recent publications focus on lung cancer screening, an environmental scanning process and understanding barriers to colorectal cancer screening in Kentucky. She has extensive experience in group facilitation, partnership sustainability, program development, epidemiology, evaluation and policy, systems and environmental change efforts. Dr. Knight specializes in building trust with stakeholders, and maintaining positive relationships across governmental, private, and nonprofit sectors, while building enthusiasm and support around complex issues in public health. Her current primary focus areas relate to Health Care Reform/Health Care Access and Cancer, Lung Cancer Prevention and Early Detection, Colon Cancer Prevention and Early Detection and cancer prevention and control evaluation. 

We’re excited to feature your work on the 80% Blog. Can you tell us about yourself, and your colorectal cancer screening program at Kentucky Cancer Consortium?
I’m the evaluation and sustainability specialist for the Kentucky Cancer Consortium and have been involved in leading cancer prevention and control efforts at the community and state levels for the past 16 years. Since 2002, the Kentucky Cancer Consortium has prioritized increasing colorectal cancer screening through convening more than 50 collaborative partners and catalyzing these partners to do more together than we could ever do on our own.

Tell us a little bit about Kentucky Cancer Consortium and the organization’s colorectal cancer screening program. How did Kentucky Cancer Consortium come together to collaborate on colorectal cancer screening? How did you identify partners?
The Kentucky Cancer Consortium (KCC) is a statewide comprehensive cancer control coalition comprised of over 70 Kentucky member organizations and 450 partners committed to reducing the significant cancer burden in Kentucky. In 2002-2003, KCC worked closely with the Kentucky Cancer Registry and other founding members, the American Cancer Society, American College of Surgeons, Kentucky Cancer Program and the Kentucky Department for Public Health to review surveillance data as well as available evidence-based interventions and selected colorectal cancer screening as a priority.

The KCC staff and founding members invited the entire Consortium membership to be involved, and our partner organization, the Kentucky Cancer Program, invited their local community-based District Cancer Councils to be involved. This group included academia, community-based organizations, health systems, health insurance companies, nonprofits/foundations, state and local government, policy organizations and professional associations. As implementation efforts continued, new partners were identified and invited to be part of the collective effort to increase colorectal cancer screening in Kentucky. This process continues as we continue to recognize gaps and needs in order to address health equity challenges.

What activities and systems changes did you implement, and how did you choose them?
KCC provided an infrastructure and a neutral “table” where partners can “sit” and work together to impact colorectal cancer in Kentucky. This included hosting regular meetings and statewide conferences, and creating opportunities for networking, coordinating, cooperating and collaborating. This infrastructure helped to catalyze efforts from more than 50 organizations who have implemented the following types of interventions: public awareness; education and outreach; provider education and training; health systems changes; policy changes (legislative, executive and organizational); and research. We chose these interventions based on funding opportunities, priorities selected from statewide conferences, reviewing the evidence, identifying champions, recognizing political will, determining needs for the state, and timing. For instance, one of our first policy changes was a statewide colorectal cancer screening program for the uninsured because we realized that we had a large population who could not access screening. However, when the Affordable Care Act was passed and Kentucky expanded Medicaid, Kentucky had one of the lowest uninsured rates in the country. Therefore, we needed to adjust our efforts and work with health systems and communities in order to help those with insurance access screening services. KCC continues to work with partners to review the data, including evaluation data, and determine what needs to be implemented in order to address gaps in screening coverage.

What success have you seen? How did you measure that success?
Between 1999 and 2016, our screening rates rose from 34.7% to 70.1%, improving more than any other state in the nation and moving from a ranking of 49th to 17th. As of 2016, one of Kentucky’s 15 Area Development Districts had achieved an 83% screening rate and four others have increased screening rates by more than 30% since 2006. As screening rates have risen, colorectal cancer incidence and mortality rates have declined dramatically. From 2001 through 2015, the incidence rate fell from 68.8% to 51.3% (a 25% decrease), while the mortality rate fell from 22.6% to 16.4% (a 27% decrease). As a result, each year in Kentucky almost 400 Kentuckians who would have been diagnosed with colorectal cancer are not diagnosed with colorectal cancer, and 200 Kentuckians who would have died from colorectal cancer don’t die from it. We measured our success by reviewing our Kentucky Behavioral Risk Factor Surveillance System (BRFSS) survey data as well as our Kentucky Cancer Registry data.

