Implementing Cancer Screening & Referrals within Community Behavioral Health Organizations Tuesday, April 28 th , 2015 Alicia Kirley, MBA J. Todd Wahrenberger, MD Va’a Tofaeono Pam Pietruszewski, MA
Welcome! Shelina D. Foderingham MPH MSW • Director of Practice Improvement • Project Director, National Behavioral Health Network for Tobacco & Cancer Control • National Council for Behavioral Health • ShelinaF@thenationalcouncil.org Margaret Jaco MSSW • Policy Associate • Project Coordinator, National Behavioral Health Network for Tobacco & Cancer Control • National Council for Behavioral Health • MargaretJ2@thenationalcouncil.org
Visit www.BHtheChange.org and • Jointly funded by CDC’s Office on Smoking & Join Today! Health & Division of Cancer Prevention & Control Free Access to… • Provides resources and tools to help Toolkits, training opportunities, virtual communities and other resources organizations reduce tobacco use and Webinars & Presentations cancer among people with mental illness and addictions State Strategy Sessions • 1 of 8 CDC National Networks to eliminate cancer and tobacco disparities in priority populations Community of Practice #BHtheChange
Congratulations to Community of Practice participating organizations! • American Samoa Community Cancer Coalition • Arapahoe/Douglas Mental Health Network • CODAC, Inc. (dba CODAC Behavioral Healthcare) • Coleman Professional Services • CommuniCare, Inc. • Credo Community Center for the Treatment of Addictions, Inc. • Mirror, Inc. • Northern Lakes Community Mental Health • Pittsburgh Mercy Health System • Way Station, Inc. 3
An Integrated Approach to Cancer Screening and Prevention in a Community Primary and Behavioral Health System Pittsburgh Mercy Health System Alicia Kirley, MBA Director of Integrated Services J. Todd Wahrenberger, MD Chief Medical Officer National Behavioral Health Network for Tobacco & Cancer Control
Pittsburgh Mercy Family Health Center • A 2010 survey of over 25,000 patients showed that only 50% of Pittsburgh Mercy Health System service consumers were receiving any routine primary care • PMFHC opened its doors in May 2012, providing a fully integrated Primary and Behavioral Health Practice • Engaging a highly complex population with complex needs takes a TEAM! • ACT Model in Primary Care: > Multi-disciplinary Care Team approach, pulling in resources from all programs > Highly engaging team meets the patient where they are in their lives 5
It takes a team! Community Teams PCP Service Coordination Peer Medical Employment Support Assistant Specialist Patient Consulting Care Psychiatrist Manager Tobacco Homeless Cessation Housing Specialist Services 6
Pre-visit, Huddle Planning & Team Meetings • EHR Clinical Decision Support Systems • Daily Huddle Checklist: Care Management Tobacco Cessation Mammogram • Weekly Multidisciplinary Team Meeting • Sticky Notes • Accountability • Follow Up on Referrals 7
Embedding Tobacco Cessation and Cancer Screening in Behavioral Health 8
Cancer Prevention and Screening An An ou ounce nce of of pr prev even ention tion is worth orth a po a pound nd of of cure re Benjamin Franklin 9
Tobacco Cessation and Lung Cancer Screening • Make tobacco cessation a part of your workflow > Know your upcoming schedule: is patient a tobacco user? If so, plan to have a TTS or other staff counsel on tobacco use Ask at EVERY encounter! > Create a system for flagging enabling services • Develop a tobacco cessation protocol that is efficient and effective • Track referrals to Tobacco Support Specialists and lung cancer screens • Document patient progression through stages of change to continuously improve your process 10
PMFHC Tobacco Cessation Protocol 11
Tobacco Screening & Cessation: The Evidence 12
“In God we trust; all others bring data” How can you choose the best screening and prevention guidelines? 13
U.S. Preventative Services Task Force Recommendations for Grading There is high certainty that the net benefit is substantial. Offer this service. A There is moderate certainty that the net benefit is moderate to B substantial. Offer this service. “It depends” there may be a benefit depending on individual patient C and their S/S. No benefit and possible harm. Discourage using this service. D I I Statement: “I/We don’t know” 14
