Decision Support and Navigation to Increase Colon Cancer Screening - PowerPoint PPT Presentation

Decision Support and Navigation to Increase Colon Cancer Screening and Reduce Disparities (AD-1306-01882) Brian Stello, MD Ronald E. Myers, PhD Professor, Thomas Jefferson University Clinical Associate Professor, Lehigh Valley Health Network September 19, 2019

Ronald E. Myers, PhD and Brian Stello, MD • Have nothing to disclose. 2

Objectives • Describe CRC and Hispanic/Latino disparity • Describe health system learning community to address disparity • Describe an intervention strategy that can increase CRC screening and reduce disparity • Describe intervention strategy impact on overall screening adherence and test-specific screening adherence • Describe a health system learning community strategy to support evidence- based intervention implementation 3

Colorectal Cancer and Screening in the US Hispanic/Latino Population Incidenc dence: e: 12,400 400 Deaths: hs: 3,800 00 Localized d ed disea ease: e: 38% 38% Screen eening non on-adher dherenc ence: 50% 50% o Increase the n e number a and % % of f non-adher erer ers who s screen een o Screening non-adherence: 50% + XX% = 80% Cancer Facts & Figures for Hispanic/Latinos 2015-2017; National Center for Health Statistics. Health, United States, 2015: With Special Feature on Racial and Ethnic Disparities. Hyattsville, MD, 2016 4

Health System Learning Communities • Learning communities are a collectivity that enables people to align around a shared purpose and connect organizations to promote cooperation on a common agenda • Health system learning communities can improve population health by • Identifying population health problems and effective evidence-based interventions, and • Supporting the adaptation, implementation and scaling of effective interventions 5

Study Participants Patients from 5 Lehigh Valley Health Network (LVHN) Primary Care Practices, Southeastern PA • Hispanic men and women aged 50-75 years of age • Visited practice within previous 2 years • No family history of CRC or colon polyps • No personal history of CRC, colon polyps, or inflammatory bowel disease • Screening nonadherent o 80% Goal: 30% adherers + [70% non-adherers (XX%) = 80%] • 6

Our Learning Community Patient and Stakeholder Advisory Committee Members Awilda Martinez, Wally Vidarrue, Ester Vittini, Luis Sanchez, Carmelo Garcia, Vivian Montes, Elizabeth Charriez, Eddy Aybar, Olga Almadovar, Dagoberto Mosquera, and Myra Piña Co-Investigators Brian Stello, MD, Constantine Daskalakis, ScD, Randa Sifri, MD, Evelyn T. González, MA, Melissa DiCarlo, MPH, MS, Melanie B Johnson, MPA, Sarah E. Hegarty, MPhil, Kyle Shaak, MPH, Alicia Rivera, Lucas Gordils-Molina, Anett Petrich, MSN, RN, Beth Careyva, MD, Rosa de-Ortiz, Liselly Diaz Consultants Carmen Guerra, MD, MSCE, FACP, Associate Professor of Medicine at the Hospital of the University of Pennsylvania, Abramson Cancer Center, University of Pennsylvania Medical Center; John M. Inadomi, MD, Cyrus E. Rubin Professor of Medicine & Head, Division of Gastroenterology, University of Washington School of Medicine ; Sally W. Vernon, PhD, Director of the Division of Health Promotion and Behavioral Sciences at the University of Texas-Houston School of Public Health 7

Patient and Stakeholder Advisory Committee (PASAC) PASAC Structure PASAC Member Engagement • • Members provided input on study materials, 12 members came from community groups, religious organizations, health support groups, intervention methods, and strategies for primary care practices, and include LVHN health reaching the population. • Members were part of the research team, with system primary care provider, specialist, and administrator representatives. the role of advising the staff on realities of • Project staff and members met 3 X a year at a working with the population and the health convenient health system location system. • • Members felt an additional role was to learn and Members included veterans, clergy, patient support, housewives, nurses, and a diabetes educate members of the Hispanic community support group president. about cancer screening. • • Members viewed themselves as an extension of Meetings were facilitated by a bilingual moderator and were conducted in both English the community, with a duty to share their and Spanish. knowledge to guide research and to improve the community health. 8