What tips would you offer to others that are working to increase colorectal cancer screening in statewide coalitions like yours?
Develop your infrastructure and support funding and staff time to convene partners in a neutral forum (e.g. KCC at the state level and the Kentucky Cancer Program at the regional level). Communicate consistently, clearly and regularly. Take the time needed (which is A LOT!) to build relationships and trust among partners. Keep reviewing the data, monitoring progress and evaluating efforts. Find out what is working well and what needs to be improved or modified. Find out what gaps and needs you have, and work together to address those needs. When you pass statewide, health system or organizational policies, develop a plan to implement those policies. Discuss and develop clear roles and responsibilities for each partner. Bring out the best in others and find as many “win-win” opportunities as you can. Celebrate successes!

Were there tools, trainings or resources that you found helpful?
Tools and resources provided by the following organizations and programs have been particularly helpful: Kentucky Cancer Registry, United States Cancer Statistics, Behavioral Risk Factor Surveillance System, Guide to Community Preventive Services, the National Colorectal Cancer Roundtable (e.g. Guide to the Development of State-Level Colorectal Cancer Coalitions, How to Increase Colorectal Cancer Screening Rates in Practice: A Primary Care Clinician’s Evidence-Based Toolbox and Guide and the 80% by 2018 Communications Guidebook: Recommended Messaging to Reach the Unscreened), CDC’s Comprehensive Cancer Control Program and the extensive resources provided by our partner organizations. We recommend participating in NCCRT trainings when available! Ask your partners and colleagues what they have available, and try to find ways to work together rather than always create something new.

Do you have any final tips for our readers that are working to achieve 80% in Every Community?
In order to achieve 80% in every community, we have to keep listening to our communities, find out what is working and what is not working, and be willing to make adjustments to reach those who have not yet been screened. We also need to work together to ensure that those who have their initial screen come back for their repeat screenings (e.g., annual FIT test). Although our goal is 80% screening in every community, we need to find ways to engage new partners in our states and communities to address colorectal cancer prevention (nutrition, physical activity, environmental exposures, etc.) as well as increasing screening.

August 29, 2019 – Author: Tessi Ross, BSN, MPA, RN, CPHQ

In February 2019 Sanford Health 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.

Tessi Ross, BSN, MPA, RN, CPHQ, Senior Quality Strategist, currently provides leadership and strategy in the areas of ambulatory quality and transforming clinical practice at Sanford Health. She has over 15 years of experience in healthcare as a Registered Nurse, with over eight years in quality and case management. She analyzes quality performance data, identifies opportunities to improve outcomes and communicates findings to senior leadership, regional executives, and the Quality & Safety leadership team. Tessi also serves as the Sanford Health program director for the Centers for Medicare and Medicaid Services (CMS) Transforming Clinical Practice Initiative (TCPI) & COMPASS Practice Transformation Network (PTN). Tessi graduated from Jamestown College in 2003 with a Bachelor of Science in Nursing and the University of North Dakota in 2014 with a Master of Public Administration – Healthcare Administration degree. She is also a Certified Professional in Healthcare Quality (CPHQ) and is trained in Lean Six Sigma.

Hi, Tessi! We’re excited to feature your work on the 80% Blog. Can you tell us about yourself, and your colorectal cancer screening program at Sanford Health?
I’m Tessi Ross, BSN, MPA, RN, CPHQ – a senior quality strategist for Sanford Health. I provide leadership and strategy in the areas of ambulatory quality, population health, and transforming clinical practice throughout our organization.  I also serve as the co-lead for Provider Education Workgroup for the North Dakota Colorectal Cancer Roundtable and Sanford Health is a member of the National Colorectal Cancer Roundtable.

Sanford Health signed the 80% by 2018 pledge back in 2015. Our goal was to screen more people, make the largest impact by detecting more colorectal cancer and ultimately improve the health of our population through early detection and prevention. Our outcome metric was to reach an 80% colorectal cancer screening rate among our eligible patients by the end of 2018.   

Tell us a little bit about Sanford Health and the organization’s colorectal cancer screening program.
Sanford Health is one of the largest health systems in the United States with integrated delivery of health care, genomic medicine, senior care and services, global clinics, research and affordable insurance. Sanford Health includes 44 hospitals, 1,400 physicians and more than 200 Good Samaritan Society senior care locations in 26 states and nine countries. Nearly $1 billion in gifts from philanthropist Denny Sanford have transformed how Sanford Health improves the human condition.

 One of the key interventions we implemented was to provide flexibility to our patients by offering multiple screening methods and delivery systems. We encourage our primary care clinics to offer colonoscopy, FIT, and FIT-DNA testing to our patients through shared decision making. Providing the take home screening options has been appealing to our unscreened patient populations that were previously hesitant to complete a colonoscopy due to personal, structural or financial barriers. We also developed a single-page teaching tool that helps patients to visually compare their options for screening.

