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State Comprehensive Cancer Control Efforts

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How have grantees implemented the CRC screening program? ... Division of Gastroenterology and Hepatology. Colonoscopy screening. SBUMC. Emergency Department ... – PowerPoint PPT presentation

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Title: State Comprehensive Cancer Control Efforts


1
CRCSDP Evaluation Overview and Case Study Results
for Program Start-Up
2
Presentation
  • Overview of the CRCSDP Evaluation Plan
  • Case Study results for Program Start-Up

3
CRCSDP Evaluation Team
  • CDC
  • Jennifer Boehm
  • Amy DeGroff
  • Jim Gardner
  • Anne Major
  • Janet Royalty
  • Sun Hee Rim
  • Blythe Ryerson
  • Laura Seeff
  • Florence Tangka
  • Ena Wanliss
  • Broader CRCSDP Team consulted as needed
  • IMS
  • Bill Helsel
  • Bill Kammerer
  • Steve Marroulis
  • Cindy Mattingly
  • RTI
  • Bela Bapat
  • Sonya Green
  • Debbie Holden
  • Sujha Subramanian
  • Rebecca Glover-Kudon

4
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?

5
What Are We Evaluating?
  • Program implementation (process)
  • Cost and cost-effectiveness (efficiency)
  • Program effectiveness (outcomes)

6
CRCSDP Evaluation Methods
  • Analysis of patient level screening data
  • Cost Analysis
  • Multiple Case Study

7
Multiple Case Study
  • Acknowledgement to all participating CRCSDP site
    staff and stakeholders
  • Case Study Team
  • Jennifer Boehm, CDC
  • Amy DeGroff, CDC
  • Sonya Green, RTI International
  • Debbie Holden, RTI International

8
Purpose of the Case Study
  • Better understand and describe the process of
    program start-up and implementation
  • Describe varied program models
  • Identify themes emerging from program start-up
    and program implementation
  • Understand facilitating factors, challenges, and
    lessons learned
  • Results intended to inform future program efforts

9
Data Collection for Case StudyProgram Start-Up
Data Collection Mode Data Collection Date Participant Summary
Telephone interviews March 2006 Individual Interviews w/ 5 Program Directors
Site visit interviews May August 2006 31 program staff 37 stakeholders total of 67 interviews
Document review Sept 2005 June 2006 Year 1 and 2 proposals, CDC site visit reports, program policies and materials, all-site calls
10
PROGRAM MODELS ORGANIZATIONAL VIEW PROGRAM MODELS ORGANIZATIONAL VIEW PROGRAM MODELS ORGANIZATIONAL VIEW PROGRAM MODELS ORGANIZATIONAL VIEW PROGRAM MODELS ORGANIZATIONAL VIEW
SITE SERVICE AREA TEST TYPE CENTRAL / DECENTRAL PROVIDER NETWORK
MD Baltimore City Colonoscopy Decentralized 5 hospitals
MO St. Louis, 4-county area FOBT Centralized 1 specialty care center
NE Statewide FOBT Centralized State health dept
NY Suffolk County Colonoscopy Centralized 1 University Medical Center
WA King, Clallam, Jefferson Counties FOBT Decentralized 10 community health centers
Centralization and decentralization are defined
based on the service delivery system for the
screening test
11
  • Baltimore CRCSDP

Maryland Dept. of Health and Mental
Hygiene Program planning oversight, fiscal
management, data management, and training
Baltimore City Colorectal Cancer Collaboration
American Cancer Society Call Center Outreach and
referral
Medical Advisory Board
Harbor Hospital Client in-reach, eligibility
determination, provider contracting and
reimbursement, colonoscopy screening, lab
services, tracking and follow-up, results
notification, data collection and reporting,
treatment referral
Union Memorial Hospital
Sinai Hospital
St. Agnes Hospital
Johns Hopkins Hospital
Site Coordinator
Site Coordinator
Site Coordinator
Site Coordinator
12
Missouri CRCSDP
  • Missouri Department of Health
  • and Senior Services
  • Program planning oversight, fiscal management,
    public education (SFL) and outreach, in-reach to
    NBCCEDP and Wisewoman clients, data management,
    and training

Medical Advisory Board
Missouri CCC
CBO Outreach and referral
NBCCEDP/WW Provider Network Client in-reach and
referral
Connect Care St. Louis Eligibility
determination, FOBT screening, lab services,
tracking and follow-up, results notification,
colonoscopy, data collection and reporting
  • Siteman Cancer Center
  • Colonoscopy, cancer treatment, data collection
    and reporting

