Promoting Colon Cancer Screening .ppt
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Promoting Colon Cancer Screening
New York City Health and Hospitals Corporation
Colorectal Cancer Summit
Ramanathan Raju, MD, MBA
June 2008
Who We Are
? 11 acute care hospitals
? Four Long-Term Care Facilities
? Six Diagnostic and Treatment Centers
? Over 80 Community Health Clinics
? Home care agency (Health and Home Care
? Managed care (MetroPlus)
Who Do We Serve
? 1.3 million individuals annually
? 1 out of 6 New Yorkers
? 435,000 uninsured patients
? 43% Hispanics, 35% African Americans, 6% Asian, 6% Caucasian, and 10% Other Minorities
? 240,000 patients - age 50 - 75 yrs
Who Do We Serve
? Ambulatory Care: FY 2007
- Total Patients: 879,882; > 5M visits
- 44% Hispanics; 35% African Americans; 8% Asian; 6% White; 7% Other
- 60% Females; 30% aged > 45 - < 74 y
- 25% Self Pay; 46% Medicaid; 8% Medicare; 8% Commercial; 13% others.
Colorectal Cancer Burden
? 1,500 colon cancer deaths each year in NYC
? Significantly higher mortality rates among African Americans
? 59% of New Yorkers report ever having colonoscopy or sigmoidoscopy
Health & Hospitals Corporation
Colon Cancer Screening Guidelines
? Colonoscopy every 10 years is the screening test of choice.
? Any colon cancer screening is better than no test.
- FOBT annually or
- Flexible sigmoidoscopy every 5 years or
- Annual FOBT plus flexible sigmoidoscopy every 5 years or
- Double contrast barium enema every 5 years
Colorectal Cancer Control Initiative
? Four Point Plan to Promote Colonoscopy:
- Enhance capacity and improve access
- Enhance provider knowledge and skills
- Enhance public awareness, patient literacy
- Evaluate outcome; performancemonitoring
Colorectal Cancer
ScreeningInitiative
? Begun in March 2003
? Colorectal Cancer Screening Workgroup
- Central Office and Facility Leadership
? Colonoscopy as gold standard for the colorectal cancer screening
? Goal to triple number of screening colonoscopies
Colorectal Cancer Control Initiative
? Enhancing Capacity
- Personnel
? Gastroenterologists - hourly sessions
? Endoscopy Nurse - training
? Patient navigator
- Physical Plant and Equipment
? Endoscopy suites
? Recovery suites
? Endoscopes
? Computer hardware and software
Colorectal Cancer Control Initiative
? Provider Education
- Forums, grand rounds
- Individual detailing
? Redesign of the Colonoscopy Process
- Direct Endoscopy Referral System
Colorectal Cancer Control Initiative
? Public Awareness and Community Outreach
- Take Care NY - multimedia campaign
- Colon Cancer Awareness Month
- Collaboration with NYCDOHMH and ASC
? Patient Education
- Limited English Proficiency
- Focus Group discussion
Total Colonoscopies Performed
Patients with Colon Polyps Removed
2003 - 2007
Patients with Colon Polyps Removed
2003 - 2007
Screening Guidelines
? Tests that find polyps and cancer
? flexible sigmoidoscopy every 5 years*
? colonoscopy every 10 years
? double contrast barium enema every 5 years*
? CT colonography (virtual colonoscopy) every 5 years*
? Tests that mainly find cancer
? fecal occult blood test (FOBT) every year*,**
? fecal immunochemical test (FIT) every year*,**
? stool DNA test (sDNA), interval uncertain*
*Colonoscopy should be done if test results are positive.
**For FOBT or FIT used as a screening test, the take-home multiple sample method should be used. A FOBT or FIT done during a digital rectal exam in the doctor's office is not adequate for screening.
Challenges Ahead
? Access to Screening
- Colonoscopy - GI specialists; trained colonoscopists
- 'New technology' - CTC; FIT; Stool DNA testing
Challenges Ahead
? Provider training
- Primary care providers
- Residency and fellowship training in GI
- Radiological procedure forvirtual colonoscopy
- Laboratory directors, pathologists and technicians
Challenges Ahead
? Patient literacy and community norms
- Myths about colon cancer
- Acceptable colon cancer screening procedure
Challenges Ahead
? Performance monitoring
-penetration in the target population
-colonoscopy
? yield of procedure
? time of conducting procedure
? caecal intubation
Conclusions
? Increased screening colonoscopy
? Increased identification of patients with adenomatous polyp (cancer prevented)
?Confront old and new challenges
- Lack of trained providers
- Community knowledge, attitude and behaviour towards colonoscopy
- New technology
Thanks!