When and why did Sanford Health decide to focus on increasing colorectal cancer screening?
Our organization’s screening rate was 68.7% in 2015, which prompted us to sign the national 80% pledge. Sanford Health’s dedication to improving the health of the populations we serve led to an internal initiative prioritizing colorectal cancer screening. We recognized that to improve, a one-size-fits-all approach would not work. Therefore, we deployed a multi-faceted approach.

What activities and systems changes did you implement, and how did you choose them?
We deployed a multi-faceted approach including the following interventions:

• Establish executive and physician leadership commitment
• Embrace organizational policies that allow all staff to practice at the top of scope
  • Clinic teams work real-time registries, identifying patients outside the clinic walls overdue for screening
  • Nurses can teach and place orders per protocol for cancer screening
  • Providers can provide further education and clinical recommendations for the remaining unscreened population
• Provide flexibility for our patients by offering multiple screening methods
  • Take home screening kits are demonstrated and strongly encouraged when the patient declines colonoscopy
  • Single-page teaching tool helps patients visually compare their options
• Reduce patient structural barriers
  • Promote patient financial assistance programs when affordability is a challenge
  • Patient portal self-referrals allow active patients to request a screening colonoscopy from the convenience of home
  • Recall letters and teaching tool are translated to 3 additional languages
  • Roles within the clinic are specifically dedicated to help patients gain access to resources to improve health equity
• Optimize tools, reminders and scripting tips
  • Our electronic medical record (EMR) now has built-in reminders to alert clinic staff and patients when they are due for preventative screening
  • Teaching handouts built into EMR so patient has access on paper after visit summary or in the patient portal
• Partner with Employee Health to offer appropriate colorectal cancer screening with flu shots
• Implement FIT mailing pilots in each regional market
• Provider assessment and feedback initiatives
  • 2018 Reward & Recognition Program
  • Low-performing Provider Accountability & Coaching Program
  • Colo-Bingo contest
• Promote data transparency to spread best practices and friendly competition

Many of our strategies and interventions were developed through the review of the NCCRT toolkits and webinars. We also developed some unique internal ideas to incentivize and motivate our teams to engage in this work.

What success have you seen? How did you measure that success?
We are proud to share our results – as of June 2019, twenty-nine of our primary care clinics are exceeding the 80% screening goal. As a system, we are moving closer to the 80% goal with a system wide screening rate of 78.1%, up 9.4 percentage points from 2015. This percentage reflects over 108,000 patients up-to-date with colorectal cancer screening, an increase of over 25,000 patients receiving screenings since 2015. In recognition of Sanford Health’s exemplary efforts to increase colorectal cancer screening, the organization not only received the NCCRT’s 2019 80% by 2018 National Achievement Award in the Hospital/Health System category, but we also became the inaugural recipient of the Organization of the Year for the 2018 North Dakota Colorectal Cancer Screening Achievement Awards given by the North Dakota Colorectal Cancer Roundtable. Dan Heinemann, MD, Sanford Health network medical officer, was also the recipient of the 2018 Champion of the Year by the South Dakota Comprehensive Cancer Control Program Colorectal Cancer Task Force.

What tips would you offer to others that are working to increase colorectal cancer screening in hospital systems like yours?
Get started! This is such rewarding and impactful work. Most colorectal cancers are preventable, and we have the ability to make a difference in the lives of our patients through early detection and prevention. The NCCRT has all of the resources and toolkits at your fingertips to get started. Identify a few champions in your clinic or health system and start putting together a plan using your improvement science tools. I would also recommend getting involved in your statewide or regional collaborative to learn best practices and share ideas.

Were there tools, trainings or resources that you found helpful?
Our partnership with the American Cancer Society and our statewide collaborative efforts have been essential to the improvements we have seen internally and across our states. We have been able to test interventions, then spread and scale best practices across our states through these collaborations. The NCCRT has many toolkits and webinar recordings on their online resource center to help get you started.  The resources that we have found most useful are the NCCRT primary care clinical practice tools (click on “primary care” under “Setting”), the Colorectal Cancer Screening Handbook for Hospital and Health Systems, the Risk Assessment and Screening Toolkit, and the Paying for Colorectal Cancer Screening Patient Navigation Toolkit.

