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Cancer Prevention _ Control Program

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Cancer Prevention _ Control Program Powered By Docstoc
					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

Cancer Program Five Point Plan
1. 2. 3. 4. 5. Provider Education Public Education Screening Capacity/Access Expansion Advocacy Priorities Evaluation

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

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

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”

DOHMH CRC Campaign

CRC Media Campaign Distribution – March’04
Distribution included: • Health Centers • HHC • Parks and Recreation centers • FBOs • NYCHA
– 181,000 apartments!

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

CRC Media Campaign – Lessons for March’05
• Caveat: could only measure 311 • Nearly 80% of 311 referrals generated from television and radio • $350,000 Article VI expand campaign May–July 2004 to buses and bus shelters

CRC Media Campaign – Lessons for March’05
• Program forged last minute successful collaboration with HHC Marketing Dept.
– DOHMH used HHC’s 311 CRC service – HHC tracked DOHMH campaign

• Future opportunities to collaborate in order to maximize reach and impact of campaigns

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

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

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

Lincoln Hospital NYCT Grant: Increase in CS Volume & Shift to Screening
2,500

Incremental success across 4 time periods: T1 = Baseline = CY 2002

2,000

1,500

Renov/ Expand  DERS 

1,000

500

PN 
0 Baseline (N=664) Apr-03 May-03 Jun-03 Jul-03 Aug-03 Sep-03 Oct-03 Nov-03 Dec-03 Jan-04 Feb-04 Mar-04

Monthly CS

Aggregate CS

Lincoln Hospital NYCT Grant: Increase in CS Volume & Shift to Screening
Incremental success across 4 time periods: T1 = Baseline = CY 2002
100% 664 470 548 994

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

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)

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%

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

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%

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

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%

Lincoln Hospital NYCT Grant:
Patient CS Adherence (4/03-3/04)
• Patient navigators (PN) lowered broken appointment rate in GI clinic to 5% (high=67%) • 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

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
• (RR=2.6, 95% CI 2.2-3.0)

– Additional factors:
• DERS (Direct Endoscopy Referral System) • Renovations and suite expansion

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

•

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

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

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


				
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