Identifying optimal approaches to scale up colorectal cancer screening: An overview of CDC’s learning laboratory Florence K.L. Tangka, PhD Senior Health Economist 11 th Annual Conference on the Science of Dissemination and Implementation in Health December 3, 2018 1
Acknowledgements • Florence K.L. Tangka 1 , Sujha Subramanian 2 , Sonja Hoover 2 , Christen Lara 3 , Casey Eastman 4 , Becky Glaze 5 , Mary Ellen Conn 6 , Amy DeGroff 1 , Faye L. Wong 1 , Lisa C. Richardson 1 .Identifying Optimal Approaches to Scale Up Colorectal Cancer Screening: An Overview of the Centers for Disease Control and Prevention (CDC)’s Learning Laboratory. Cancer Causes and Control (In Press) 1 Centers for Disease Control and Prevention 2 RTI International 3 Colorado Department of Public Health & Environment 4 Washington State Department of Health 5 HealthPoint 6 West Virginia University • CDC’s Colorectal Cancer Control Program Evaluation Working Group (CRCCP) RELIABLE TRUSTED SCIENTIFIC DCPC 2
Agenda • Background • Colorectal Cancer • CDC’s Colorectal Cancer Control Program (CRCCP) • CRCCP Evaluation & CDC’s CRCCP Learning Laboratory • Findings • Data Use and Dissemination of Findings RELIABLE TRUSTED SCIENTIFIC DCPC 3
4 Background: Colorectal Cancer & CDC’s Colorectal Cancer Control Program
Colorectal Cancer • 2nd leading cause of cancer death in the US • Screening for colorectal cancer (CRC) is beneficial Can find abnormal growth in the colon or rectum • Can find cancer at a curable stage • • USPSFT recommends screening average-risk adult age 50-75 • In 2016, only 67.3% of adults were up-to-date with CRC screening • Unlikely screened groups include: men, Hispanics, American Indians, Alaska Natives, people aged 50 to 64 years, city dwellers, and those with lower education and income levels • Lower screening rates directly contribute to higher death rates from CRC. RELIABLE TRUSTED SCIENTIFIC DCPC 5
Colorectal Cancer Control Program (CRCCP) Purpose: to increase colorectal cancer screening rates among low-income, high-need populations by: • Implementing evidence-based interventions described in the Guide to Community Preventive Services (the Community Guide) and other supporting strategies in partnership with health systems. • Providing screening and follow-up services for a limited number of program-eligible people. 1: The Guide to Community Preventive Services, https://www.thecommunityguide.org/topic/cancer RELIABLE TRUSTED SCIENTIFIC DCPC 6
The CRCCP has evolved over time. 2005 -2009 2009-2015 2015-2020 CRCCP Demonstration CRCCP DP15-1502 CRCCP DP09-903 & 14-1414 Project 29 grantees 30 grantees 5 grantees (states, tribes, and territories) (states, universities, and tribe) (state, county, city, and university) Focus: Focus: Focus: 1. Delivery of CRC screening and Health systems change 3 1. Delivery of colorectal diagnostic services cancer (CRC) screening and 2. Delivery of CRC screening and 2. CRC screening promotion for diagnostic services diagnostic services (6 grantees underserved populations only) Results: Results: Viable strategy 1 Limited reach 2 1 Cancer , Supplement 119(15), August 1, 2013; 2 Monograph in development; 3 Satsangi A, DeGroff A . Planning a National-level Outcome Evaluation of the Colorectal Cancer Control Program. J Ga Public Health Assoc 2016: Supplement to Vol 6(2). https://doi.org/10.21633/jgpha.6.2s16 RELIABLE TRUSTED SCIENTIFIC DCPC 7