13
Nebraska CRCSDP
  • Nebraska Health and Human Services
  • Program planning oversight, fiscal management,
    outreach (SFL), eligibility determination, FOBT
    screening, provider contracting, treatment
    referral, and data management

Medical Advisory Board
NBCCEDP WiseWoman Provider Network Client
in-reach and referral
CCC
Laboratory FOBT lab analysis, results
notification
Endoscopists Colonoscopy, data
collection and reporting
Recall Coordinating Center Tracking and
follow-up
NE Cancer Centers Cancer Treatment
14
New York CRCSDP
  • Stony Brook University
  • Medical Center
  • Department of Preventive Medicine
  • Program planning oversight, fiscal management,
    outreach, eligibility determination,
    pre-colonoscopy assessment, patient navigation,
    tracking and follow-up, data management

Medical Advisory Board
Suffolk County Department of Health Services 10
Community Health Centers Client In-reach and
referral
Community Advisory Board
Stony Brook University Medical Center Division of
Gastroenterology and Hepatology Colonoscopy
screening
SBUMC Emergency Department Complications
SBUMC Department of Radiology Radiology
Services
SBUMC Surgical Oncology Medical
Oncology Cancer Treatment
SBUMC Pathology Department Lab Services
15
Washington CRCSDP
Medical Advisory Board
CRC Task Force, CCC
Public Health Seattle King County Program
planning oversight, fiscal management, data
management, training, public education and
outreach
ACS CIS
10 Sites
Community Health Clinic Client in-reach,
eligibility determination, patient education,
FOBT screening, tracking and follow-up, FOBT lab
analysis, results notification, data collection
and reporting
Community Health Clinic
Community Health Clinic
Community Health Clinic
Family Planning Clinic
Project Access Patient navigation
Endoscopist Colonoscopy
Endoscopist Colonoscopy
Endoscopist Colonoscopy
Public Health Seattle King County Facilitate
access to cancer treatment
16
Start-Up Results
  • Facilitators
  • Challenges
  • Lessons Learned

17
Program Start-Up Facilitators
  • Existing infrastructure
  • Partnerships
  • Clinical expertise
  • Program champions

18
FacilitatorInfrastructure
  • Overall, its been a huge advantage to have the
    existing B C program to build on. Staff
  • Hook onto an existing program like the NBCCEDP.
    I cant imagine starting cold with no
    relationships in place. Staff

19
FacilitatorPartnerships
  • I dont know if we could have had some of the
    doors open as wide and as quickly if we didnt
    have the comp cancer program. Staff
  • When youre partnering, youre being economical
    with your resources and the money you save can go
    to doing an extra colonoscopy, extra outreach
    efforts, etc. Stakeholder

20
FacilitatorClinical Expertise
  • I would reiterate how important it is to have
    the clinical advisory capacity of some kind
    whether it be a committee or not . . . Were
    program managers managing a program, so I think
    its important to have people with expertise
    Staff

21
Program Start-Up Challenges
  • Administrative barriers
  • Contracting with GI specialists
  • Treatment concerns
  • Limited resources
  • CDC delays and policy revisions

22
ChallengeContracting with GI Specialists
  • Its sort of a balancing act, and even with
    concerned physicians GI specialists who are
    interested and want to do this systematic
    approach. It may not make sense when you look at
    it from the business managers side, or from
    medical people, billing staff, contract people,
    all of them . . . our system disrupts their
    systems. Its not really value added for them,
    theres no advantage for them.

23
ChallengeTreatment Concerns
  • If weve had any challenge its been issues
    around diagnosis and treatment for patients
    coming through and handling that issue with the
    other departmentsWhen we begin talking about
    screening uninsured patients, the next issue is
    who to turn to if the person needs help if
    diagnosed. Those issues were a challenge for us.
    There was a lot of back and forth and indecision
    about moving things forward. Stakeholder

24
Lessons LearnedProgram Start-Up
  • Clinical expertise is critical (MAB, staff)
  • Build on existing infrastructure (NBCCEDP)
  • Leverage partner resources (CCC)

25
Lessons LearnedProgram Start-Up
  • Effective collaboration is essential to building
    a service delivery system
  • Fit provider context
  • Treatment resources are needed
  • Start-up time is 9-12 months

26
Lessons LearnedStart-Up Time
  • It doesnt matter how much planning you do
    ahead of time, there are things you dont
    anticipate. Things take longer, everything takes
    longer than anticipated.

27
THANK YOU CRCSDP Programs!
  • Maryland Department of Health and Mental Hygiene
  • Missouri Department of Health and Senior Services
  • Nebraska Department of Health and Human Services
  • Public Health Seattle King County
  • Research Foundation of SUNY, Stony Brook
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