Evaluation and Implementation of State Comprehensive Cancer Control Plans: Evolving Lessons

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Evaluation and Implementation of State
Comprehensive Cancer Control Plans Evolving
Lessons

• APHA 2005 Annual Meeting
• Epidemiology Section
• Session 3187.0
• 1230200 PM
• Monday, December 12, 2005

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Welcome

• Moderators
• Linda Fleisher, MPH
• Director, Cancer Information, Education, and
  Research Program, Division of Population Science,
  Fox Chase Cancer Center
• Stanley H. Weiss, MD, FACP
• Professor, Department of Preventive Medicine and
  Community Health, UMDNJ-New Jersey Medical School

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Session Overview

• There will be 5 presentations
• and a
• Question Answer period

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Session Overview

• 1) Enhancing infrastructure and evaluation
  Collaboration with and training of local health
  planners to build cancer control infrastructure,
  and development of baseline structures to support
  evaluation
• 2) Utilizing research and data Use of
  epidemiologic data in community assessments

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Session Overview

• 3) Building partnerships Local implementation,
  coalition building, and partnerships with other
  local public health agencies/organizations
• 4) Assessing cancer burden Estimating and
  utilizing prevalence
• 5) Addressing cancer disparities in minority
  (Hispanic/Latino) communities
• 6) Question and Answer Period

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Enhancing Infrastructure and Evaluation
Collaboration with and training of local health
planners to build cancer control infrastructure,
and development of baseline structures to support
evaluation

• Stanley H. Weiss, MD
• Professor,
• UMDNJ-New Jersey Medical School and UMDNJ-School
  of Public Health

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• I wish to acknowledge my colleagues who have
  contributed to this project
• Margaret L. Knight, RN, MEd Loretta L. Morales,
  MPH
• Daniel M. Rosenblum, PhD Sharon L. Smith, MPH
• Jung Y. Kim, MPH Susan L. Collini, MPH
• Judith B. Klotz, DrPH Marcia M. Sass, ScD
• David L. Hom, MS Arnold M. Baskies, MD

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Background

• Executive Order 114
• OCCP and the Governors Task Force
• established

1st New Jersey Comprehensive Cancer Control
Plan released
1st Status Report to the Governor
submitted (required biennially)
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NJ-CCCP Organizational Structure
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Background

• Began with 350 volunteers from various
  disciplines
• Currently over 550 volunteers
• These volunteers are stakeholders representing
  clinicians, public health officials, survivors
  and their families, community-based
  organizations, advocates, administrators,
  insurers, researchers

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Background

• Cancer ranks as one of the top health concerns of
  NJ residents in opinion surveys
• Yet no comprehensive capacity and needs
  assessment had ever been conducted in NJ
• No inventory of cancer-related resources
  available on a statewide basis
• Difficulty tracking progress of implementation of
  the NJ-CCCP

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Identification of Needs

• 1) Data and Data Systems
• Baseline capacity and needs assessment
• To understand cancer burden and disparities in
  each county and statewide
• To compare data from one county to each other and
  to the state as a whole
• To understand current cancer-related services,
  resources, and gaps in New Jersey
• Mechanisms to systematically collect data to
  monitor the extent of progress

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Identification of Needs

• 2) Partners who have relevant expertise
• Data and scientific expertise
• State Cancer Registry
• State BRFSS Epidemiologist-Coordinator
• NCIs Regional Cancer Information Service
• Public health, epidemiology, and statistical
  experts
• Industry and academia
• Workgroups and their Chairs
• Health services and planning
• NJCEED Program
• Cultural competency experts
• Local health planners

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Identification of Needs

• Identifying what data are needed helps define
• Most appropriate personnel to recruit
• Type of data systems
• When to develop data systems
• How to build in mechanisms for evaluation

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Implementation of NJ-CCCP

• Ten Workgroups
• Local NJCEED programs and county cancer
  coalitions
• Each group identifies areas of focus and
  strategies to address
• Synergy among Workgroups and local cancer
  coalitions and other organizations encouraged

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Implementation of NJ-CCCP

• Strategy Tracking Database
• Supports implementation of NJ-CCCP strategies and
  related tasks by monitoring of those strategies
  progress
• Electronic version of the NJ-CCCP developed
• Index of goals, objectives, and strategies
• Electronic linking between key elements
  (strategies, timelines, and key parties
  responsible for implementation)
• Activity reports generated every 6 months, with
  Workgroups updating progress on specific
  strategies

