HOW STANDING ORDERS HELPED US IMPROVE CANCER SCREENING: REPORT FROM A NEW PPRNet MEMBER
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Transcript of HOW STANDING ORDERS HELPED US IMPROVE CANCER SCREENING: REPORT FROM A NEW PPRNet MEMBER
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HOW STANDING ORDERS HELPED US IMPROVE CANCER SCREENING: REPORT FROM A NEW PPRNet MEMBER
JULIO A SAVINON, MD
RIO GRANDE MEDICINE INC.
HARLINGEN, TX
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IN CASE SOMEBODY ASKS WHERE HARLINGEN IS
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ABOUT HARLINGEN
• Population: 65,679; increases by 14% annually. Most over 18 years old (near 70%)
• Winter Texans• 2 major hospitals• All specialties available.• Need for improvement: poverty, uninsured,
lifestyle…
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ABOUT RGM
• More than 2,500 patients and growing
• 2 providers (1 IM, 1 FP)
• 4 MAs,2 Secretaries, 2 billers, one office manager, and others.
• EMR
• PPRnet.
• Managed care and ACO participation
• Level 3 PCMH
• Bariatric medicine and referrals.
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USING PPRNet REPORTS
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CANCER FACTSESTIMATES FROM ACS FOR 2014
• 96,830, 40,000 new cases of COLON CA AND RECTAL CANCER, respectively. 50,310 expected to DIE.
• 232,670, 62,570 new cases of invasive and in situ BREAST CANCER, respectively. 40,000 expected to DIE.
• 12,360 new cases of invasive CERVICAL CANCER. 4,020 expected to DIE.
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MORE CANCER FACTS
• Estimated cost for 2009 was US $216.6 billion, 86 billion for direct medical cost, 130 billion for indirect (lost productivity).
• Early detection usually results in less extensive treatments and better outcomes; to less suffering.
• The USPSTF recommends screening mammography for women 50-74 years, biennial.
• For cervical cancer: initiate at age 21; every 3 years, or every 5 years with HPV co-testing for women ages 30-65, then stop if not any abnormality.
• For colon cancer: colonoscopy age 50, every 10 years, until age 75, or until life expectancy is less than 10 years. FOBT yearly; sigmoidoscopy with FOB every 3 years. BE is not recommended by USPSTF.
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CANCER SCREENING FACTSSOURCE: MKSAP 16 and NCI
• Breast cancer mortality reduction with mammography: 10-20%.
• Cervical cancer reduction with PAP: 95% (at least 80% including mortality reduction)
• Colon cancer reduction with colonoscopy: 53-72% (similar for sigmoidoscopy, left colon), mortality reduction: 31%; with FOBT 17-20% cancer reduction; mortality reduction: 15-33%
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RISK OF CANCER SCREENINGsource: NCI
• Overdiagnosis and unnecessary treatments.• False positive with additional testing and
anxiety• False negative with false sense of security and
potential for delay in diagnosis• Radiation, bleeding, perforation, death.• Cost
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BREAST CANCER SCREENING SOURCE: CDC, US, 2010, MAMMOGRAPHY
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COLON CANCER SCREENINGSOURCE: CDC, BRFSS, US, 2010
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CERVICAL CANCER SCREENINGSOURCE: NATIONAL CENTER FOR HEALTH STATISTICS.
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PAP TEST AFTER IMPLEMENTATION OF STANDING ORDERS AT RGM
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MAMMOGRAM AT RGM AFTER IMPLEMENTATION OF STANDING ORDERS
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COLON CANCER SCREENING AT RGM AFTER STANDING ORDER IMPLEMENTATION
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CONCLUSION.
•STANDING ORDERS ARE HELPING US IMPROVE CANCER SCREENING
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THE END