New Links to Colorectal Cancer Prevention American Cancer Society Wellmark Foundation

Program Goal Increase age appropriate colorectal cancer screenings through collaboration with medical providers. Our primary care practices are located in 15 counties in Iowa and South Dakota. These counties exceed state and national incidence for colorectal cancer.

Colorectal Cancer Incidence Age-adjusted rates per 100,000 Iowa Incidence Rate: 62.9 S Dakota Incidence Rate: 61.9 U.S. Incidence Rate: 53.1 Source: CDC National Program of Cancer Registries Cancer Surveillance System (NPCR-CSS) 2006 data and SEER United States Cancer Statistics 2003.

Project Plan Education Health professionals Patients Public Awareness Increase age and risk appropriate colorectal cancer screening by health care providers in targeted practices

Process to increase colorectal cancer screening by health care providers Query software programs for patients ages Audit records to determine screening status of each patient. Send letter from primary care physician requesting patients call their office to schedule an appointment for screening.

Process to increase colorectal cancer screening by health care providers Identify patients requiring earlier colorectal cancer screening due to family medical history. Send high risk letter to patient ; request family health history. Place screening status reminder on patient record for each patient without screening. Place American Cancer Society/Clinic ads in the local newspapers.

Reporting Measures Increased colorectal cancer screening rates over baseline rates by at least 10% per provider Numbers of patients identified and letters sent from primary care practice Number of colonoscopies scheduled Results from colonoscopy reports Number of patients at high risk for genetic colorectal cancer identified

Process Results: Akron Mercy Medical Clinic Number of letters sent: 736 Number of additional colonoscopies since project initiated: 276 Increase over baseline: 92%

Colonoscopy Results: Akron Mercy Medical Clinic Number of abnormal colonoscopies: 66 Number of colon cancers detected: 0 Number of high risk surveys: 19

Akron (Plymouth County)Results to date: Program-Initiated Colonoscopies Based on 175 colonoscopy reports received to date

Process Results: Primghar Mercy Medical Clinic Number of letters sent: 214 Number of additional colonoscopies since project initiated: 148 Percent increase over baseline: 80%

Colonoscopy Results: Primghar Mercy Medical Clinic Number of abnormal colonoscopies: 67 Number of colon cancers detected: 3 Number of high risk surveys: 2

Primghar (O’Brien County)Results to date: Program-Initiated Colonoscopies Based on 129 colonoscopy reports received to date

Process Results: Hartley Mercy Medical Clinic Number of letters sent: 300 Number of additional colonoscopies since project initiated: 59 Percent increase over baseline: 30%

Colonoscopy Results: Hartley Mercy Medical Clinic Number of abnormal colonoscopies: 20 Number of colon cancers detected: 0 Number of high risk surveys: 0

Results to date: Program-Initiated Colonoscopies Based on 52 colonoscopy reports received to date

Benefits Early screening Reduces incidence Detects colon cancer at an earlier, more treatable stage Identifies and educates families at high risk of colon cancer due to genetic mutations

Increase in Colonoscopy Screens Goal: 10% over baseline

Results to date: Program-Initiated Colonoscopies Based on 391 colonoscopy reports received to date

Barriers to Colorectal Screening Anxiety Lack of education No insurance High deductibles

The Colossal Colon: Seeing is Believing