Breast Cancer Screening • Referral To: > Mammogram (Film and Digital) Women age 40-49: Grade C recommendation Women age 50-74, every 2 years: Grade B recommendation Women age >74: Grade I > MRI: Grade I > Self Breast Exam: Grade D > CBE: Grade I > BRCA Mutation testing only if family history: Grade B 15
Cervical Cancer Screening • PAP Cytology > Women under 21: Grade D > Women 21 to 65 every 3 years: Grade A > Women 30 to 65 every 5 years with HPV Co-testing: Grade A > Women over 65 (low risk): Grade D > HPV Testing under age 30: Grade D 16
Colorectal Cancer Screening • FOBT, Flex Sig, Colonoscopy: Grade A > Age 50 to 75: Grade A > Age 76 to 85: Grade C > Age over 85: Grade D > CT and Fecal DNA: Grade I > Gloved Rectal and Prophylactic Aspirin: Grade D 17
Tobacco Use & Lung Cancer Screening • Low Dose Computed Tomography (CT Scan): Grade B > Asymptomatic adults aged 55 to 80 years who have a 1 pack per day for 30 years smoking history > Screen annually > Discontinue screening when the patient has not smoked for 15 years • Tobacco Use: Grade A > Questionnaire: Are you a tobacco user? Frequency and duration Motivation to quit? Counseling and education 18
Cancer Screening (what not to do…) • Oral Cancer: Grade I • Ovarian Cancer: Grade D (unless BRCA gene, etc.) • Pancreatic Cancer: Grade D • Prostate Cancer PSA Testing: Grade D • Skin Cancer: Grade I • Testicular Cancer: Grade D • Bladder Cancer: Grade I 19
Putting Prevention into Practice • Embed Tobacco Support Specialists in a variety of settings • Trainings to all staff to understand screening criteria • Involve your ENTIRE team • Use handouts and keep it simple! • Use charts and graphs to remind yourself • Utilize EHR alerts and CDSS • Know the evidence, don’t waste time on practices that have no evidence, even if they are easy to perform 20
Guest Speaker #2 Va’a Tofaeono • Special Projects Coordinator , American Samoa Community Cancer Coalition • vtofaeono@gmail.com
American Samoa Community Cancer Coalition • Began in 2004 2 nd Leading Cause of Death • • Non-Profit Community Based Organization • Mission “Helping the people of American Samoa Fight Cancer” • Develops and Maintains a Comprehensive Cancer Control Map • Prevention to End of Life 22
Cancer Data 23
Cancer Data 24
Cancer Data 25
Cancer Data 26
Available Services • ASCCC Does Not Provide Direct Clinical Services • LBJ Tropical Medical Center • DOH Breast and Cervical Cancer Early Detection Program 27
Screening Guidelines • Gathered current information • Comprised Ad-Hoc Committee • Established Draft Guidelines • Reviewed and Approved by LBJ and DOH Medical Executive Committee • Developed Physician Educational Materials 28
Outcomes • Provider Compliance • Chart Audit > Provider Performance > Increase in Quality Care • New Electronic Health Record System • What’s Next? 29
Fa’afetai Tele Lava Va’a Tofaeono Special Project Coordinator American Samoa Community Cancer Coalition vtofaeono@gmail.com or 684-258-8745
Guest Speaker #3 Pam Pietruszewski, MA • Integrated Health Consultant, National Council for Behavioral Health • PamP@thenationalcouncil.org
Why Screening? People with serious mental illnesses die 25 years earlier on average than the general population • Medications, especially atypical antipsychotic drugs, effect on weight gain, dyslipidemia and glucose metabolism • Modifiable risk factors: High rates of smoking, lack of weight management/nutrition, and physical inactivity Morbidity and Mortality in People with Serious Mental Illness, 2006. National Assoc of State Mental Health Program Directors, Medical Directors Council
Abdominal Aortic Depression Aneurysm Tdap Oral Heart Disease Bladder Cholesterol Preventive Care Ovarian Diabetes HPV Colorectal Hepatitis C
U.S. Preventive Services Task Force Rankings Cervical The USPSTF recommends the service. There is A high certainty that the net benefit is substantial. Colorectal Breast The USPSTF recommends the service. There is high certainty that the net benefit is moderate or Lung B there is moderate certainty that the net benefit is moderate to substantial.
Cervical Cancer Screening • Women ages 21 to 65 years with cytology (Pap smear) every 3 years Or • For women ages 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years
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