Do you have any final tips for our readers that are working to achieve 80% in Every Community?
Our shared efforts to reach 80% are improving screening rates across our country. However, we still have many communities and populations that are being left behind. According to the Centers for Disease Control, about 1 in 3 adults appropriate for colorectal cancer screening are still not getting screened as recommended. We have the obligation to continue having conversations with patients about their options for colorectal cancer screening and identifying the barriers in those communities to develop effective mitigating strategies. I would recommend starting to filter your data by age, gender, race, zip code, etc. to identify the disparities that exist in your clinic/health system. This will allow you to work with those communities and populations to identify focused interventions needed to improve their screening rates.  

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

August 5, 2019 – Author: Heather M. Brandt, PhD

August 4-10, 2019 is National Health Center Week (NHCW) and this year’s theme is “America’s Health Centers: Rooted in Communities.” Heath centers serve all people, regardless of who they are, where they are from, and whether or not they have health insurance. For this reason, health centers play a critical role in providing primary and preventive care services to adults who might not otherwise have access to these services, including colorectal cancer screening. Learn more about our nation’s health centers and the care they provide to 28 million patients – or 1 in every 12 people – in every state, territory, and the District of Columbia.

What better week than NHCW to reflect on the incredible progress health centers are making in the fight against colorectal cancer. Colorectal cancer screening rates in health centers have climbed by 12 percentage points (rising from 30.2% in 2012 to 42% in 2017) since health centers began reporting colorectal cancer screening rates through the Uniform Data System (UDS) in 2012. Today you’ll hear from Heather M. Brandt, PhD, about local successes in achieving 80% screening rates in health centers in South Carolina.

Dr. Brandt is professor of health promotion, education, and behavior in the Arnold School of Public Health at the University of South Carolina. She is the program director of the Centers for Disease Control and Prevention-funded Colorectal Cancer Screening Program in South Carolina.

 Additional contributors to this work include Hiluv S. Johnson, LMSW, program coordinator, and Cynthia Calef, MAML, a program implementer, with the Colorectal Cancer Screening Program in South Carolina. We also wish to acknowledge Dr. Crystal Maxwell, Chief Medical Officer of Sandhills Medical Foundation and Kim Hale, Senior Manager of State and Primary Care Systems with the American Cancer Society.

Over the last four years, the Colorectal Cancer Screening Program in South Carolina has worked with eight federally-qualified health center systems and partners in South Carolina to implement evidence-based interventions to increase colorectal cancer screening. When we take a look at the impact of the program within the FQHCs systems in which we work, we have seen an average increase of 17 percentage points in colorectal cancer screening rates from 2015 to 2018. Among the eight health centers that have worked with us the longest, we have seen an average increase of 24 percentage points in this same time frame. While this is a great success, most of our partners fall well below the national 80% goal – but the progress is remarkable and a credit to the hard work and dedication of our health center partners to prevent and detect colorectal cancer early among the clients they serve. How did we land here?

As one of my colleagues (Dr. Karen Kim, University of Chicago) has said, over the past four years of work, supported by the Centers for Disease Control and Prevention’s (CDC’s) Colorectal Cancer Control Program, we have been building a plane while we were flying it. I like to add that we knew we were building a plane, and we knew we wanted the plane to fly and keep flying after the end of the grant. In reviewing our progress, we have built a fine plane that continues to be tweaked as we confront new challenges together. One of the health center systems that has been traveling with us on this journey is Sandhills Medical Foundation, and this health center system has soared to new heights.

Sandhills Medical Foundation has been providing quality comprehensive health care since 1977 as a federally-qualified health center serving rural and largely low-income residents of Chesterfield, Kershaw, Lancaster, and Sumter Counties in South Carolina. Two health center locations – Lugoff and McBee – have been a part of the Colorectal Cancer Screening Program in South Carolina. However, the processes and approaches implemented in these two sites were implemented system-wide. Sandhills Medical Foundation implemented priority, evidence-based interventions of provider reminders and provider assessment and feedback as well as supportive strategies (small media, professional education, training, and technical assistance) and additional activities (signing the 80% Pledge, policy implementation, and developing champions). Facilitation of new system-level changes with a commitment from health center partners, dedicated designated colorectal cancer champions, strong leadership from their system’s Chief Medical Officer (Dr. Crystal Maxwell), implementation of evidence-based interventions, and a standard operating procedure for colorectal cancer screening were all key ingredients. Designated staff members helped to ensure that the process for colorectal cancer screening was being followed. You could consider these important elements of an effective pre-flight checklist.

“We offer colorectal cancer screening at every visit and every type of colorectal cancer screening to our patients. Anything and any way to get them screened!”

