Tackling Inequality in Cancer Prevention

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Tackling Inequality in Cancer Prevention Control

• Birgit Bogler, M.P.A.
• Deputy Director, Cancer Prevention Control
• New York City Department of Health Mental
  Hygiene
• October 14, 2004

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Cancer Program Five Point Plan

• Provider Education
• Public Education
• Screening Capacity/Access Expansion
• Advocacy Priorities
• Evaluation

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1. Provider Education

• Extended CHI CME credit through 7/2005
• Developing Expert Recommendations for
  Strengthening Colonoscopy Services
• Publication end of fall
• CRC Public Health Detailing
• Provide TCNY partners with CRC materials and
  technical support

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2. Public Education

• Watch Bob Quit of CRC
• Collaboration with Worksite Wellness
• Increase screening of DOHMH employees
• Employees serve as peer role models
• 1 AA woman and 1 Hispanic man
• Colonoscopy experiences will be profiled on DOHMH
  intranet

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2. Public Education

• Employee testimonial
• Inconvenient prep
• 4 days no fruits, vegetables, seeds or skins
• No aspirin
• Not enough information about what happens if
  polyp found
• Waiting room need for informational video
• Procedure was nothing

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DOHMH CRC Campaign
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CRC Media Campaign Distribution March04

• Distribution included
• Health Centers
• HHC
• Parks and Recreation centers
• FBOs
• NYCHA
• 181,000 apartments!

• Distributed almost 400,000 pieces of colon cancer
  screening material

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CRC Media Campaign Lessons for March05

• Caveat could only measure 311
• Nearly 80 of 311 referrals generated from
  television and radio
• 350,000 Article VI expand campaign MayJuly 2004
  to buses and bus shelters

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CRC Media Campaign Lessons for March05

• Program forged last minute successful
  collaboration with HHC Marketing Dept.
• DOHMH used HHCs 311 CRC service
• HHC tracked DOHMH campaign
• Future opportunities to collaborate in order to
  maximize reach and impact of campaigns

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3. Screening Capacity Access Expansion

• NY Community Trust grant to test effect of
  patient navigators on screening CO
• Exceeded expectations
• Inspiration to develop Expert Recommendations
  for Strengthening Colonoscopy Services
• Expanded to Brooklyn

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Lincoln Hospital NYCT Grant

• 4/03 Patient Navigators hired
• Communicate with patients
• Identity barriers to communication
• Improve patient adherence to CO
• Follow-up to ensure treatment, if applicable

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Lincoln Hospital NYCT Grant

• 8/03 Direct Endoscopy Referral System (DERS)
  implemented
• Screening tool for PCP to identify average risk
  patients for direct screening CO
• 11/03 Lincoln completes renovations/ expansion of
  Endoscopy suite

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Lincoln Hospital NYCT GrantIncrease in CS
Volume Shift to Screening Incremental success
across 4 time periods T1 Baseline CY 2002
Renov/ Expand ?
DERS ?
PN ?
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Lincoln Hospital NYCT GrantIncrease in CS
Volume Shift to Screening Incremental success
across 4 time periods T1 Baseline CY 2002
664
470
548
994
100
80
60
40
20
0
Baseline
PN pre DERS (4/03-7/03)
Pre Renov. (8/03-10/03)
Post Renov. (11/03-3/04)
Diagnostic
Screening
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Lincoln Hospital NYCT Grant Impact on Volume
(4/03-3/04)

• Baseline Lincoln under average (1,000) annual CO
  volume compared to HHC
• During grant, CO 3-fold (664 ? 2,012)
• Goal 1,500
• Screening CO volume 6.6-fold (185 ? 1,224)
• Adenomas found 3.9-fold (72 ? 284)
• Cancers found 1.4-fold (31 ? 42)

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Lincoln Hospital NYCT Grant Impact on Volume
(4/03-3/04)

• Since grant Lincoln top HHC CO performer in total
  and screening volumes
• Screening rate 54
• HHC average 39
• Outpatient facilities average 42

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Lincoln Hospital NYCT Grant Impact on Volume
(4/03-3/04)

• Comparing hospitals performing CO for all
  quarters 2003 through Q1 2004
• Lincoln 28 for total CO
• 1 Montefiore
• Lincoln 11 for screening CO
• 1 NY Westchester Square

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Lincoln Hospital NYCT Grant Impact on Deaths
(4/03-3/04)

• Lincoln finding more early stage CRC
• Lincoln found 70 at stages 0-2
• HHC average (2003) 65
• Citywide average (1996-2001) 34
• Nationwide average approximately 40

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Lincoln Hospital NYCT Grant Impact on Deaths
(4/03-3/04)

• Estimated number of deaths averted 35
• Found 10 more cancers
• Found 200 extra adenomas 25 people
• 25 of adenomas become cancer
• 50 of people with CRC die

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Lincoln Hospital NYCT Grant Program Reach
(4/03-3/04)

• During the grant period, 15 of total CO went to
  the uninsured
• Expected figure was less than 10
• 40 of patients who completed CO were men
• Expected figure was 33

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Lincoln Hospital NYCT Grant Patient CS Adherence
(4/03-3/04)

• Patient navigators (PN) lowered broken
  appointment rate in GI clinic to 5 (high67)
• Uninsured patients adhered as often as insured
• 77.4 insured and 76.5 uninsured completed test
• Completion rate includes surgical clinic patients
  no PN
• Completion rates substantially lower in surgical
  clinic

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Lincoln Hospital NYCT Grant Impact of Patient
Navigators

• PN had measurable effect
• NYAM evaluation indicates likelihood patients
  keep CO appointment 3-fold after Lincoln hired
  PN
• (RR2.6, 95 CI 2.2-3.0)
• Additional factors
• DERS (Direct Endoscopy Referral System)
• Renovations and suite expansion

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4. Advocacy Priorities

• Special Medicaid category for CRC like that for
  Healthy Women Partnership
• 10 charity care for preventive services like
  colonoscopy
• H1-B visas to staff GI lines in medically
  underserved facilities
• Time-off with pay for CRC screening for city
  employees

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5. Evaluation

• Since our CRC campaign started last year, CO has
  increased 16 in NYC and 43 at HHC

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Next Steps

• Focus groups on African Americans and cancer
• Mount Sinai Division of Cancer Prevention
  Control, Lincoln Hospital Cancer Program and NCI
• Taskforce on GI Staffing in medically underserved
  areas
• Work toward H1-B legislation for more GI doctors
  in Health Professional Shortage Areas

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Next Steps

• Complete the 2nd Annual CRC Summit Gracie Mansion
• Obtain your Pledges to
• Become a Take Care New York Partner
• Become a C5 member
• Support the 2005 Colon Cancer Challenge