Study Design (Contacts in Spanish or English as preferred by patient) 9

Study Hypotheses • H1: Overall screening adherence in DSNI Group > SI Group • H2: Test-specific (stool blood test (SBT) and colonoscopy) screening adherence in DSNI Group > SI Group 10

Table 1. Baseline Survey Data (N=400) Cha haracteris istic ic N (%) %) Age ge < 60 60 Years 277 277 (69) 69) > 60 60 Years 123 123 (31) 31) Race Ra White Wh 133 133 (33) 33) Black ck 118 118 (30) 30) Other/Unk nkno nown 149 149 (37) 37) Gende nder Fe Female 235 235 (59) 59) Male 165 165 (41) 41) 11

Table 1. Baseline Survey Data (continued) Cha haracteris istic ic N (%) %) Marit ital S Status us Married o or L Livi ving as Married 192 192 (48) 48) No Not Married ed 208 208 (52) 52) Lang ngua uage at H Home me Spa panis nish 331 331 (83) 83) Both Spa pani nish a and E nd Eng nglish 41 41 (10) 10) Engli lish 28 28 (7) 7) Insur uranc nce S Status Insured 281 281 (70) 70) No Not Ins nsured o d or U Uns nsur ure 119 119 (30) 30) 12

Table 1. Baseline Survey Data (continued) Screeni ning ng Dec ecision S Stage N (%) Dec ecided ed N Not to t to S Screen een 4 ( 1) 1) Not P Planning to g to Screen en 9 ( 2) 2) Undec ecided ed about S Screen eening 47 47 (12) 2) Dec ecided ed to to S Scree een 340 340 (85 85) Tot otal al 400 0 (100) 00) 13

Table 2. Overall and Test-Specific Adherence 14

Summary and Publication • CRC screening adherence was almost 5 times greater in the DSNI Group than in the SI Group • SBT screening and colonoscopy screening adherence were more than 4 times greater and almost 9 times greater, respectively, in the DSNI Group than in the SI Group • Publication: Myers RE, Stello B, Daskalakis C, Sifri R, Gonzalez ET, DiCarlo M, Johnson MB, Hegarty SE, Shaak K, Rivera A, Gorkils-Molina L, Petrich A, Careyva B, de-Ortiz R, Diaz L. Decision support and navigation to increase colorectal cancer screening among Hispanic patients. Cancer Epidemiol Biomarkers Prev. 2- 18;28(2):384-391. 15

Conclusions • A patient-centered CRC screening intervention for Hispanic primary care patients in the LVHN was successful o DSNI + SI had a significantly greater positive impact on overall and test-specific CRC screening adherence than SI alone • Health system learning community-based research on the implementation of the DSNI in health systems and with vulnerable populations is needed. 16

Community Conference The and we community all came learned 17

Developing a Health System Learning Community • Patient Centered Outcomes Research Institute (EAIN 2471) & Thomas Jefferson University support o Develop a scalable collective impact learning community model for implementing evidence-based cancer screening interventions in health systems o Obtain support for using the model to reduce disparities in cancer screening and related outcome Publications : Myers RE, DiCarlo M, Romney M, Fleisher L, Sifri R, Soleiman J, Lambert, Rosenthal. Using a Health System Learning Community Strategy to Address Disparities. Learning Health Sys , (18) September, 2018; Man L, DiCarlo M, Lambert, Sifri, R, Romney M, Fleisher L, Myers RE. A Learning Community Approach to Identifying Interventions in Health Systems to Reduce Colorectal Cancer Screening Disparities. Prev Med Reports , (12): 227-232,2018. 18

PADEL Consortium • Jefferson Health • Lehigh Valley Health Network • Penn State Health • Christiana Care Health System 19

Learn More • www.pcori.org • info@pcori.org • #PCORI2019 21

Thank you. Questions? Ronald E. Myers, PhD Brian Stello, MD Professor Clinical Associate Professor Thomas Jefferson University Lehigh Valley Health Network ronald.myers@jefferson.edu brian.stello@lvhn.org 22