– Amy Collin, LPN Quality Improvement Director at Sandhills Medical Foundation

Based on 2018 data, Sandhills Medical Foundation – as a health center system – is one of two health center systems in South Carolina to have achieved the national goal of 80%. Also based on 2018 data, Lugoff and McBee’s annual colorectal cancer screening rates reached 83%. Dr. Maxwell has attributed the success in exceeding the 80% goal to strong commitment at all levels of the health center system.

Cindy Calef, program implementer with the Colorectal Cancer Screening Program in South Carolina, stated, “We had the pleasure of working directly with two of the four adult primary health care sites of Sandhills Medical Foundation – Lugoff and McBee. I have enjoyed working with the dedicated staff at these sites since 2015. Both of these sites have strong leadership and colorectal cancer champions dedicated to their patients.”

It is safe to say the plane is flying and appears to be on a flight path for future success as evidenced by the achievements of Sandhills Medical Foundation. Fasten your seat belts as we continue to work with our health centers to achieve their goals – and prevent and detect colorectal cancer early through screening.

Lastly, if you work in or with health centers, I strongly encourage you to check out NCCRT’s signature resource for health centers, Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Community Health Centers, as well as other resources in the NCCRT Resource Center, which offer step-by-step instructions on how to implement evidence-based strategies to increase screening in a variety of settings.

We hope you’ll join us in sharing a round of applause for our nation’s health centers. Visit www.healthcenterweek.org to learn more about National Health Center Week and find ways to show your appreciation for their work.

May 23, 2019 – Author: Keith Winfrey, MD, MPH

New Orleans East Louisiana Community Health Clinic is this year’s 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 achieve colorectal cancer screening rates of 80% and higher.

Dr. Keith Winfrey is the Chief Medical Officer for the New Orleans East Louisiana Community Health Center (NOELA CHC). He is an Assistant Professor of Medicine at the Tulane University School of Medicine, having completed his residency in Internal Medicine and a fellowship in Preventive Medicine at the Tulane University School of Medicine. He also holds a Masters’ Degree in Health System Management from the Tulane University School of Public Health and Tropical Medicine.

Dr. Winfrey has been with NOELA CHC since 2009 and has served as the Chief Medical Officer since 2011. He has guided NOELA CHC through the practice transformation process to become a Level III “Patient-Centered Medical Home” and to improve the health center’s efficiency and effectiveness in chronic disease management and disease prevention.

Dr. Winfrey serves on the steering committee for the Louisiana Colorectal Roundtable, the clinical committee for the Taking Aim at Cancer Louisiana initiative, and is the current Clinical Branch Chairman for the Louisiana Primary Care Association.

In May 2019, Dr. Winfrey received AstraZeneca’s Cancer Community (C2) Catalyst for Change Award. This 4-minute video describes his work and offers a glimpse into the community served by NOELA CHC.

Hi, Dr. Winfrey! We’re excited to feature your work on the 80% Blog. Can you tell us a little about yourself and how you ended up working on colorectal cancer screening?
It’s an honor to share our story with you. I’ve had an interest in individual and population-based medicine since completing a dual-residency in Internal & Preventive Medicine at Tulane School of Medicine 17 years ago. After returning to New Orleans following Hurricane Katrina, I joined the medical staff at Tulane School of Medicine and was later assigned to the Tulane Community Health Center – New Orleans East. [The name was later changed to New Orleans East Louisiana CHC in 2012]. In 2013, while we were preparing our 2012 UDS report (the first year that the Health Resources and Services Administration included colorectal cancer screening as a Uniform Data System measure for community health center grantees), the initial analysis revealed that our health center had a 3% colorectal cancer screening rate. That’s when colorectal cancer screening became a priority for us. In 2014, our health center began working with the American Cancer Society and later learned about the NCCRT‘s 80% by 2018 initiative. We signed the pledge and adjusted our goal to coincide with the NCCRT’s mission.

Tell us a little bit about NOELA Community Health Center.
NOELA CHC was initially founded by Tulane University School of Medicine in August 2008. We are located in a diverse, low-income, community which consists predominately of Vietnamese, African-American and Latino residents and we average over 14,000 encounters per year. We care for close to 4,000 unique patients per year, 78% of whom fall below 200% of the Federal Poverty Level (FPL) and 60% have incomes at or below the FPL. Our health center strives to offer comprehensive primary and preventive health services for the entire family. In particular, we provide adult and pediatric primary, preventive, and behavioral health care services, OB/Gyn services, and chronic disease management for conditions such as diabetes, hypertension, obesity, and hepatitis B and C. We employ the patient-centered medical home model, and our preventive care services include health education and initiatives to improve immunization and cancer screening rates.

