CRC News – Week of August 14, 2017

The following email news update was shared with NCCRT members and partners on Friday, August, 18th, 2017. Please email nccrt@cancer.org to subscribe to our regular email updates.

 

Happy 8/18 Day, the official holiday of the 80% by 2018 effort!   Lots of news to share, as we celebrate our self-created holiday…

Register for 80% by 2018 Progress Webinar, to be held on Tuesday, Oct. 3rd at 1:00pm ET:
Please register for a special upcoming webinar 80% by 2018 Progress, which will feature NCCRT Chair and ACS Chief Cancer Control Officer, Dr. Richard Wender. The webinar will be held at 1:00pm ET on Tuesday, October 3rd. The purpose of the webinar is look at the latest CRC screening measures and discuss what they tell us about our progress and challenges, discuss the urgency needed over the next 15 months and share plans for the transition to the next iteration of our colorectal cancer screening work. This webinar will be open to NCCRT members, ACS staff, 80% by 2018 partners, CDC grantees and others interested in the effort.  You must be pre-register to join the webinar.

2016 UDS Rates for CRC Screening are Now Available:
The 2016 national average for CRC screening in HRSA-funded health centers has just been released and is at 39.9%, which increased from 38.3% in 2015. Visit the HRSA website for an additional understanding of the rates. There are now 28 community health centers (CHCs) that have reached 80%, a jump up from 19 last year! View our 80% by 2018 Hall of Fame to see the list of these centers that are meeting or exceeding our shared goal. Congratulations to all our colleagues working in health centers, as well as to the many of you who work to support health centers on this continued improvement!

NCCRT Celebrates National Health Center Week with 80% by 2018 Blog:
Join us in celebrating community health centers this week, National Health Center Week (NHCW), by checking out our new 80% by 2018 Blog post on the critical role of CHCs in the fight against CRC. Thank you to Drs. Durado Brooks and James Hotz, co-chairs of NCCRT’s Community Health Center Task Group, for sharing their reflections on the incredible progress CHCs are making to increase CRC screening. Share the link (http://ow.ly/WL2dI) and/or retweet/repost the messages we’ve already shared through @NCCRTnews and facebook.com/coloncancerroundtable.

Also, be sure to visit the NHCW blog to read a post authored by NCCRT chair Dr. Rich Wender and visit https://healthcenterweek.org/ to find social media tools, a media toolkit, fact sheets, and more to use in thanking the CHCs that you work with. Finally, please join us in giving a shout out to the nearly 200 CHCs that have pledged 80% by 2018! #ValueCHCs

Replay of NCCRT Webinar on Links of Care Now Available:
In case you missed it, you can access a replay of the NCCRT July 27th webinar Links of Care: Successes and Lessons Learned from Three Pilot Sites. Many thanks to our presenters, Sue Lagarde, Julia Williams, Chris Singer and Kara Riehman for sharing their lessons learned during the webinar! As a reminder, all NCCRT webinars are archived and can be accessed here.

Updated CDC Community Guide for Colorectal Cancer Screening Interventions Released:
In case you missed it, the CDC recently posted their updated community guide for CRC. The recommendations now place a bigger emphasis on multi-component interventions. The major findings are that multicomponent interventions increased colorectal cancer screening by any test by a median of 15.4 percentage points when compared with no intervention. The largest screening increases were seen among multicomponent interventions that combined approaches from each of the three strategies or that combined approaches to increase community demand and access. Learn more by looking at this one-pager with additional information. Many thanks to Stacey Fedewa for sharing this update with us.

ACS Study Shows Colorectal Cancer Death Rates Rising in People Under 55:
An ACS study appeared last week in the Journal of the American Medical Association (JAMA), showing that colorectal cancer mortality rates have increased in white adults ages 20 to 54 since the mid-2000s, after falling for decades. You can view the JAMA article here. These findings reinforce earlier ACS work published last February that identified an increase in colorectal cancer incidence rates among young and middle-aged adults in the US. You can also view an NCCRT news article on the study here. Congratulations to Rebecca Siegel, as well as the other authors, for their continued work on this important issue.

Upcoming Cancer Moonshot Funding Opportunities
Following receipt of the Blue Ribbon Panel (BRP) report, the NCI established implementation teams to consider multiple ways to fund Cancer Moonshot-related research. The teams have identified and the NCI Board of Scientific Advisors has approved nine upcoming funding opportunity announcements that directly address the goals of the Cancer Moonshot, including one on Accelerating Colorectal Cancer Screening and Follow-Up Through Implementation Science (ACCSIS). While these funding opportunities have not yet been formally released, they are expected to be formerly published in the coming months pending the appropriation of fiscal year (FY) 2018 funding for Cancer Moonshot. To learn more about these FOA’s please visit the Cancer Moonshot Upcoming Funding Opportunities web page.

Eleven Additional State Teams Selected to Attend September 80% by 2018 Forum
Eleven (11) state teams have been selected to attend the third 80% by 2018 Forum in Atlanta, GA on September 6th and 7th. All teams include six (6) organizations/key members.  Selected teams are: Colorado, Connecticut, Maryland, North Dakota, South Carolina, Washington, Illinois, Kansas, Montana, Ohio, and West Virginia. This is the third in a series of forums sponsored by CDC, the National Cancer Institute, the American Cancer Society, the NCCRT, NACDD, NACHC, HRSA and other national partners.  Participants will receive training on topics such as reaching out to partners and stakeholders, enhancing patient navigation systems, and communication strategies for clinics and health systems, while working to create a state colorectal cancer screening action plan. Congratulations to these eleven teams!