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Implementation of NJ-CCCP
Sample strategy progress report
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Implementation of NJ-CCCP

• Sample strategy progress report, continued

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Capacity Needs Assessment

• Baseline Capacity and Needs Assessment (C/NA) in
  each county was one of the first implementation
  steps of the NJ-CCCP
• Major components required for all reports
• Demographics and local infrastructure (e.g.,
  transportation)
• Resources (e.g., health care facilities, schools,
  CBOs, etc.)
• Cancer statistics
• Recommendations that integrate the first three
  components

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Capacity Needs Assessment

• Local health planners - County Evaluators (CEs)
• Already involved in local community
• Experience with health services and planning
• Responsible for conducting the C/NA and
  formulating recommendations for action for
  implementation at the county and state level

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Capacity Needs Assessment

• Due to varying levels of knowledge in
  epidemiology and statistics, we provided training
  for all CEs to gain a basic understanding of key
  concepts
• Training
• 5 training sessions in 2003 (FY)
• 11 monthly follow-up meetings in 2004 (FY)
• Monitoring
• Extensive report guidelines, including guidelines
  for data use and analysis, developed and updated
  for full report and report summary
• Peer-review processes established
• Process evaluation for each training session

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Capacity Needs Assessment

• Accountability
• Public availability of final reports, including
  posting on the internet
• Attribution of authorship, to ensure
  professionalism and accountability of the highest
  level
• Encouragement (and sometimes requirement) of
  collaboration among CEs
• Goal All counties to reach for excellence

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Capacity Needs Assessment

• To address the need for information on resources
  in each county, the Cancer Resource Database of
  New Jersey (CRDNJ) was developed
• Comprehensive delineation of cancer-related
  resources available in each county
• hospitals, federally qualified health centers,
  hospices, CEED agencies, mammography facilities,
  gastroenterologists, support services, etc.

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Capacity Needs Assessment

• Sample analysis of CRDNJ data

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Capacity Needs Assessment

• Development of the CRDNJ
• Standard data collection forms were based on
  forms shared by the American Cancer Society,
  which we extensively modified
• Centralized data processing, analysis, and
  cross-checking
• Identifying all resources is extremely difficult
  due to funding and time limitations
• Collected at local level on statewide basis
• Informs the public, local health planners,
  service providers, outreach workers, and
  researchers
• Data have been geo-coded for GIS applications

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Capacity Needs Assessment

• Sample map of CRDNJ data using GIS technology
• Data for Camden County Hospitals

1. Cooper Hospital 2. Our Lady of Lourdes Medical
Center 3. Kennedy Memorial Hospital, Cherry
Hill 4. Virtua West Jersey, Voorhees 5. Kennedy
Memorial Hospital, Stratford 6. Virtua West
Jersey, Berlin
of persons 60 yrs
Prepared by CPAC 2004
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Capacity Needs Assessment

• Strengths of community-based personnel
• Fits New Jersey culture, home rule
• Often native to local area, understands nuances
  of community
• Strengthens and invests in the local community
  infrastructure
• Ideal for assessments at the local level
• Improved buy-in from local community
• Strengths of using consultants for epidemiology
  and statistical analyses
• Specialized training, knowledge, experience
• Objectivity
• Scientific review

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Local Infrastructure

• Expansion of coalition building into countywide
  entities through NJDHSS funding
• Many County Evaluators evolved into role of the
  County Cancer Coalition Coordinator

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Local Infrastructure

• Local experts who are well-versed in both
  community outreach and epidemiology/statistics
• Training can provide basic knowledge/skills
• But, based on our experience, developing all
  skills within one position may not be realistic
• In order to complete the C/NA, individual CEs
  evolved into teams

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Summary

• Critical factors for successful implementation
• Leadership, coordination and integration of all
  activities by State Health Agency (OCCP)
• Scientific experts to give direction on
  epidemiological and methodological aspects and
  database development (UMDNJ)
• Qualified, motivated, local health planners
• Cooperation among all partners

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Summary

• Development of new data systems to fill data gaps
  should be built into planning and implementation
  timelines.
• Systematic analyses can lead to the development
  of more specific and detailed recommendations to
  improve execution of current and planning for
  future comprehensive cancer control plans.
• Details will be exemplified in the presentations
  that follow.