Evaluation Report to the Governor�s Task Force on Cancer by HC12062711339


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

     APHA 2005 Annual Meeting
       Epidemiology Section
          Session 3187.0
          12:30–2:00 PM
     Monday, December 12, 2005
   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

Session Overview

     There will be 5 presentations
                 and a
      Question & Answer period

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

Session Overview
3) Building partnerships: Local
   implementation, coalition building, and
   partnerships with other local public health
4) Assessing cancer burden: Estimating and
   utilizing prevalence
5) Addressing cancer disparities in minority
   (Hispanic/Latino) communities
6) Question and Answer Period
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
 UMDNJ-New Jersey Medical School and
    UMDNJ-School of Public Health
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

    May                   January           December
                                             
 2000       2001   2002     2003     2004     2005     2006   2007   2008

                                    First 5-year plan: 2003–2007

  Executive  1st New Jersey 1st Status
 Order 114:  Comprehensive Report to the
OCCP and the Cancer Control Governor
 Governor’s        Plan     submitted
                 released   (required
 Task Force
 established                biennially)

NJ-CCCP Organizational Structure

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

 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

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

Identification of Needs
2) Partners who have relevant expertise
 Data and scientific expertise:
       State Cancer Registry
       State BRFSS Epidemiologist-Coordinator
       NCI’s 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
Identification of Needs

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

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

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
   Activity reports generated every 6 months, with
    Workgroups updating progress on specific
Implementation of NJ-CCCP
    Sample strategy progress report

Implementation of NJ-CCCP
Sample strategy progress report, continued

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:
1. Demographics and local infrastructure (e.g.,
2. Resources (e.g., health care facilities, schools,
   CBOs, etc.)
3. Cancer statistics
4. Recommendations that integrate the first three
Capacity & Needs Assessment
   Local health planners - County Evaluators
     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

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
Capacity & Needs Assessment
 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
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.

Capacity & Needs Assessment


 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-
     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
 Capacity & Needs Assessment
Sample map
 of CRDNJ          1. Cooper Hospital
 data using        2. Our Lady of Lourdes
                      Medical Center
    GIS            3. Kennedy Memorial
                      Hospital, Cherry Hill
technology:        4. Virtua West Jersey,
                   5. Kennedy Memorial
 Data for             Hospital, Stratford
                   6. Virtua West Jersey,
 Camden               Berlin
                                          # of persons
  County                                    ≥ 60 yrs

 Prepared by
 CPAC 2004
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                             27
Local Infrastructure
 Expansion of coalition building into
  countywide entities through NJDHSS
 Many County Evaluators evolved into role
  of the County Cancer Coalition

Local Infrastructure
   “Local experts” who are well-versed in
    both community outreach and
     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

   Critical factors for successful
     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

 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.

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