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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.   Provider Education
2.   Public Education
3.   Screening Capacity/Access Expansion
4.   Advocacy Priorities
5.   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:     • Distributed almost
• Health Centers             400,000 pieces of
• HHC                        colon cancer
                             screening material
• Parks and
  Recreation centers
• FBOs
• NYCHA
   – 181,000 apartments!
    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
Incremental success across 4 time periods: T1 = Baseline = CY 2002




                                     Renov/
                                     Expand
                                       

                       DERS
                        

    PN
     
                Lincoln Hospital NYCT Grant:
         Increase 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
 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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