CPCRN Collaboration with CDC Office of Colorectal Cancer Programs

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CPCRN Collaboration with CDC Office of Colorectal
Cancer Programs

• Roshan Bastani and Matt Kreuter
• CPCRN Meeting
• Boston, Nov 1-2, 2007

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CDCs Colorectal Cancer Screening Demonstration
ProgramLaura Seeff MDAssociate Director for
Office of Colorectal Cancer ProgramsDivision of
Cancer Prevention and Control, CDC September 7,
2007
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Number of People Requiring Colorectal Cancer
Screening Procedures (in millions), 2000
Total Population Ages 50 76.5 million
Average Risk Population70.1 million
Need Screening General population41.8
million 50-64 years of age, uninsured, lt250
FPL2.7 million
Seeff LC, Manninen D, Dong F, Chattapodhyay,
Nadel MR, Tangka F, Molinari N. Is there
endoscopic capacity to provide colorectal cancer
screening to the unscreened Population in the
United States? Gastroenterology 2004 127
1661-1669
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Context of CRC Demonstration Screening Program

• National Breast and Cervical Cancer Early
  Detection Program (NBCCEDP)
• Begun in 1991 through congressional legislation
• Current colorectal cancer screening in US
• Opportunistic
• Distinct public and private sector screening
  programs
• States
• Health Care Systems
• CDC designed CRC demonstration screening program
• To determine feasibility of establishing
  organized screening program for underserved
  population using federal funds
• To learn how best to implement CRC screening at
  community level
• To explore NBCCEDP model
• To inform current and future organized CRC
  screening efforts

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Process to Establish Program

• Summer 2004 two stakeholder meetings held
• Clinical experts and health scientists from
  screening programs (states, health systems and
  other countries), other federal health agencies
  and partner organizations
• Key decisions from meetings
• Applicants from any non-profit medical entity
  that offered services to low-income persons
  underinsured for CRC
• State or county health departments
• Hospital systems
• NBCCEDP program
• Applicants must show collaboration with
  CDC-funded CCC Program in state
• Focus on average-risk persons 50
• Priority given to programs ready to begin
  screening within 6 months
• Programs selected August 2005, funded through
  August 2008

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Program components

• Provision of screening and diagnostic services
• Patient support
• Data collection and tracking
• Program management
• Public education and outreach
• Establishment of quality services standards
• Maintenance of relevant partnerships
• Evaluation of program process and effectiveness
• Case studies
• Clinical Data Assessment
• Cost Assessment
• Treatment

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CRC Demonstration Screening Sites 2005-2008
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Demonstration Program Sites

• Maryland Department of Health and Mental Hygiene
• City-based (Baltimore) working with 5 hospitals
• Primary screening with colonoscopy
• Missouri Department of Health and Senior Services
• City-based (St Louis) working with provider
  network and FQHCs
• Focus on African American population
• Screening with FOBT colonoscopy for follow-up
  and for primary
• screening for high-risk clients
• Nebraska Department of Health and Human Services
• State-wide program using NBCCEDP framework
• Screening with FOBT colonoscopy for follow-up
  and for primary
• screening for high-risk clients

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Demonstration Program Sites

• Public Health - Seattle King County
• County based (King, Clallam and Jefferson
  counties) using NBCCEDP framework
• Focus on American Indian, Alaska Native and
  African American population
• Screening with FOBT colonoscopy for follow-up
  and for primary screening for high-risk clients
• Stony Brook University Medical Center/SUNY
• County based-Suffolk County
• University hospital collaborating with county
  health departments
• Primary screening with colonoscopy

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Clients Enrolled (n2,245), FY 07
American Indian/Alaska Native 4
Multiple 1
Asian/PI 2
Black 20
White 72
By Gender
By Race
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Screening Tests Performed by Test Type, FY 07
(n1,386)
Other Screening Test, n5
Colonoscopy n583
FOBT n798
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Status of FOBT Kits Distributed (n1,492)
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Results of FOBT Kits Returned, FY 07 (n794)
Positive
Negative
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Colonoscopy Results, FY 07Screening (n472)
1 Cancer n4
1 Other n2
17 Polyps n55
81 Negative n269
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Client Final DiagnosisAll Tests Combined, FY 07
(n1,322)
Cancer n7
Polyps n253
Negative n1062
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CDCs Screen for Life Campaign Materials

• Patient Fact Sheets/Brochures
• Posters
• Public Service Announcements
• Available in English and Spanish
• Web Site www.cdc.gov/screenforlife

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A Call to Action Prevention and Early Detection
of Colorectal Cancer

• Provider education learning tool in a PowerPoint
  presentation
• Developed to generate a greater awareness among
  primary care providers about colorectal cancer
  screening
• Publicly available at http//www.cdc.gov/cancer/c
  olorectal/publications/slide_sets.htm

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What Are We Evaluating?

• Program implementation (process)
• Cost and cost-effectiveness (efficiency)
• Program effectiveness (outcomes)

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Key Evaluation Questions

• How have grantees implemented the CRC screening
  program?
• What are the costs of the varied program models
  implemented by grantees?
• What are the screening outcomes for clients
  served through the CRCSDP?
• What are the changes in screening rates for the
  priority population and general population?

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CRCSDP Evaluation Methods

• Analysis of patient level screening data
• Cost Analysis
• Multiple Case Studies

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CPCRN Collaboration with CDC Office of Colorectal
Cancer Programs

• Participation on advisory committees, etc of the
  Office of Colorectal Cancer Programs
• possible input into higher level decisions re
  how to craft future demonstrations, what models
  might be most efficient and effective, etc
• Evaluation
• existing demonstrations
• Planning evaluations to build into future
  demonstrations
• Technical assistance being sought by state and
  local health departments re their CRC screening
  programs/plans

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CPCRN Collaboration with CDC Office of Colorectal
Cancer Programs

• Plan a conf call to include additional persons
  from the CDC CRC program to learn details about
  the evaluations built into the current
  demonstrations
• Develop a document that lists scientific areas of
  expertise reflected in the CPCRN network.
• E.g., evaluation, health communications, cultural
  tailoring of materials, outcomes research,
  cost-effectiveness assessment, etc. including
  sub-categories within some of the broader areas.
• This would help Laura's office understand in what
  
• ways we might be able to collaborate.

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CPCRN Collaboration with CDC Office of Colorectal
Cancer Programs

• Other possible multi-site projects
• Assess endoscopy capacity in program catchment
  areas or CPCRN site catchment areas
• Interventions to increase male participation
• Interventions to increase return rate of FOBT
  kits
• Rigorous assessment of program effectiveness