What activities and systems changes did you implement, and how did you choose them?
Our first priority for improving colorectal cancer screening rates was to adopt a certified electronic health record that we would use to measure screening rates and one with the capability of producing disease registries. We then developed a registry of patients that were either due for colorectal cancer screening or up to date with screening and identified the method in which screening was satisfied. Next, we stressed to our providers the importance of their recommendation in motivating patients to take action. From there, we hired several essential staff members, including a quality improvement director and several patient navigators. Once the foundation was in place, we then began adding various evidenced-based interventions (EBIs) until we found the ones that worked best for us. The EBIs or strategies that were most effective were promoting stool-based testing using a global opportunistic-based approach and providing regular patient and provider reminders. The patient reminders were provided by mailings and over the phone and the provider reminders occurred in the form of pre-visit planning reports. Practice assessment and feedback was provided monthly, and we developed new data analysis and reporting as we went along.  

I understand you began working with two area hospitals to establish an Open Access Endoscopy (OAE) agreement. How did this work?
Yes, along with members of the Louisiana Colorectal Cancer Roundtable and the Louisiana Primary Care Association, we identified the endoscopy providers most commonly utilized by our local Federally Qualified Health Centers (FQHCs). We then proceeded to meet with them to discuss the referral process and identify opportunities for improving efficiency. Through this process, we were able to understand the most important barriers the endoscopist encountered when screening our patients. These barriers included ensuring patients achieved an adequate bowel prep, minimizing “no-shows”, identifying patients’ co-morbidities and anesthesia risk, and ensuring the patient had reliable transportation. As a result of several meetings, we were able to reach an OAE agreement with one provider that allowed our patients to forgo the pre-procedure encounter with the endoscopist and be placed directly on the endoscopy schedule as long as certain key criteria were met. This greatly improved efficiency for our low-risk patients that were willing to undergo screening colonoscopy.

What success have you seen? How did you measure that success?
Over the course of six years, we’ve seen our overall colorectal cancer screening rate increase from 3% in 2012 to 80% by 2018. This has been in large part a result of annual stool-based testing. However, we’ve also seen a significant increase in patients completing screening colonoscopy. What’s been even more encouraging is to see patients that were initially only interested in stool-based testing, after two or three years, develop the courage to complete a screening colonoscopy.

What tips would you offer to others that are working to increase colorectal cancer screening in underserved communities?
When working with underserved communities, patience and repetition is key. Be prepared to repeat your message frequently and in various forms before the patient actually follows through with the test. Providers must initiate the discussion around risk factors, family history, and acceptable screening modalities and ancillary staff should support the provider’s recommendations. Next, consider using motivational interviewing techniques to meet patients where they are with regards to their understanding and willingness to undergo screening and then focus on offering the screening test that they are most likely to complete. Finally, it’s important to ensure that your organization has the proper foundation in place to support high-quality screening (i.e. “buy-in” from administration, a certified electronic health record, the right complementary staff, and a reliable tracking mechanism).

Were there tools, trainings or resources that you found helpful?
Yes. The article “Strategies for Expanding Colorectal Cancer Screening at Community Health Centers” by Sarfaty, Doroshenk, et al was the initial resource that we used to develop our plan. Later the “How to Increase Colorectal Cancer Screening Rates in Practice: A Primary Care Clinician’s Evidence-Based Toolbox and Guide, 2008” and the “80% by 2018 Communications Guidebook: Recommended Messaging to Reach the Unscreened” were resources that were used to identify various evidenced-based interventions that we later employed.

Do you have any final tips for our readers that are working to achieve 80% in Every Community? 
I hope our story inspires other organizations to believe that improvements in colorectal cancer screening are possible. Improving screening rates can seem deceptively simple in the beginning but can become frustrating and discouraging when change is not quickly recognized. Take the time to prepare your team and organization, set realistic and achievable goals, and celebrate successes. Finally, if something is not working for your population, change it! Each community is different, so it’s important for each institution to understand which messages their patient population will be most likely to respond to and focus on it.

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

December 19, 2018 – Author:Rich Killewald, Senior Data Manager, Cancer Control Intervention at the American Cancer Society

Rich Killewald is the Senior Data Manager, Cancer Control Intervention at the American Cancer Society. In this role, he manages data and information for a suite of community-based initiatives to increase access to cancer screenings and reduce cancer-related disparities in underserved communities. Throughout his career, Rich has held a number of data management, analysis, and program evaluation positions in regional and nationwide nonprofit organizations. Rich holds a Master of Nonprofit Management degree from Regis University in Denver, CO. He lives in Phoenix, AZ with his wife and two children.

