2. Colorectal Cancer a Leading Cause of Cancer Death in NYC
This graph represents the latest counts of leading cancer deaths in NYC. Lung cancer continues to be the number one cancer killer. However, our focus in this presentation is the number 2 cancer killer in NYC, colorectal cancer.
Colorectal cancer (CRC) can potentially be prevented via CRC screenings. This presentation focuses specifically on colonoscopies for CRC screening.
Source: NYC Office of Vital Statistics,

3. Colon Cancer Prevention: NYC Screening Colonoscopy Adherence Trending Upward
From 2003 to 2016, colonoscopy screening in New York City went from 42% to 69%.
This translates to a 64% increase, or an additional 902,000 people who were screened in 2016 compared to 2003.
Although New York City has made great progress in increasing the colonoscopy screenings, there is still room for improvement.
Data Source: NYC DOHMH Community Health Survey,
Trend is significant at p < .001.

4. Gaps in NYC Screening Colonoscopy Adherence by Race/Ethnicity Narrowing
From , the Community Health Survey detected no statistically significant racial disparities in colonoscopy screening rates between White and Black, Asian or Latino New Yorkers.
The elimination of disparities by race/ethnicity for screening colonoscopy rates was a huge accomplishment for NYC. This was in large part due to the incredible work of NYC Health + Hospitals.
The inequities by race/ethnicity in colon cancer prevention evident in 2003 were eliminated by In 2016, the New York City Community Health Survey shows that Asians/Pacific Islanders had significantly lower rates of timely screening colonoscopy as compared either to Blacks or Hispanics, for New Yorkers ages 50 and older. No significant differences were found in rates of timely screening colonoscopy between Whites and other races/ethnicities.
Data Source: NYC DOHMH Community Health Survey,
Trend for each race/ethnicity is significant at p < .001.

5. Colonoscopy Adherence Lower for Uninsured New Yorkers
The largest disparity that persists is the one between the insured and the uninsured.
In 2016, screening colonoscopy for New Yorkers with health insurance was 69%, while it was just 44% for the uninsured.
The uninsured percent estimate should be interpreted with caution, because the sample size is small.
This disparity brings us to the story of the inception of the NYC Community Cares Project (CCP).
Data Source: NYC DOHMH Community Health Survey, 2016.
*Estimate should be interpreted with caution. Sample size is small, making the estimate potentially unreliable.

6. NYC Community Cares Project (CCP) Model Links Uninsured Patients to Care
Leverages NYS Certificate of Need requirement for charity care from Ambulatory Surgery Centers
Creates linkages between primary care and endoscopy
PCPs directly refer uninsured patients for colonoscopy
Endoscopy Center provides free colonoscopy screenings
CCP aims to reduce inequity between the insured and the uninsured.
CCP leverages a NYS Certificate of Need requirement. This states that free standing ambulatory surgery centers must reach targeted levels of service for the uninsured to obtain their facility license.
CCP acts as a liaison between these ambulatory surgery centers (Endoscopy Centers, ECs) and community health centers (CHCs) to create linkages between primary care and endoscopy. In this model, primary care physicians directly refer their eligible uninsured patients to partnered ECs for colonoscopy. The ECs provide free colonoscopy screenings, as well as free anesthesia and pathology.
The NYC Community Cares Project is a collaboration supported by the C5 Coalition, the NYS Department of Health and the NYC Department of Health and Mental Hygiene.

7. NYC CCP Referring Sites
NYC Health + Hospitals Gouverneur
NYC Health + Hospitals Morrisania
NYC Health + Hospitals Sydenham (Renaissance)
NYC Health + Hospitals Cumberland
NYC Health + Hospitals East New York
NYC Health + Hospitals Kings County
NYC Health + Hospitals Queens
Primary Care Centers
Boriken Neighborhood Health Center
Charles B. Wang Community Health Center
Community Healthcare Network
Institute for Family Health
The William F. Ryan Community Health Network
Family Healthy Centers at NYU Langone
Urban Health Plan
Jamaica Hospital Medical Center
Mount Sinai - EHHOP
Grameen VidaSana
Health + Hospital Primary Care Sites
CCP is partnered with 56 clinical sites in New York City. Of these, 8 are NYC Health + Hospitals. CCP is partnered with 5 out of the 7 Gotham Health sites.
Active participating sites as of October 2017.