Relevant Journal Articles
Here are a few relevant articles/studies that may be of interest:

A study on patient navigation and colonoscopy completion that was published in the American Journal of Preventive Medicine found that navigation significantly improved colonoscopy screening completion among a racially diverse, low-income population. The study concludes that the results contribute to mounting evidence demonstrating the efficacy of patient navigation in increasing colorectal cancer screening and that screening can be further enhanced when navigation is combined with other evidence-based practices implemented in healthcare systems and the community. Congratulations to NCCRT friends, Amy DeGroff, Paul Schroy and Djenaba Joseph, as well as the other study authors.

The journal Cancer published a study that found a centralized mailed program with stepped increases of support increased CRC screening adherence. The study concluded that in a health care organization with clinic-based activities to increase CRC screening, a centralized program led to increased CRC screening adherence over 5 years. Congratulations to Bev Green and the other study authors!  Many thanks to Durado Brooks for bringing this study to our attention.

A study published in Clinical Gastroenterology and Hepatology found that replacing the guaiac fecal occults blood test (gFOBT) with the fecal immunochemical test (FIT) increased the proportion of individuals screened. The study concluded that replacement of the gFOBT with the FIT should be strongly considered by all healthcare systems.  Congratulations to NCCRT friend, Jim Allison, as well as the other authors! Many thanks to Durado Brooks for bringing this study to our attention.

The American Journal of Gastroenterology published an article highlighting ACG’s role in the national 80% by 2018 effort. Many thanks to Jordan Karlitz, Anne-Louise Oliphant, Dave Greenwald and Mark Pochapin for documenting this important work.

The Annual NCCRT Meeting will Be in December this year!  Save the Dates — December 6th, 7th and 8th
Members, please mark your calendars for this year’s meeting of the National Colorectal Cancer Roundtable, which will be held on December 7th and 8th at the DoubleTree Hilton in Bethesda, MD. Pre-conference sessions will be held on Wednesday, December 6th. The general meeting is tentatively scheduled to start at 8:00 am on Thursday, December 7th and wrap up no later than 12:30 pm on Friday, December 8th. You will receive more detailed information regarding the meeting in the coming months.

 

 

 

CRC screening rates reach 39.9% in FQHCs in 2016

The Health Resources and Services Administration (HRSA) recently reported 2016 Uniform Data System (UDS) data shows significant gains in colorectal cancer (CRC) screening rates in the nation’s federally qualified health centers (FQHCs), also called community health centers.

The UDS CRC screening rate reached 39.9% in 2016, which amounts to a more than five percentage point jump since the launch of the 80% by 2018 campaign in 2014. Furthermore, 28 health centers reached the 80% goal in 2016, up from 19 in 2015.

Health centers served nearly 26 million patients in 2016, many of which are at or below the federal poverty level and come from underserved communities that experience lower CRC screening rates. Because of this, health centers have tremendous potential to improve CRC screening rates and to reduce CRC morbidity and mortality in racially and ethnically diverse, socioeconomically challenged communities across the country.

The NCCRT would like to congratulate our partners at HRSA and the National Association for Community Health Centers (NACHC) for championing 80% by 2018 among their grantee and member health centers partners. And most of all, we’d like to share a huge round of applause for the staff and providers at health centers for their persistence and innovation in working day in and day out to provide eligible patients with the opportunity to screen for this largely preventable disease.

Read more about the incredible work happening in health centers and NCCRT and the American Cancer Society’s work to support their efforts in a post from Dr. Rich Wender, NCCRT chair, on the NACHC blog and a post from Drs. Durado Brooks and Jim Hotz, NCCRT Community Health Center Task Group co-chairs, on the NCCRT blog.

Visit the HRSA website to learn more about the UDS measure and to find the UDS screening rate for health centers in your state.

Celebrating National Health Center Week

August 14, 2017 – Authors: Durado Brooks, MD, MPH and James Hotz, MD

August 13-19, 2017 is National Health Center Week (NHCW) and this year’s theme is “Celebrating America’s Health Centers: The Key to Healthier Communities.” Today you’ll hear from Durado Brooks, MD, MPH and James Hotz, MD, co-chairs of NCCRT’s Community Health Center Task Group on the critical role that health centers play in increasing access to colorectal cancer screening.

Durado Brooks, MD, MPH, Vice President, Cancer Control Interventions, has worked for the American Cancer Society since 2000, focused on strategies to improve the prevention and early detection of cancer and reduce cancer disparities. A graduate of the Ohio State University, he attended medical school and completed his internal medicine residency at Wright State University School of Medicine. He received his MPH at Harvard, and practiced primary care medicine in community health centers in Ohio and in Dallas, TX.

 

James Hotz, MD founded Albany Area Primary Health Care, a community health center with 21 clinical sites serving over 36,000 poor and rural patients in Southwest Georgia, where he serves as Clinical Services Director. He is an Associate Clinical Professor at Mercer University’s School of Medicine and is the former chairman of the Board of Phoebe Putney Memorial Hospital and the Georgia Association for Primary Health Care. He served two terms on the Board of Directors of the National Association of Community Health Centers. Dr. Hotz currently serves on the Board of Directors of the Cancer Coalition of South Georgia and is chair of the Steering Committee of the Georgia State Cancer Plan and the Georgia Colorectal Cancer Roundtable. He has a MD from Ohio State University and completed his Internal Medicine Internship and Residency at Emory University School of Medicine.