 Rich generally shared his expertise with the NCCRT by analyzing our 2018 80% Partner Survey data, preparing the highlights report, and authoring this guest blog post.

In September 2018, the NCCRT released the fourth annual 80% Partner Survey to more than 1,800 NCCRT members and 80% Pledge partners. We received 240 completed surveys from a diverse group of organizations, including hospitals, community health centers, cancer centers, community organizations, nonprofits, academic institutions, and others. We are so grateful to our members and supporters who took the time to share both valuable feedback about NCCRT resources and about what is and what isn’t working as we continue towards our goal of 80% In Every Community.

The comprehensive overview of the survey results, which was shared with the Steering Committee during the NCCRT Annual Meeting on November 13, is available here. Please see below for key highlights.

Our partners were doing more to increase rates in 2018
Partner organizations were asked about the types of activities used to increase colorectal cancer screening rates (e.g., patient and public education, working with underserved communities, employers, and insurers). While previous results were already impressive, the 2018 results highlighted that our partners were doing more than ever to increase colorectal cancer screening rates. In fact, responding organizations reported doing more activities in 70% of the categories evaluated. What’s also impressive is that many organizations are planning to learn about and do even more activities in the coming months to increase screening rates!

These increased efforts have paid off!
Of the organizations that set goals to track, increase, and/or support a partner with increasing screening rates, 64% of organizations reported their colorectal cancer screening rate increased in the last year. This figure was up three percentage points from 2017.

Interventions work!
Survey responses included many examples of partner organizations implementing and adapting interventions to drive up colorectal screening rates in their communities. “Patient/member reminders and recall” and “Offering patients/members a choice of stool test or colonoscopy” topped the list of successful interventions. See below for the complete list.

NCCRT resources viewed as useful
A key component of the partner survey was to gather information on the awareness and usefulness of NCCRT’s resources (e.g., webinars, Colorectal Cancer Screening Best Practices Handbook for Health Plans, Evaluation Toolkit). Overall, NCCRT resources were viewed as useful by 97.6% of the partner organizations that used the resources. But there is work to be done around building awareness of the resources. Overall, 18.2% of responses did not know about the available resources.

Finally, I’d like to thank our colleagues at the American Cancer Society Statistics & Evaluation Center who programmed and conducted the survey, and again, thank you to NCCRT’s members and 80% by 2018 pledged partners who generously shared their time by completing the survey.

April 5, 2018 :: Author: Author: Anjelica (“Anjee”) Davis and Richard Wender, MD

Anjelica (“Anjee”) Davis serves as President of Fight Colorectal Cancer, a national nonprofit founded in 2005. Ms. Davis co-chairs the NCCRT Public Awareness and Social Media Task Group and is a member of the steering committee.

Dr. Richard Wender is the Chief Cancer Control Officer of the American Cancer Society and the Chair of the NCCRT.

To say we were excited about March 2018 would be an understatement. After all, the last four years of our 80% by 2018 effort have been an incredible journey. Building off our award-winning collaboration from March 2017, this year the NCCRT joined Fight Colorectal Cancer and the American Cancer Society, with support from the Mayo Clinic, Exact Sciences, UPS, and others, to host Colorectal Cancer Screening Coast to Coast: Driving toward 80%. We decided to take our messages about the importance of screening on the road, and honestly, what creates more lasting memories than a great American road trip?

True to every great road trip, we made sure to travel to excellent destinations and to invite old and new friends to join us along the way. To really do this the right way – we of course needed a sweet ride.

Road Trip Requirement #1: Excellent Destinations

The NCCRT team made its way to Los Angeles, Washington, D.C., and Arizona; but the beauty of the effort was that events to promote colorectal cancer screening were taking place all around the country. We saw a wave of engagement from partners and colleagues wanting to ensure that March 2018 had the same energy and collaborative spirit that the 80% campaign has had from the beginning.

Partners across the nation were encouraged to submit their own local events to
populate the map above on the CRCCoast2Coast.org website.

From Anchorage, Alaska to Denver, Colorado, to Porter, Maine, the messages about colorectal cancer screening were shared coast to coast with creativity and passion. By the end of April, we’d marked 96 unique events that took place. Each destination was unique and the “stops” included a range of events:  watch parties, state proclamation signings, lobby days, press briefings, radio interviews, state roundtable meetings, shining blue lights on buildings, bridges and skylines, health fairs and more!