8. NYC CCP Participating Ambulatory Surgery Sites
Carnegie Hill Endoscopy Center
East Side Endoscopy Center
Advanced Endoscopy Center
Flushing Endoscopy Center
Manhattan Endoscopy Center
New York GI Center
Queens Endoscopy Center
West Side GI Center
South Brooklyn Endoscopy Center
Queens Boulevard Endoscopy Center
The Endoscopy Center of NY
Gramercy Park Digestive Disease Center
Liberty Endoscopy Center
NYC CCP has partnered with 56 clinical sites and has established
over 50 clinical partnerships!
CCP is partnered with 13 ECs and has established over 50 clinical partnerships between CHCs and ECs.
Active participating sites as of October 2017.

9. CCP Participating Sites Across the City and Colonoscopy Screening Rates
Our primary care sites and ECs are scattered through 4 out of the 5 boroughs (all except Staten Island). The largest concentration of sites is in Manhattan, which has the most free standing ECs as noted by the red stars.
Many of the areas of NYC with the lowest colonoscopy screening rates also do not have many options for ECs, and so people may have to travel for the screening.
Colonoscopy Screening Rates Data Source: NYC DOHMH Community Health Survey, 2016.

10. NYC CCP Data Collection
From all participating sites DOHMH collects:
Number of colonoscopy referrals received from primary care centers
Number of patients scheduled for colonoscopy
Number of patients screened by colonoscopy, no-shows, cancellations
Number of patients with adenomas detected during colonoscopy
Number of patients with a colon cancer diagnosis
Each month CCP collects de-identified data from our partnered CHCs and ECs to assess the program and provide feedback to participating sites.
From CHCs:
How many referrals were made
How many patients were screened by colonoscopy
How many patients were scheduled
How many colonoscopy reports were received
From ECs:
How many patients were referred
How many patients were medically cleared
How many patients were “no shows”
How many patients cancelled
How many reports were sent to the CHC confirming that a screening colonoscopy was completed
How many patients had adenomas removed
How many cancer diagnoses were made and if any, what stage
These data points are essential to aggregating information on the program’s progress.

11. NYC CCP New Colonoscopy Screenings Increase Year Over Year
This graph shows the number of referrals (left) and the number of colonoscopy screenings (right) from
The numbers for both referrals and screenings have been steadily increasing. At the end of 2017, almost 6,000 patients were referred for colonoscopy and more than 3,000 had screenings completed free of cost.
As you may notice, there is a completion gap between the number referred and those actually screened. This number hovers around 50% and is a sign that although much progress has been made, barriers remain. These include transportation, bowel prep, language, etc. that need to be addressed to close the completion gap.

12. Uninsured Lives Potentially Saved from Cancer: CCP Site Adenoma Detection Increasing
This graph represents the number of screenings vs. adenomas from 2014 to Adenomas removed during a colonoscopy represent a potential averted cancer, as an adenoma may progress to colon cancer.

13. NYC CCP Provides Feedback Reporting to Participating Sites
CHC 2 2
CHC 1
CHC 3
Endo Center A
The data collected monthly from the CHCs and ECs are important because on a quarterly basis data are aggregated into Feedback Reports and distributed to respective sites. These reports are useful in showing sites their progress as well as highlighting barriers and areas for improvement. We hope this will lead to continuous improvement.
The reports show total screenings/referrals by the specific site compared to the unidentified top performer and referrals and screenings by CHC/ partnered EC.

14. NYC CCP Feedback Tracks Colonoscopy Completions and Cancer Diagnoses
Lastly, the reports show scheduling outcomes (what happens after the point of referral) and screening outcomes. Much of the data is reported by the ECs as they provide the scheduling and screening outcome data.
This type of reporting is an evidence-based approach that encourages continuous improvement because it allows sites to visually note their gaps and successes.

15. Thank You!
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