Cancer Screening Programs Workgroup Active members: CDC NCI OHSU UW Expert Affiliates – Emory and UCLA

Project Objectives and Aims

Aim 1 – CRCCP-1 impact on EBI use Analyze CRCCP-1 EBI data 2010-2015 In process Share survey instrument with workgroup, identify potential manuscripts Instrument shared

EBI use (mostly) increased 0ver time

But implementation did not get easier… Ease of implementation, 1=very difficult, 5=very easy

Aim 2: CRCCP-2 CRCCP-2 funds 31 Grantees 2015-2020 All Grantees must partner with 1+ healthcare systems to implement 2+ EBIs Client reminders Reducing structural barriers Provider reminders Provider assessment and feedback Each healthcare system is providing clinic-level data, baseline and annually

WA: Health System Partners – Year 1 HealthPoint Sea Mar 3rd largest FQHC in WA 80,000 patients/year 13 clinics in King County 13,908 patients eligible for CRC Goal – increase screening rate 51% to 60% Largest FQHC in WA More than 200,000 patients/year 28 medical clinics in WA Attempt to reach 15,000 patients Goal – increase screening rate 28% to 40%

WA - Planned Interventions HealthPoint SeaMar 9 Clinics will participate Mailed FIT kits Patient reminders Provider assessment and feedback Pilot FluFIT, 2-3 sites Provider education Group patient education All clinics will participate Mailed FIT kits Patient reminders Provider assessment and feedback Provider education Patient digital stories

CRCCP-2 program reach: totals* Health systems: 92 Clinics: 296 Patients, ages 50-75: 492,234 Providers: 2,153 * Totals reflect data from 24 of 30 grantees and do not include data from clinic worksheets that had missing IDs.

Program reach* Mean Median Range Per Grantee Health Systems 4 3 1 - 12 Clinics 12 8 1 - 40 Per Clinic Patients, ages 50-75 1,674 863 27 – 19,744 Providers (n= 286) 1 - 130 * Data from 24 of 30 grantees.

CLINIC TYPE* (N= 296) 78% of clinics are Patient Centered Medical Home-recognized * Data from 24 of 30 grantees.

Primary test type used in clinics* (N= 296) * Data from 24 of 30 grantees.

CRC SCREENING RATES AT BASELINE* (N=286) Chart Review (n= 35) EHR (n= 264)* Mean 37% 33% Median 32% Range 2% - 76% 0.3% - 85% *Of the clinics reporting an EHR-calculated screening rate, 73% somewhat or very confident in the accuracy of the screening rate; 17% reported not confident, and 10% did not report a confidence level.

Clinics with EBIs in place at baseline *Data from 24 of 30 grantees.

Grantee survey content Respondent characteristics Program management Implementation activities Non-health system partners Data use Training and TA needs Component 2 grantees – CRC screening delivery 15

Aim 3: NBCCEDP and EBIs NBCCEDP starting to do similar Grantee surveys Data collected 2013, 2015, planned 2016 Advantage of CRCCP and program integration?

Grantee survey content Respondent information Program activities – EBIs, PN, CHWs Clinical service delivery Provider network Non-screening partnerships Data use Training and TA Program management 17

Work in Progress & Next Steps

Manuscripts Papers in progress for CRCCP-1 Identifying potential manuscripts for CRCCP-2 Descriptive paper with clinic baseline data describing reach of CRCCP (clinics and patients) and presence of EBIs Considering data analysis/manuscripts for NBCCEDP Presence of CRCCP, integration of programs within Grantee

Contribution to D & I Science

D & I questions Ease of implementation – what’s happening? Program integration – help, hinder, no effect on EBI implementation? Public health/clinical partnerships and EBI implementation  impact on screening rates

Contribution to Cancer Prevention and Control

Contributions Partnership with CDC, nation-wide reach Important transitions Only providing screening for those who cannot afford to pay  combined with population-level efforts ACA and different implementation in states  eligible population, identification, and reach

CPCRN opportunities Other workgroups interested in FQHCs FQHC Tobacco Partner with CDC on sub-studies of Grantees Case studies of program implementation Mixed methods studies of promising practices Be mindful: Grantee and Partner burden

Thank you! Discussion