Colorectal Cancer Screening: 2014 Change in methodology from previous years. 2011 and 2013:...
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Colorectal Cancer Screening: 2014 • Change in methodology from previous years. • 2011 and 2013: administrative (claims) data only, rate per 1,000 mm. • 2014: hybrid (administrative data + medical record review), percentage. • 2014 data are not comparable to earlier years. • Benchmark established by Committee, based on high performing FQHCs in Oregon. Oregon QHOC - July 2015
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Transcript of Colorectal Cancer Screening: 2014 Change in methodology from previous years. 2011 and 2013:...
Oregon QHOC - July 2015
Colorectal Cancer Screening: 2014
• Change in methodology from previous years. • 2011 and 2013: administrative (claims) data only, rate per 1,000 mm. • 2014: hybrid (administrative data + medical record review), percentage.
• 2014 data are not comparable to earlier years.
• Benchmark established by Committee, based on high performing FQHCs in Oregon.
Oregon QHOC - July 2015
Colorectal Cancer Screening:Comparative data
0%
20%
40%
60%
80%
100%
46.20%
58%64%
Oregon Medicaid (2014) National Commercial 50th percentile (2014)National Medicare 50th percentile (2015)
Oregon QHOC - July 2015
Oregon QHOC - July 2015
Next steps• OHA will publish 2015 chart review guidance document this
summer.
• Metrics & Scoring Committee to determine if colorectal cancer screening will continue as incentive measure in 2016 in their July meeting.
• If continuing as incentive measure, Committee will revisit benchmark for 2016.
Key messages
– Consider your screening approach– Understand your population– Make continual improvements– Assure follow-up care
Colorectal Cancer statistics for Oregon
Stage of CRC detection* CRC screening disparity*
*Source: Oregon State Cancer Registry
*Source: Behavioral Risk Factor Surveillance Survey
Free FIT vs. Free colonoscopy program
• Study included uninsured patients aged 54-64 at the John Peter Smith Health Network, a safety net health system.
• Randomized patients into 3 groups:– Free FIT (n = 1593)– Free colonoscopy (n = 479)– Usual care (n = 3898)
Gupta et al. JAMAIM 2013
Mailed FIT programs are effective
Type of clinic intervention Effect size N studies
Direct mailed fecal tests
5.8% - 24% 4
Telephone reminders
NS – 6.1% 3
Decision support tool
NS 2
Patient navigation 9.5% - 18.8%
6
Flu FIT 16.3% 1
Legislative update
• 2014 OR passed legislation that requires insurance companies to treat to colonoscopy as a screening colonoscopy, even if polyps are removed. This means that patients who go in for a screening colonoscopy will not be surprised by co-pays and deductibles.
• 2015 OR passed legislation that requires insurance companies to not impose patient co-pays or deductibles for follow-up colonoscopies when a FIT test is positive. This means to there is no financial barrier to follow-up colonoscopy for insured patients.
Colorectal Cancer (CRC) Screening – Promising Practices in Implementing Evidence-based
Interventions
Facilitator: Melinda M. Davis, PhDDirector of Community Engaged Research,
Oregon Rural Practice-based Research Network (ORPRN)Research Assistant Professor, Department of Family Medicine
QHOC Meeting * July 13, 2015 * Salem, OR
Colorectal Cancer (CRC) Screening – Promising Practices in Implementing Evidence-based
Interventions
Facilitator: Melinda M. Davis, PhDDirector of Community Engaged Research,
Oregon Rural Practice-based Research Network (ORPRN)Research Assistant Professor, Department of Family Medicine
QHOC Meeting * July 13, 2015 * Salem, OR
Panelists
• Tran Miers, RN– Clinical Programs Director– Virginia Garcia Memorial
Health Center
• Daisuke Yamashita, MD– Medical Director– OHSU Family Medicine at
South Waterfront– Assistant Professor OHSU
Department of Family Medicine
• Coco Yackley– Operations Manager– Columbia Gorge Health
Council (Pacific Source Columbia Gorge CCO)
• Kevin Heidrick, PA– Regional Medical Director,
Associate Medical Director for Utilization Management
– Yakima Valley Farmworkers
Session Overview
• Quick Orientation– Test options, screening targets– Evidence-base– Now what?