? American Cancer Society
? New York City Council
? NYC Department of Health & Mental Hygiene
? New York Community Trust
Promoting Colon Cancer Screening
New York City Health and Hospitals Corporation
Colorectal Cancer Summit
Ramanathan Raju, MD, MBA
June 2008
Who We Are
? 11 acute care hospitals
? Four Long-Term Care Facilities
? Six Diagnostic and Treatment Centers
? Over 80 Community Health Clinics
? Home care agency (Health and Home Care
? Managed care (MetroPlus)
Who Do We Serve
? 1.3 million individuals annually
? 1 out of 6 New Yorkers
? 435,000 uninsured patients
? 43% Hispanics, 35% African Americans, 6% Asian, 6% Caucasian, and 10% Other Minorities
? 240,000 patients - age 50 - 75 yrs
Who Do We Serve
? Ambulatory Care: FY 2007
- Total Patients: 879,882; > 5M visits
- 44% Hispanics; 35% African Americans; 8% Asian; 6% White; 7% Other
- 60% Females; 30% aged > 45 - < 74 y
- 25% Self Pay; 46% Medicaid; 8% Medicare; 8% Commercial; 13% others.
Colorectal Cancer Burden
? 1,500 colon cancer deaths each year in NYC
? Significantly higher mortality rates among African Americans
? 59% of New Yorkers report ever having colonoscopy or sigmoidoscopy
Health & Hospitals Corporation
Colon Cancer Screening Guidelines
? Colonoscopy every 10 years is the screening test of choice.
? Any colon cancer screening is better than no test.
- FOBT annually or
- Flexible sigmoidoscopy every 5 years or
- Annual FOBT plus flexible sigmoidoscopy every 5 years or
- Double contrast barium enema every 5 years
Colorectal Cancer Control Initiative
? Four Point Plan to Promote Colonoscopy:
- Enhance capacity and improve access
- Enhance provider knowledge and skills
- Enhance public awareness, patient literacy
- Evaluate outcome; performancemonitoring
Colorectal Cancer
ScreeningInitiative
? Begun in March 2003
? Colorectal Cancer Screening Workgroup
- Central Office and Facility Leadership
? Colonoscopy as gold standard for the colorectal cancer screening
? Goal to triple number of screening colonoscopies
Colorectal Cancer Control Initiative
? Enhancing Capacity
- Personnel
? Gastroenterologists - hourly sessions
? Endoscopy Nurse - training
? Patient navigator
- Physical Plant and Equipment
? Endoscopy suites
? Recovery suites
? Endoscopes
? Computer hardware and software
Colorectal Cancer Control Initiative
? Provider Education
- Forums, grand rounds
- Individual detailing
? Redesign of the Colonoscopy Process
- Direct Endoscopy Referral System
Colorectal Cancer Control Initiative
? Public Awareness and Community Outreach
- Take Care NY - multimedia campaign
- Colon Cancer Awareness Month
- Collaboration with NYCDOHMH and ASC
? Patient Education
- Limited English Proficiency
- Focus Group discussion
Total Colonoscopies Performed
Patients with Colon Polyps Removed
2003 - 2007
Patients with Colon Polyps Removed
2003 - 2007
Screening Guidelines
? Tests that find polyps and cancer
? flexible sigmoidoscopy every 5 years*
? colonoscopy every 10 years
? double contrast barium enema every 5 years*
? CT colonography (virtual colonoscopy) every 5 years*
? Tests that mainly find cancer
? fecal occult blood test (FOBT) every year*,**
? fecal immunochemical test (FIT) every year*,**
? stool DNA test (sDNA), interval uncertain*
*Colonoscopy should be done if test results are positive.
**For FOBT or FIT used as a screening test, the take-home multiple sample method should be used. A FOBT or FIT done during a digital rectal exam in the doctor's office is not adequate for screening.
Challenges Ahead
? Access to Screening
- Colonoscopy - GI specialists; trained colonoscopists
- 'New technology' - CTC; FIT; Stool DNA testing
Challenges Ahead
? Provider training
- Primary care providers
- Residency and fellowship training in GI
- Radiological procedure forvirtual colonoscopy
- Laboratory directors, pathologists and technicians
Challenges Ahead
? Patient literacy and community norms
- Myths about colon cancer
- Acceptable colon cancer screening procedure
Challenges Ahead
? Performance monitoring
-penetration in the target population
-colonoscopy
? yield of procedure
? time of conducting procedure
? caecal intubation
Conclusions
? Increased screening colonoscopy
? Increased identification of patients with adenomatous polyp (cancer prevented)
?Confront old and new challenges
- Lack of trained providers
- Community knowledge, attitude and behaviour towards colonoscopy
- New technology
Thanks!
? American Cancer Society
? New York City Council
? NYC Department of Health & Mental Hygiene
? New York Community Trust