1. Keys To Success Stephen Taplin MD, MPH Deputy Associate Director, Healthcare Delivery Research Program Division of Cancer Control & Population Sciences, NCI December 10, 2015

2. 2 You miss 100% of the shots you don’t attempt Wayne Gretzky

3. 3 This is the beginning We listened We Talked We planned And now we go home and continue

4. Screening implementation is a multilevel Problem State National Improved Quality of Cancer Care Improved Cancer-Related Health Outcomes Community PracticeSetting Provider/Team Family & Social Supports Individual Patient Family / Social Supports Family dynamics Friends, network support Individual Patient Biological factors Socio-demographics Insurance coverage Risk status Co-morbidities Knowledge, attitudes, beliefs Decision-making preferences Psychological reaction/coping Provider / Team Knowledge, communication skills Perceived barriers, norms, test efficacy Cultural competency Staffing mix & turnover Role definition Teamwork Local Community Community Level Resources Medical care offerings Population SES Lay support networks Private cancer organizations Local Hospital & Cancer Services Market Level of competition Managed care penetration Percent non-profit Specialty mix Local Professional Norms MD practice organizations Use of guidelines Practice patterns National Policy – Affordable Care Act Structure Culture State Policy reimbursement of clinical trials Stucture Culture advocacy groups attitued/expectations Organization / Practice Setting Leadership Organizational structure, policies & incentives Delivery system design Clinical decision support Clinical information systems Patient education & navigation Taplin & Zapka – JNCI 2010 -- We have to think about all the levels

5. 5 Key #1:  You are not alone  State Cancer Control Plans  For example  State X – 20% decrease in late-stage disease among African Americans, Asian & Pacific Islanders  by ….2015  Increase affordable & timely Dx colonoscopy and Rx  Education, promotion, advocacy  Primary Care Associations  Technical Assistance  Resources (QI experience, data & reports, grant opportunities)  Federally Qualified Health Centers  Populations at risk, UDS reporting  The People we want to affect!

6. 6 Key # 2  This CRC effort is not a unique process What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement ActPlan StudyDo A. Who? 1.Leadership a. State b. Organization c. Medical team 2.Who else? a. Advisory board? B. What? 1. Multiple activities 2. Evidence-based options a. communication b. activities in practice 3. Measurement and feedback C. How? 1. Make a plan 2. Assemble a team 3. Get Patients screened 4. Coordinate

7. 7 Key # 3: Build on what you’ve learned and gathered here! 1) Complete the plans  Leadership support?  Recruit other centers?  Credible data and baseline assessment? 2) Build the team  Establish coalitions  Recruit gastroenterologists  Clarify capabilities, roles, responsibilities within state  Clarify capabilities, roles responsibilities within participating centers 3) Offer patients screening  Systematize the offer 4) Coordinate Care across the screening process  Monitor Progress –measurement & feedback

8. 8 Key #4: Learn from your failures and your successes  Plan/Do/Study/Act cycles  We learn from everything if we pay attention  How was the plan received?  A means for improvement?  Who resisted the work and why?  Change in emphasis?  Clarify roles further?  Find /offer data?  Where did the systemization break down?  At the outset?  When roles got foggy?  Was coordination successful?  Adequate data available?  Did you seek IT support

9. 9 Key # 5: Persist  Screening Measures can be rewarding  ….or discouraging  Get more data  Tu et al – Adaptive reserve matters – 4/15/2015  FQHC survey and evaluation of CRC implementation  Corley et al - Adenoma Detection Rate  Effect of single DRE?  Role of Cancer Centers?  Get more help  Plan for consultation and reconvening of the team  Adjust (Act)

10. 10 It takes a village… American Cancer Society  Durado Brooks, MD, MPH  Randy Schwartz, MSPH  Lorrie Graaf, RN  Sarah Shafir, MPH  Todd Tyler, BS National Cancer Institute  Stephen Taplin, MD, MPH  Cindy Vinson, PhD, MPA  Veronica Chollette, RN, MS National Association of County and City Officials  Brandie Adams, MPH Centers for Disease Control and Prevention  Nikki Hayes, MPH  Ena Wanliss, MS  Angela Moore, MPH  Anne Major, BA  Faye Wong, MPH Health Resources and Services Administration  Laura Makaroff, DO National Colorectal Cancer Roundtable  Mary Doroshenk, MA Project Consultant  Kerstin Ohlander, MS

11. 11 And you Questions/Comments? Thank you References: 1.Taplin et al Implementing Colorectal Cancer Screening in Community Health Centers. Medical Care 2008 2.Sarfaty et al Strategies for Expanding Colorectal Cancer Screening at Community Health Centers. CA CANCER J CLIN 2013;63:221–23

12. www.cancer.gov www.cancer.gov/espanol References: 1.Taplin et al Implementing Colorectal Cancer Screening in Community Health Centers. Medical Care 2008 2. Sarfaty et al Strategies for Expanding Colorectal Cancer Screening at Community Health Centers. CA CANCER J CLIN 2013;63:221–23