• Panel Q&A Discussion (40 min)• Small Group Activity (20 min)• Large Group Debrief (10 min)• Next Steps (5 min)
CRC Screening Options
The US Preventive Services Task Force (USPSTF) recommends regular CRC screening between 50-75 using:• High-sensitivity fecal occult blood test (FOBT)
annually• Flexible sigmoidoscopy every five years with
FOBT every three years.• Colonoscopy every 10 years
CRC Screening Targets• Oregon Health Authority:
– 47.0% for 2015, TBD for 2016!
• National Colorectal Roundtable– Coalition of 70+ public, private,
and voluntary organization– Led by American Cancer Society
and Centers for Disease Control and Prevention
– Goal: Increase the use of CRC screening tests among the population for whom screening is recommended.
Evidence-based CRC Screening Interventions
Findings synthesized from three systematic reviews (Holden et al 2010; Brouwers et al 2011; Sabatino et al 2012)
Level Effective Mixed/Insufficient/Not Reported
Patient • Patient reminders (5-15%)• One-on-one interactions
(14.6-41.9%)• Reducing structural
barriers – e.g., mailing FOBT/FIT (14.6-41.9%)
• Small media• Mass media• Group education• Reducing out-of-pocket
expenses• Client incentives
Provider • Assessment & feedback • Provider reminders• Provider incentives
Health System or Community
• Improving referral patterns or introducing patient navigators (7-28.2%)
Not What, How??
“The research priority is to design and test interventions to increase screening and CRC
screening discussions, building on the effective approaches identified…and tailored to specific
population needs.”
Holden et al (2010)Enhancing the Use and Quality of Colorectal Cancer Screening
AHRQ Evidence Report/Technology Assessment
Panelists
• Tran Miers, RN– Clinical Programs Director– Virginia Garcia Memorial
Health Center
• Daisuke Yamashita, MD– Medical Director– OHSU Family Medicine at
South Waterfront– Assistant Professor OHSU
Department of Family Medicine
• Coco Yackley– Operations Manager– Columbia Gorge Health
Council (Pacific Source Columbia Gorge CCO)
• Kevin Heidrick, PA– Regional Medical Director,
Associate Medical Director for Utilization Management
– Yakima Valley Farmworkers
Question 1
• Briefly describe your practice/CCO setting and your role within this context (particularly in relation to CRC screening improvement).
Question 2
• What is your practice/CCO doing to improve colorectal cancer (CRC) screening?– Why did you choose to implement this
intervention?– When did you start doing this work? How has your
approach changed over time?– What resources have you used to implement
this/these interventions?– Is it working?
Question 3
• What is your ideal vision for improving CRC screening in your practice/CCO moving forward?
Question 4
• What advice would you give other practices/CCOs that are working to improve CRC screening rates?– How would your advice differ for those actively
implementing CRC screening interventions versus those considering the options?
Small Group Discussion
• Break into four small groups
• Discussion questions:– What is your practice/CCO currently doing to
enhance CRC screening?– What CRC screening interventions did you hear
about today that you might try in your practice/CCO?
Large Group Debrief
• Come back together!
• Report out by small group facilitators (1 min)• Group comments, thoughts• Final remarks
– Gloria Coronado, PhD– Melinda Davis, PhD
Next Steps
• Next QHOC Meeting– Date: September 14th, 2015– Topic: Traditional Health Workers
• Before you leave: Please complete today’s session evaluation
OHSU FM AT SOUTH WATERFRONT PANEL MANAGEMENT
Daisuke Yamashita MD
Panel Manager MA Clinician
HM
Room Pt, Review HM
Pend orders
Sign orders
Perform orders
Update HM modifiers
EHR reminder
placement/Other
specific reminders in the schedule
Discuss HM
Review Schedul
e
Reach In
Panel Manager Clinician Nurse visit Lab/Image/Consult
Reach Out
Review Pt’s Charts/reportsPlace appropriate Reminder
Review and co-sign orders
Contact Pt (My Chart, letter,
phone)
Clinic Visit(ie: Colon Cancer Screen
shared decision)
Place orders and sign
Arrange Orders
Nurse visit(Labs, immunizations)
Tests/Consults(ie: mammogram, eye visit)
Pt message regarding HM
“Aha!”Identify All Appropriate
gaps for each pts (all shots!)
• Colorectal Cancer Screening Registry
Quarterly Reports
• Colorectal Cancer Screening Registry
Quarterly Reports