With more than 9,000 delivery sites in all 50 states, the District of Columbia, Puerto Rico and U.S. territories, community health centers deliver a critical network of care to over 25 million Americans. In fact, one in every fifteen people in the United States rely on health centers for quality, affordable health care.

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.

What better day than Health Screenings Day of National Health Center Week (NHCW) to reflect on the incredible progress health centers are making in the fight against colorectal cancer. But first, we’ll share a bit of history on how NCCRT and the National Association of Community Health Centers (NACHC) have teamed up to support health centers in making screening for colorectal cancer a priority.

A confluence of factors made 2011 an ideal time to launch a major effort to prioritize colorectal cancer screening in health centers. The Health Resources and Services Administration (HRSA) was gearing up to begin requiring health centers to track and report colorectal cancer screening rates in the Uniform Data System (UDS), HRSA’s core tracking system for reviewing the operation and performance of health centers. Simultaneously, experts began encouraging health centers to become recognized as patient-centered medical homes. Health centers were going through a period of major transformation, experiencing significant growth, and installing new systems at a time when the new UDS requirements were motivating them to improve the delivery of quality colorectal cancer screening.

Also in 2011, the NCCRT established our Community Health Center Task Group, partnered with NACHC to convene a summit on increasing colorectal cancer screening in community health centers, and commissioned a strategy paper on the same topic, which was subsequently used to inform the NCCRT’s signature resource for health centers: Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Community Health Centers. Not long after, NACHC and HRSA became two of the very first organizations to sign the 80% by 2018 pledge, and ever since NCCRT, NACHC, and HRSA have collaborated to provide countless resources, tools, and trainings to support health centers in working together on this shared goal.

Health centers have embraced the challenge, and we now have the data to show their work is generating impressive results. Colorectal cancer screening rates in health centers have jumped more than five percentage points since the launch of the 80% by 2018 initiative in 2014. UDS data for 2016 released last week show health centers have reached a remarkable 39.9% screening rate. Furthermore, as of 2016, 28 health centers have already reached the 80% goal. The map below illustrates the 2015 screening rate in each state. We’ll update this post with the 2016 map as soon as it’s available.

Today on NACHC’s blog, Dr. Richard Wender, NCCRT chair, shares an example of how Peoples Community Health Clinic of Iowa recently exceeded the 80% screening goal, skyrocketing their rates from a baseline rate of 31% in 2013. Countless other health centers are making similarly remarkable gains, including two recent 80% by 2018 National Achievement Award honorees. Learn from interviews with honorees C.L. Brumback Primary Care Clinics of Florida and Coal Country Community Health Centers of North Dakota about how they implemented evidence-based strategies to transform colorectal cancer screening delivery in their clinics.

The Community Health Center Task Group, with active engagement from HRSA and NACHC, continues to create resources to try and tackle some of the toughest challenges health centers face when it comes to creating quality colorectal cancer screening programs, including the new Paying for Colorectal Cancer Screening Patient Navigation Toolkit and guidance on using electronic health records to facilitate colorectal cancer screening. Developed in partnership with NACHC and health center experts, guidance for health centers that use eClinicalWorks is already available and new guidance for NextGen users will be available in the next few months. We are also continuing to learn and share information about how communities have been able to create the medical neighborhood needed to provide follow up colonoscopies for patients who need them through our Links of Care pilots. These are tough problems with no easy answers, but we are always trying to learn and offer the best advice we can and invite people to send their challenges or solutions to us.

And we know the work takes patience and determination; there is no magic bullet to increasing screening rates. The health centers that are seeing the largest gains are committing time and resources to thoroughly and honestly examine their workflows, implement evidence-based quality improvement strategies, measure progress, and course correct. The work takes dedication, but the rewards could not be more important.

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.

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We highlight successes, leaders, best practices, and tools that are making an impact in the nationwide movement to reach 80% screened for colorectal cancer.

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CRC Death Rates Rising in People Under 55

Although the risk of colorectal cancer remains low for young and middle-aged adults, rising mortality strongly suggests that the increase in incidence is not only earlier detection of prevalent cancer, but a true and perplexing escalation in disease occurrence.

A new report finds that colorectal cancer mortality rates have increased in adults under 55 since the mid-2000s after falling for decades, strengthening evidence that previously reported increases in incidence in this age group are not solely the result of more screening. The rise was confined to white individuals according to the report, which appears in the Journal of the American Medical Association.

As reported previously by American Cancer Society investigators, colorectal cancer (CRC) incidence has been increasing in the United States among adults younger than 55 years since at least the mid-1990s. The increase thus far is confined to white men and women and is most rapid for metastatic disease. CRC mortality overall is declining rapidly, masking trends in young adults, which have not been comprehensively examined.

For the current study, ACS investigators led by Rebecca Siegel, MPH analyzed CRC mortality among persons aged 20 to 54 years by race from 1970 through 2014 using data from the National Center for Health Statistics, representing more than 99% of deaths in the United States. The analysis included 242,637 people ages 20 to 54 who died from CRC between 1970 and 2014.

