1. The Value of Partnerships: Advancing Our Efforts Through Collaboration ICC Cancer Summit October 3-4, 2011 Lorrie Graaf, American Cancer Society Bobbie Bohnsack, American Cancer Society Chris Espersen, Primary Health Care, Amy Fletcher, Telligen

2. Session Objectives Gain a better understanding of how to leverage existing partnerships to increase cancer screening rates. Receive the tools and resources available for assessing readiness for policy and systems change. Identify ways community health centers, health care systems, and providers can implement the cancer screening toolkit in their practices.

3. What is Collaboration? Process Includes Exchanging Information Enhancing Capacity Sharing Resources Improving Outcomes Common Purpose and Mutual Benefit

4. Collaboration Benefits Align similar goals and objectives Coordinate efforts to reach similar populations Identify common problems and gaps and opportunities for addressing them Become effective and efficient Solve similar problems together Learn from each other It’s already happening in many communities!

5. Collaboration Components Priority Activity Joint Work Plan Resource Leverage Policy Related Activity Data Sharing Progress Tracking and Reporting

6. In Summary Collaboration is a: Process Way to enhance capacity to achieve common goals Means to promote collective thinking and problem solving Way to stretch resources while creating greater impact

7. The Value of Partnerships: Advancing Our Efforts Through Collaboration How to Increase Preventive Cancer Screening Rates in Practice Bobbie Bohnsack, MHA Director, Community Partnerships American Cancer Society, Health Equity Department

8. Toolkit Overview Developers Wide dissemination Purpose Multiple versions

9. Make a Recommendation The primary reason patients say they are not screened is because a doctor did not advise it.. Develop a Screening Policy Create a standardized course of action. Measure Practice Progress Establish a baseline screening rate and set an ambitious practice goal. Be Persistent With Reminders Track test results and follow-up with providers and patients.

10. Essential Tools: Tools that Save Lives Essential #1: Make a Recommendation – Assessment of patient readiness – Provide educational materials – Community outreach to underserved populations

11. Essential Tools: Tools that Save Lives Essential #2: The Office Policy/Screening Policy – Vital component – Allows for a systematic approach – Training recommendations – Examples included in toolkit, multiple options for customizing

12. Essential Tools: Tools that Save Lives Essential #3: Office Reminder Systems – Cues to take action – Can be directed at patients, clinicians, or both – Can be simple, or complex, with the more complex systems having the greatest benefit – Physician and patient reminders are critical

13. Essential Tools: Tools that Save Lives Essential #4: Effective Communication System – Maximizes what little time there is with patients, increasing clear delivery of advice Staff Involvement Tracking Measuring Progress Well thought out, planned communication strategies save time, resources, and LIVES.

14. Interactive Web-Based Version

15. Resources www.cancer.org www.canceriowa.org www.cancer.org/webmd

16. Questions? Bobbie Bohnsack, MHA Director, Community Partnerships American Cancer Society, Health Equity Dept. bobbie.bohnsack@cancer.org Phone: 515-727-0063

17. The Value of Partnerships: Advancing Our Efforts through Collaboration Chris Espersen, Primary Health Care Inc

18. Overview FQHC PHC Goals and Objectives of PHC-ACS Partnership Using the Toolkit in CHC setting Outreach efforts

19. Federally Qualified Health Centers 1960s War On Poverty Quality care as a right for all regardless of ability to pay Serve 19 million annually 40% uninsured 1/3 are children 1 in 19 people in US rely on an FQHC for primary care

20. Primary Health Care, Inc Four medical clinics (3 in Des Moines, 1 in Marshalltown) Pediatrics, OB/GYN, internal medicine, family practice, HIV, dental, mental health, supportive services, pharmacy 25,000 patients, 90K+ visits – ¼ homeless – 53% uninsured – 50% minority (Polk County=19.3%) – Refugee influx

21. Goals and Objectives Baseline data Increase screening rates Outreach to 1000 women

22. Make a Recommendation Provider knowledge, attitude and beliefs survey Training Tracking plan!

23. Develop a Screening Protocol Initial check in – Providers – Patients Documentation Involving ALL staff

24. Be Persistent With Reminders Referral coordinator Workflow Tracking referrals

25. Measure Practice Progress Monthly chart pulls – N=70 EMR data collection plan – universal

26. Community Outreach Preventive Care and Medical Home Care Coordination and Communication outside the clinic walls Passion: – “I really liked the training and I learned a lot. With the information given I think it will give me a great start to be a community outreach worker by having the ability to have a positive effect on the African American community. I think it is important to get the message out.”

27. The Value of Partnerships: Advancing Screening Efforts Through Participation Amy Fletcher, Telligen October 4, 2011

28. Background Colorectal cancer is the most common malignant cancer diagnosed among Iowans It is the second leading cause of cancer death 95% are 50 years of age and older University of Iowa College of Public Health: State Health Registry 2011 Cancer in Iowa Report

29. Background Good News Over the last two decades incidence rates have decreased 18% Mortality rates have declined over 30% Bad News According to the 2008 Iowa BRFSS reports 59.8% of Iowans 50 years and older were screened by any appropriate method with the proper time frame University of Iowa College of Public Health: State Health Registry 2011 Cancer in Iowa Report

30. Partners Collaborate Common goal to increase CRC screening rates in primary care practices Iowa Cancer Consortium – Barriers to Screening Workgroup American Cancer Society Telligen – Quality Improvement Organization

31. FIT Kit Project Each provider site received 200 Fecal Immunochemical Tests with stamped envelopes Reagent Toolkit with letter template and stamped envelopes ACS brochures and instructional DVD Tracking log Educational material for staff

32. Why Focus on Primary Care? Primary care physicians have it in their power to improve the screening rates 80 – 90% of people over age 50 see a physician each year

33. Method The project was based on the four essentials from the National Colorectal Cancer Roundtable’s How to Increase Colorectal Cancer Screening Rates: Physician recommendation Office screening policy Patient reminders Practice progress measurement

34. Physician Recommendation The most consistently influential factor in cancer screening Participating physicians were asked to discuss CRC screening with all eligible patients

35. Office Screening Policy Office staff were encouraged to develop processes to increase patient compliance ACS patient education material reinforced physician recommendation Best practice Follow up phone calls to patient

36. Patient Reminders EHR reports identified patients overdue for CRC screening Reminder letters sent Patients were given a FIT kit or recommendation for another screening option

37. Results Data shows a screening rate increase of 9.8% Individual provider rates were as high as 16.4% 57% of FIT kits distributed were returned

38. Questions? Thank you for participating in the Cancer Summit 2011!