Buildings and neighborhoods in Denver, Colorado light up in blue

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Stories and photos from these events keep pouring in. There are too many to post here, but we encourage you to check out the Twitter feed (hashtags #80by2018 and #CRCcoast2coast) to see what happened! If you hosted an event you’d like recognized, it’s not too late to post! To get it added to the map, email us the details and any photos. If you tweet about it and tag us (@NCCRTnews) we’ll be sure to share!

Road Trip Requirement #2: Friends, Old and New

We were energized to have survivors, celebrities, physicians, advocates, legislators, health professionals, and many others contribute time, stories, and passion to the cause.

LA Kick-off Event – March 8 The kick-off event took place on March 8^th at Smashbox Studios in Los Angeles, where partners came together to share stories about hope, emphasize the importance of screening, celebrate our progress, and look to the road ahead. The event featured survivors, partners, experts, and celebrity guests who we interviewed on a “blue carpet.” Stage IV survivor Teri Griege gave us messages about hope and stage II survivor Thomas Lopez shared a personal story about his son; actor Luke Perry made a quick virtual appearance (and got photo bombed by KJ Apa of Riverdale, the TV show in which the two star); country singer and Fight CRC national spokesman Craig Campbell serenaded us with a song he wrote for survivors; Telemundo star Stephanie “Chiquibaby” Himonidis delivered screening messages in Spanish; CDC’s Dr. Lisa Richardson talked about the importance of reaching people where they are; Katie Couric teased her mystery man colonoscopy date; and we all cheered for the 2018 80% by 2018 National Achievement Award winners.

  Our messages about screening reached far more than those in attendance in Los Angeles. CRCCoast2Coast.org received over 2,300 website hits, the Blue Carpet pre-show and the CRC Coast to Coast live stream show gathered over 23,600 views and reached 69,500 people, collectively. The show was also shared far and wide by partners, such as Katie Couric, Stand Up to Cancer, National Alliance for Hispanic Health, the American College of Gastroenterology(ACG), Telemundo star Chiquibaby, and many others. Getty Images came out to take editorial photos, and Telemundo aired a series of spots about colorectal cancer and colon health, following the show. All combined, our web and social media presence reached more than 9.7 million people and generated more than 103.3 million impressions. If you missed the live show, you can still watch the recorded broadcast or view the short highlights video below. We know we’ll be turning back to it for inspiration throughout the rest of 2018! But the work didn’t stop after March 8. Friends kept our momentum going throughout the entire month. Business leaders rang the opening bell for NASDAQ; survivors gathered in Washington, D.C. for a lobby day and hill briefing; public health leaders put up yard signs and blue lights all throughout Denver, CO neighborhoods; FQHC staff hosted a watch party in Porter, Maine. We truly went coast to coast! Road Trip Requirement #3: The Sweet Ride Finally, no road trip would be complete without the sweetest of rides. In fitting fashion, UPS, one of the latest—and among the largest—organizations to make a commitment to working toward the 80% screening goal, offered to put our colorectal cancer screening messaging on the side of a UPS truck., The truck was showcased at the two signature events in LA and D.C. We know the journey to 80% by 2018 does not end after March, we will keep driving toward 80% well after this year is done.

@UPS reveals #CRCcoast2coast UPS truck! @AmericanCancer @FightCRC @ExactSciences @NCCRTnews pic.twitter.com/3O3Zfx8csa — Rich Wender (@RichWender) March 8, 2018

  The Road Does Not End Here

Whether you celebrated with us in person, turned a city blue, or shared your own story of survivorship, your passion and dedication are making a difference and saving lives. We are grateful for you! Now, as our March 2018 travels become memories, we look ahead to the rest of 2018 rejuvenated and committed. Screening rates are going up; more than 150 health systems, clinics, and localities have reached 80%; hundreds more have seen their rates increase; and an additional 3.3 million more people were screened between 2014 and 2016. The progress we are making together is exciting; more and more organizations are joining this campaign by the day. And as Dr. Lisa Richardson reminded us during the Los Angeles broadcast, our work doesn’t end here. We’re not going to stop until all have a chance to benefit from the life-saving potential of screening. Let’s take this momentum and drive forward into the remainder of the year and beyond. Where will we be in March 2019? Live broadcasting from the moon? Let’s just say we’re not ruling it out…  

Wrapping up the coast to coast tour for March 2018 with @RichWender & @AnjeeDavis! #80by2018 #conc2018 https://t.co/zSqKPf3nzw — Fight CRC (@FightCRC) March 20, 2018