CRC mortality rates among those ages 20 to 54 declined from 6.3 per 100,000 in 1970 to 3.9 in 2004, at which point mortality rates began to increase by 1.0% annually, eventually reaching 4.3 per 100,000 in 2014. The increase was confined to white individuals, among whom mortality rates increased by 1.4% per year, from 3.6 in 2004 to 4.1 in 2014. Among black individuals, mortality declined throughout the study period at a rate of 0.4% to 1.1% annually (from 8.1 in 1970 to 6.1 in 2014). Among other races combined, mortality rates declined from 1970-2006 and were stable thereafter.

While mortality remained stable in white individuals ages 20 to 29 from 1988-2014, it increased from 1995-2014 by 1.6% per year in those ages 30 to 39 years, and from 2005-2014 by 1.9% per year for those ages 40 to 49 years and by 0.9% per year for those ages 50 to 54 years. Conversely, rates declined in black individuals in every age group. The authors note that these disparate racial patterns are inconsistent with trends in major risk factors for CRC like obesity, which is universally increasing.

The authors say rising CRC mortality in people in their 50s was particularly unexpected because screening, which can prevent cancer as well as detect it early, when it is more curable, has been recommended starting at age 50 for decades. Screening prevalence has increased for all age groups over 50, but is lower in people 50 to 54 than in those 55 and older: 44% versus 62%, respectively, in 2013, according to the National Health Interview Survey.

“Although the risk of colorectal cancer remains low for young and middle-aged adults, rising mortality strongly suggests that the increase in incidence is not only earlier detection of prevalent cancer, but a true and perplexing escalation in disease occurrence,” said Siegel. “It is especially surprising for people in their 50s, for whom screening is recommended, and highlights the need for interventions to improve use of age-appropriate screening and timely follow-up of symptoms.”

The NCCRT is committed to mobilizing our members to identify ways that we can work together to address gaps in research, policy, and education. We are in the early stages of planning a small group strategy meeting on early onset CRC this winter. The NCCRT is also commissioning a new primary care clinician’s module to aid primary care providers in transforming internal practices around the identification and appropriate management of patients at familial risk of CRC, as well as improve timely recognition and evaluation of young adults presenting with symptoms and/or signs of CRC. Read more about our reflections on the implications of these trends for our work, including what we can do now.

 

New CRC Screening Recommendations from the Community Guide

The Community Preventive Services Task Force (CPSTF) now recommends multicomponent interventions to increase colorectal cancer screening. Multicomponent interventions or using a combination of interventions, to increase cancer screening may be coordinated through healthcare systems, delivered in community settings, or both.

Visit the links below to learn more about these new recommendations:

 

 

$500,000 awarded to help reduce CRC disparities in American Indian and Alaska Native populations

The American Cancer Society has awarded $100,000 in grants to five community health centers across the country to reduce colorectal cancer disparities in American Indian and Alaska Native populations through the Community Health Advocates implementing Nationwide Grants for Empowerment and Equity (CHANGE) Grant Program.

The grants are $100,000 each and span two years. The grantees are:

  • Arctic Slope Native Association in Barrow, Alaska
  • Fond du Lac Services Division in Cloquet, Minnesota
  • Keweeenaw Bay Indian Community in Baraga, Michigan
  • Native Americans for Community Action in Flagstaff, Arizona
  • Riverside San Bernardino County Indian Health Inc. in Grand Terrace, California

“CHANGE grants serve as a catalyst for partners to implement and sustain interventions to effectively engage and mobilize patients and implement systems and policies that are essential to increasing access to timely cancer screenings and appropriate follow-up,” said Laura Makaroff, DO, senior director, Cancer Control Intervention at the Society. Racial and ethnic minority and uninsured individuals are more likely to develop cancer, and die from it, than the general U.S. population. The American Cancer Society is committed to addressing the unequal burden of cancer.”

Colorectal cancer is one of only two cancers that can be prevented through the detection and removal of precancerous lesions. Yet despite the disproportionate impact of the disease on the American Indian and Alaska Native population, screening rates remain low in these populations.

Since 2011, corporate funders have contributed $21.8 million to fund the American Cancer Society’s CHANGE Grant Program. The primary goal of the CHANGE Grant Program is to increase cancer screening rates within communities experiencing cancer disparities. The Society has awarded more than 524 grants to community-based partners to implement evidence-based interventions that provide culturally and linguistically appropriate outreach and education to empower and mobilize the community to access screening resources and help ensure follow-up care is available.

Since 2011, these grant recipients have reached individuals with more than 2.4 million outreach and education interventions and contributed to more than 795,000 breast, cervical, and colorectal cancer screening exams provided at low or no cost.

 

Webinar – 80% by 2018 Progress

During this webinar, Richard Wender, MD, NCCRT Chair and Chief Cancer Control Officer of the American Cancer Society, will share an update on the progress of the 80% by 2018 initiative. Dr. Wender will share the latest data on colorectal cancer screening rates, call on partners to double down on our efforts for the remaining 15 months of the initiative, and begin to discuss the transition to our work beyond 2018.