The CRCCP consists of two distinct components: Component 1 Component 2 All 30 Grantees 6 Grantees Only Partner with health systems to implement Provide high quality CRC screening, evidence-based interventions (EBIs) and diagnostics, patient navigation, and other supportive activities (SAs). support services to eligible patients. EBIs: Patient eligibility criteria: • • Patient reminders Un- or underinsured • • Provider reminders <250% of the federal poverty level • • Provider assessment & feedback 50-64 years-old • • Reducing structural barriers Asymptomatic and average risk SAs: • Small media • Patient navigation/community health workers • Provider education • Health IT RELIABLE TRUSTED SCIENTIFIC DCPC 8
The CRCCP funded 30 grantees in 2015 Washington, D.C. RELIABLE TRUSTED SCIENTIFIC DCPC CDC DP15-1502 CRCCP Grantees 9
CRCCP Evaluation & Learning Laboratory
11 CRCCP – Key Evaluation Questions Are colorectal cancer screening rates going up? What is the return on investment? RELIABLE TRUSTED SCIENTIFIC DCPC
12 CDC’s CRCCP Learning Laboratory CDC’s Division of Cancer Prevention and Control F. Tangka (applied research) and A. DeGroff (program services) Health Systems, Medical Centers, and Clinics Coordinating Implementation and Evaluation in the Real-World Setting Center Peer-Reviewed Implementation Webinars Intervention Research Tools Journal Procedures and Case Studies and Methods Publications Manuals Presentations
CRCCP Learning Laboratory Grantees and Health System Partner Participants
14 Interventions at a Glance Patient and Provider Incentives Navigation for FIT & Colonoscopy FIT Mailings and Processes Multicomponent Interventions Health Information Technology - Azara Integrated Cancer Screening Programs Center for Colon Cancer Research University of South Carolina
Findings
Among clinics enrolled in the first year of CRCCP , CRC screening rates increased by 8.3 percentage points from baseline to PY2 Mean Baseline Mean PY1 Annual Mean PY2 Annual Screening Rate Screening Rate Screening Rate Baseline n=346; PY1 n= 336; PY2 n= 319 Source: Clinic data submission, Component 1 only, 29 reporting, thru April 2018. Screening rate % reflects weighted mean rate. RELIABLE TRUSTED SCIENTIFIC DCPC 16
The reach of the CRCCP grantees is significant Source: Clinic data submission, April 2018, Component 1 only, all 30 reporting (Includes clinics recruited in PY1, 2, and through March of PY3) RELIABLE TRUSTED SCIENTIFIC DCPC 17
And continues to grow as new clinics are recruited. # of clinics # of patients, aged 50 to 75 1,114,136 643 997,425 541 708,520 413 py1 py2 py3 py1 py2 py3 Source: Clinic data submission, April 2018, Component 1 only, all 30 reporting (Includes clinics recruited in PY1, 2, and through March of PY3) RELIABLE TRUSTED SCIENTIFIC DCPC 18
Grantees are primarily working with FQHCs Source: Clinic data submission, April 2018, Component 1 only, all 30 reporting (Includes clinics recruited in PY1, 2, and through March of PY3) RELIABLE TRUSTED SCIENTIFIC DCPC 19
A closer look at CRCCP clinics 643 are Federally- serve high use FOBT/FIT tests Qualified Health percentages of as the primary CRC CRCCP Centers (FQHCs) uninsured patients screening test type Clinics (>20%) Source: Clinic data submission, April 2018, Component 1 only, all 30 reporting (Includes clinics recruited in PY1, 2, and through April of PY3) RELIABLE TRUSTED SCIENTIFIC DCPC 20
Year 1 analyses identified four factors associated with greater increases in clinic-level CRC screening rates Free CRC CRC screening CRC screening Implemented policy fecal tests champion 3-4 EBIs DeGroff A, Sharma K, Satsangi A, Kenney K, Joseph D, Ross K, Leadbetter S, Helsel W, Kammerer W, Firth R, Rockwell T, Short W, Tangka F, Wong F, Richardson L. Increasing Colorectal Cancer Screening in Health Care Systems Using Evidence-Based Interventions. Preventing Chronic Diseases 2018 August 9; Volume 15:E100 RELIABLE TRUSTED SCIENTIFIC DCPC 21
Some Results from Economic Evaluation of CRCCP
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