Speaker:

Richard Wender, MD
Chair, NCCRT
Chief Cancer Control Officer, American Cancer Society

 

 

 

Registration is required. The webinar is open to NCCRT members, 80% by 2018 partners, CDC grantees, ACS Health Systems and Communications staff, and new partners interested in getting engaged in colorectal cancer screening efforts.

A replay of the webinar will be made available a few days after the webinar on the NCCRT webinar archive webpage.

 

CRC News – Week of July 10, 2017

The following email news update was shared with NCCRT members and partners on Friday, July, 14th, 2017. Please email nccrt@cancer.org to subscribe to our regular email updates. 

Register for Thursday, July 27th Webinar on Links of Care
Join us on Thursday, July 27th at 1:00pm ET for an NCCRT webinar, during which we will share what we’ve learned so far from our Links of Care pilot project. Registration is now open. The Links of Care pilots seek to improve colorectal cancer screening and follow up care for uninsured and underinsured patients by strengthening relationships between community health centers and the surrounding medical neighborhood. Speakers will include: Suzanne Lagarde, Julia Williams, Chris Singer and Kara Riehman, who will provide a brief overview of specific pilots, while also discussing implementation, workflows, partnerships, successes/challenges and lessons learned.

The webinar is open to NCCRT members, 80% by 2018 partners, CDC grantees, ACS Health Systems and Communications staff, and new partners interested in getting engaged in colorectal cancer screening efforts. You must be registered to join the webinar.  Please visit this site to register and for additional background.

New Blog on the Great Plains Quality Innovation Network
A new 80% by 2018 Blog, featuring the work of the Great Plains Quality Innovation Network, an 80% by 2018 National Achievement Award Honoree, is now available. Learn about their “All teach, all learn” approach and their creative use of jelly beans to motivate providers! Thank you to Emily Bell for her work on the blog, and of course, special thanks to Nancy Beaumont and Judy Beck for sharing their incredible work with us!

If you or your colleagues would like to share on social media, you are welcome to use our shortened URL (http://ow.ly/WL2dI) and/or to retweet/repost the messages we’ve already shared through @NCCRTnews and facebook.com/coloncancerroundtable.

NCCRT Leadership News
We wanted to share the news that our friend and colleague, Holly Wolf, retired from her long career in public health at the end of June. We will miss Holly greatly, as she has been a smart and thoughtful colleague, who served in many different capacities, including as the long-time Co-Chair of the NCCRT Policy Action Task Group, along with fellow Co-Chair Lynda Flowers.

Having said that, we are grateful that Holly’s hand-picked replacement, Citseko Staples, Senior State and Local Campaign Manager of ACS CAN, has agreed to join Lynda as Co-Chair of the NCCRT’s Policy Action Task Group. Citseko combines a great policy mind with a deep understanding of field legislative activity around colorectal cancer screening across the states. She will be an excellent complement to Lynda’s Washington perspective. Thank you Citseko! Please join me in welcoming Citseko in her new role.

Replay Available of Webinar on How to Evaluate Activities to Increase CRC Screening and Awareness: Evaluation Toolkit
In case you missed it, you can access a replay of the June 27th webinar on our updated How to Evaluate Activities to Increase CRC Screening and Awareness: Evaluation Toolkit here. Special thanks to our excellent presenters: Cheryl Holm Hansen, Amanda Hane, Heather Dacus, Heather Brandt and Andi Dwyer!

As a reminder, all NCCRT webinars are archived and can be accessed here.

New Colon Cancer Alliance Grants Program
The Colon Cancer Alliance launched its first peer-reviewed grants program and is proud to announce that this year’s grant cycle is now open. One grant in the amount of $125,000 will be awarded over a two-year period to support the salary and benefits of the researcher while working on mentored, young-onset colorectal cancer research. Applications are being accepted from June 1-August 31, 2017. This grant will be awarded in December 2017. Click to access the online application and grant guidelines. Please contact CCA’s Stephanie Guiffre at sguiffre@ccalliance.org with questions!

New Moonshot Research Project on CRC Screening
The Accelerating Colorectal Cancer Screening and follow-up through Im­plementation Science (ACCSIS) is a research project designed to test im­plementation strategies that substan­tially improve colorectal cancer screen­ing and follow-up rates in populations where baseline rates remain low. The RFA, submitted by the Blue Rib­bon Panel Prevention and Screening Implementation Team, places an em­phasis on addressing disparities in CRC screening and follow-up, including in underserved racial and ethnic minori­ty populations and rural and hard-to-reach populations.  Based on the panel’s Implementation Science Working Group Report, the proposal addresses the issue of subop­timal uptake of evidence-based cancer prevention and screening programs, particularly among underserved populations. According to the report, effective scaling up of CRC screening and fol­low-up, HPV vaccination, and tobacco cessation interventions could result in 389,900 fewer new cancer cases annually and 318,500 fewer cancer deaths annually. Each research grant in this RFA will in­clude a description of “hotspot” catch­ment areas and populations of focus, with data on low rates of screening and follow-up, emphasizing reduction or elimination of disparities, as well as a two-phase “Signature” trial that would test comparative strategies for improving uptake and sustainment of evidence-based CRC screening and fol­low-up care. The budget for ACCSIS is $15 million in total costs over five years, with $12 mil­lion for the research grants and $3 mil­lion for the creation of a coordinating center.

Relevant Articles and Studies
Here are a few relevant articles/studies that may be of interest:

A new CDC report on Higher Deaths from Cancer in Rural America shows that cancer death rates are falling more slowly in rural areas than in urban areas, but proven strategies can help reduce these disparities. While rural areas have lower rates of new cases of cancer than urban areas, they have higher cancer death rates. Incidence rates were higher in rural areas for several cancers, including those linked to tobacco use such as lung cancer, and those that can be prevented by screening such as colorectal and cervical cancers. This report is the first comprehensive description of cancer incidence and deaths in rural and urban areas.

Along that note, some of you may also find this Rural Monitor story on colorectal cancer screening that puts the spotlight on some of the good work rural states are doing to increase colorectal cancer screening.

Cost-Effectiveness of Waiving all Copayments for Colorectal Cancer Screening Among Medicare Beneficiaries. New data presented at the annual Digestive Disease Week® looked at Cost-Effectiveness of Waiving all Copayments for Colorectal Cancer Screening Among Medicare Beneficiaries. Click here to view the study abstract. The study concludes that it can be used to help inform the public debate and policy on the potential costs and benefits of waiving all copayments for colonoscopies used in CRC screening and suggests that waiving these copayments will likely be a very cost-effective legislation. Here is an additional story explaining the analysis. Thank you to Emily Bell and Barry Berger for bringing this analysis to our attention, and congratulations to NCCRT colleagues, Reinier Meester, Frank Berger, and Ann Zauber, as well as the other authors!

Insurance Coverage for CT Colonography Screening: Impact on Overall Colorectal Cancer Screening Rates. A new journal article has been published in Radiology, entitled Insurance Coverage for CT Colonography Screening: Impact on Overall Colorectal Cancer Screening Rates. The study found that insurance coverage of CT colonography for CRC screening was associated with a greater likelihood of a patient being screened and a greater likelihood of being screened with a test that helps both to detect cancer and prevent cancer from developing (CT colonography or colonoscopy). Congratulations to NCCRT members Drs. Jennifer Weiss, David Kim and Perry Pickhardt, as well as the other authors! Additional thanks to Emily Bell for bringing this article to our attention.

Register for CDC’s August National Cancer Conference
Only 30 days until the 2017 CDC National Cancer Conference in Atlanta! In addition to an exciting list of plenary speakers including Joan Lunden, the conference includes a thought-provoking line-up of concurrent sessions. Online registration ($375 rate) closes August 4. On-site registration ($425 rate) will be available for the first two days of the conference, August 14 and 15, 2017. For more details and registration information, please visit the conference website.

New Biomarker Resource for Patients from Fight CRC
Fight CRC asked that we share a new resource called Biomarked. As you know, treatment decisions for many CRC patients are not one-size-fits-all. This campaign was designed alongside Fight CRC advocates who offered their insights into their confusion about biomarkers (and other topics involved in making treatment decisions). Fight CRC worked to create a resource that explains the factors involved in choosing the best treatment option and how to undergo a conversation with their treatment teams. Fight CRC is hopeful that patients, caregivers and medical professionals alike will all use this resource, which includes a mini-magazine, conversation starter, videos, blogs, and FAQs about biomarkers. We invite you to check it out! https://FightCRC.org/Biomarked Please contact Fight CRC’s Danielle Burgess at danielle@fightcolorectalcancer.org with questions.

Seeking Submissions to the 80% by 2018 Hall of Fame!
Has your organization reached an 80% colorectal cancer screening rate? Or do you work with a partner that’s reached the 80% milestone? If so, we want to hear from you! Share your success to get your organization’s name listed on the 80% by 2018 Hall of Fame. Organizations will also receive an 80% Screening Rate Stellar Achievement Web Badge to display on websites and social media.

 

 

 

New CDC report shows incidence and mortality from colorectal cancer higher in rural America

A new study published in CDC’s Morbidity and Mortality Weekly Report shows slower reduction in cancer death rates in rural America (a decrease of 1.0 percent per year) compared with urban America (a decrease of 1.6 percent per year). The report is part of a series of MMWR studies on rural heath.

The report is the first complete description of cancer incidence and mortality in rural and urban America. Researchers found that rates of new cases for lung cancer, colorectal cancer, and cervical cancer were higher in rural America. In contrast, rural areas were found to have lower rates of new cancers of the female breast and prostate. Rural counties had higher death rates from lung, colorectal, prostate, and cervical cancers.

“While geography alone can’t predict your risk of cancer, it can impact prevention, diagnosis and treatment opportunities – and that’s a significant public health problem in the U.S.,” said CDC Acting Director Anne Schuchat, M.D. “Many cancer cases and deaths are preventable and with targeted public health efforts and interventions, we can close the growing cancer gap between rural and urban Americans.”

In the study, researchers analyzed cancer incidence data from CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results program. Cancer deaths were calculated from CDC’s National Vital Statistics System. Counties were grouped by urbanization and population size.

Key findings from analysis of cancer rates

  • Death rates were higher in rural areas (180 deaths per 100,000 persons) compared with urban areas (158 deaths per 100,000 persons). Cancer deaths in rural areas decreased at a slower pace, increasing the differences between rural and urban areas.
  • While overall cancer incidence rates were somewhat lower in rural areas (442 cases per 100,000 persons) than in urban areas (457 cases per 100,000 persons), incidence rates were higher in rural areas for several cancers, including those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers.
  • While rural areas have lower incidence of cancer than urban areas, they have higher cancer death rates. The differences in death rates between rural and urban areas are increasing over time.

“Cancer – its causes, its prevention, and its treatment – is complicated,” said Lisa C. Richardson, M.D., oncologist and director of CDC’s Division of Cancer Prevention and Control. “When I treat cancer patients, I don’t do it alone – other healthcare professionals and family members help the patient during and after treatment. The same is true for community-level preventive interventions. Partnerships are key to reducing cancer incidence and the associated disparities.”

The CDC researchers also identify a number of proven strategies that can reduce the gaps in new cancer cases and deaths. Read the study to learn more.

 

Interview with Great Plains Quality Innovation Network—80% by 2018 National Achievement Award Honoree

July 5th, 2017 :: Authors: Nancy Beaumont and Judy Beck, RN, MSN

On February 1, 2017, Great Plains Quality Innovation Network (Great Plains QIN) became an honoree recipient of the 2017 80% by 2018 National Achievement Awards, a program designed to recognize individuals and organizations who are dedicating their time, talent and expertise to advancing needed initiatives that support the shared goal to regularly screen 80% of adults 50 and over by 2018.

Nancy Beaumont, the State Program Director for the South Dakota Foundation for Medical Care, has been an active member of the South Dakota Council on Colorectal Cancer (2004-present), a statewide alliance of individuals and organizations working together to reduce the burden of colorectal cancer. Nancy serves as an advisor to the South Dakota Comprehensive Cancer Control Plan Advisory Committee (2007-present), and is a member of the South Dakota Chronic Disease Partners Steering Group (2007-present). Additionally, Nancy serves on the American Cancer Society South Dakota State Leadership Board, volunteering her time and efforts by engaging key stakeholders in the development of key processes to allow informed decision making and improved health outcomes.

Judy Beck, RN, MSN, serves as the Quality Improvement Program Director for Quality Health Associates of North Dakota. She is the State Program Director for North Dakota serving the Great Plains QIN. Judy has experience as a certified oncology nurse and a nurse manager of a cancer center. In this role, she participated in the health system’s cancer committee to address colorectal cancer screening and colorectal cancer rates. Judy serves as co-lead for the Great Plains QIN’s regional efforts to improve colorectal cancer screening rates in North Dakota, South Dakota, Nebraska, and Kansas.

Hi, Judy and Nancy! We’re excited to feature your work on the 80% by 2018 Blog. Can you tell us a little about yourself and how you ended up working on colorectal cancer screening?
[Judy] My 30+ years of experience as a nurse includes working with cancer patients as a certified oncology nurse. In this role, I cared for patients with colorectal cancer, some survived while others did not. Many of us know someone with colorectal cancer. Personally, this includes family and friends. As the Quality Improvement Program Director for Quality Health Associates of North Dakota, I’m working with a talented team from the Great Plains QIN to tackle colorectal cancer in a big way.

[Nancy] Colorectal cancer has been a priority of mine as it is known to be preventable through early detection and screening and too many adults are not getting tested as recommended, leading to considerable suffering to families. The need to raise awareness aligns with my ongoing commitment to the advancement of a high quality, patient centered, and cost effective health care system. Throughout my career, I’ve had the opportunity to work alongside of clinicians, community members / consumers, and employers in state-wide coalitions and task forces to collectively push toward a common goal of preventing cancers and saving lives. In my role as Quality Director at the South Dakota Foundation for Medical Care, I continually work to create an environment of collaboration, engaging key stakeholders in the development of processes to allow informed decision making and improved health outcomes.

Tell us a little bit about the Great Plains Quality Innovation Network.
The Great Plains Quality Innovation Network-Quality Improvement Organization (GP QIN-QIO) was awarded the Centers for Medicare and Medicaid Services (CMS) contract to serve as the QIN‐QIO for Kansas, Nebraska, North Dakota, and South Dakota in 2014. Through this contract, we work with healthcare providers, including primary care physicians, to implement data-driven quality initiatives to improve health care. We offer technical assistance, tailored education, best practices, tools, and resources. Through these efforts, we intend to improve patient safety, reduce harm, and improve clinical care at the local and regional levels.

When and why did the Great Plains QIN decide to focus on increasing colorectal cancer screening?
Data revealed that the four states we serve have colorectal cancer incidence rates that are higher than the national average and colorectal cancer screening rates that are far below the national average. According to data from the Centers for Disease Control and Prevention, the national average incidence of colorectal cancer is 39.9/100,000. Incidence rates in our Midwest region range from 44/100,000 in North Dakota, to 39.8/100,000 in Kansas. The 2012 Behavior Risk Factor Surveillance System (BRFSS) data showed colorectal cancer screening prevalence among our states with North Dakota ranked 42 of 51, Nebraska 38 of 51, South Dakota 32 of 51, and Kansas 25 of 51. The data indicated there was significant room for improvement in our care delivery systems within our region. To address this, we submitted a proposal and were awarded funding from CMS with a two-year special innovation project. Our project currently supports primary care physicians from 57 clinics committed to improving their colorectal cancer screening rates, which in turn saves lives by preventing or finding the disease early and increasing the possibility of survival.

How did you recruit clinics to work on colorectal cancer screening?
To recruit clinics, we first reached out to those who were working with our QIN-QIO on other quality improvement efforts. By sharing the statewide incidence and screening data for each state, we recruited clinics wanting to impact this data by improving their screening rates. Over 80% of the clinics working on this project have confirmed this commitment by taking the 80% by 2018 pledge. Most of the health systems working with this project are smaller, rural clinics that lack the same level of resources found within large health systems. Many are Federally Qualified Health Centers (FQHCs) and Rural Health Centers.

What kinds of training and technical assistance do you offer clinics? And how do you communicate and collaborate with them across such a large region?
To improve colorectal cancer screening rates, we implemented interventions to promote system changes within primary care practices. To accomplish this, we provided education and technical assistance to support clinics to implement the four essentials found in the  NCCRT evidence-based toolkits, Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Community Health Centers and How to Increase Colorectal Cancer Screening Rates in Practice: A Primary Care Clinician’s Evidenced-Based Toolbox and Guide. The four essentials include making a physician recommendation, developing a screening policy, implementing reminder systems, and measuring practice progress.

Our special innovation project used a regional Learning and Action Network (LAN) as the foundation to provide access to tools, resources, education, subject matter experts, and networking opportunities. We partnered with the American Cancer Society and other stakeholders to offer webinars on topics covering current knowledge and guidelines about appropriate colorectal cancer screening, evidence-based practices for improving screening rates, and strategies for overcoming barriers to screening. We used an “all teach, all learn” approach. One of the webinars featured one of our recruited Kansas clinics, who shared their lessons learned from their successful journey in which they exceeded the 80% screening goal. Using webinars and posting resources on the Great Plains QIN website enabled us to extend our reach to all clinics across the four-state region. Readers outside our region are welcome to visit the site to download tools and view archived webinars.

What kinds of changes have the clinics implemented? And how did they select their interventions?
Clinics have engaged in a wide variety of changes based on their technological capacity, staffing structure, and current screening goals. Interventions range from placing a fecal immunochemical test (FIT) kit on the counter as a reminder to the provider to hiring a colorectal cancer screening coordinator to better manage the complex patient reminders and testing follow-up. Key elements to successful screening rate improvements include electronic health record optimization and screening navigation to ensure FIT kits are returned and colonoscopy preparation and procedures are conducted.

One clinic used jelly beans to track if the provider or the nurse recommended the screening and the corresponding percentage of patients who followed through. We’ve found that developing fun and easy ways to track a rapid improvement cycle or create some competition among healthcare teams helps to engage the staff.

I understand several clinics piloted providing patients with FIT kits during annual flu shot clinics (FluFIT).
In a regional effort to promote colorectal cancer screening methods including annual stool tests, various partners collaborated to promote and implement the FluFIT program across our four-state region. Partners included the American Cancer Society, Great Plains Tribal Chairmen’s Health Board, North Dakota Department of Health, South Dakota Comprehensive Cancer Control Program, and the South Dakota Department of Health.

We worked from the four essentials highlighted in NCCRT’s toolkits for primary care and www.flufit.org to develop a FluFIT LAN, which included a webinar series, “office hours” teleconference calls, and technical assistance planning meetings. Our “Fast Track to FluFIT Webinar Series” covered how to assemble a FluFIT team, develop a FluFIT workflow, and systems to support follow up. We then used the office hours to troubleshoot obstacles and share best practices, tools, and resources. To provide technical assistance, Great Plains QIN staff conducted site visits and conducted individual planning meetings.

Thirty sites implemented FluFIT clinics in the fall of 2016, including FQHCs, Indian Health Service clinics, a pharmacy site, and others, many in rural areas. Learn more about this regional initiative in the “FluFIT: Double Disease Prevention” poster, shared at the CMS Quality Conference in December 2016.

Kaitlin Nolte from Kansas Foundation for Medical Care (left) and Tasha Peltier (right) from Quality Health Associates of North Dakota

What success have you seen? How did you measure that success?
Of the 43 clinics that are currently able to track their colorectal cancer screening rate, all have reported improvements, with one screening as many as 84% of eligible patients. It’s early to see measurable impact from the FluFIT clinics since this was the inaugural flu season for the project, but early indicators are promising. Clinic sites who have operationalized and/or hosted FluFIT programs along with other evidence-based interventions in previous seasons have documented increases in colorectal cancer screening rates.

What lessons learned would you share with others that support primary care clinics with training and technical assistance related to colorectal cancer screening?
Aligning our efforts with state and regional stakeholders also committed to the 80% by 2018 campaign supported not only our recruited clinics, but helped spread efforts across each state. We have learned from clinics some of the challenges they encounter with using their electronic health record systems to track their screenings rates, which may result in the need for costly upgrades. Using the “all teach, all learn” approach allowed clinics to discuss their challenges and share strategies with each other. One-on-one technical assistance provided through coaching calls and/or site visits helped clinics successfully implement interventions from NCCRT’s primary care toolkits.

Do you have any final tips for our readers that are working to achieve 80% by 2018?
We learned so much from this work, but the following three themes emerged as essential keys for success:

  1. Developing strong partnerships and promoting collaboration resulted in a greater reach and network of organizations interested in quality improvement efforts.
  2. Identifying and unifying the efforts of champions across organizations increases credibility and creates accountability for continued progress.
  3. Providing tools for implementing policy and systems change is a key factor for implementing a sustainable quality improvement effort.

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

 

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