Building Community Health Center Capacity for Cancer Prevention Through Quality Improvement Coaching and Peer Support

New England Colorectal Cancer Screening Learning Collaborative for Community Health Centers Pilot

Authors:

Lynn Basilio (Presenter)
American Cancer Society

Randy Schwartz, American Cancer Society
Neil Maniar, American Cancer Society
Morgan Daven, American Cancer Society

Public Health Statement: In the United States, colorectal cancer (CRC) is the third most commonly diagnosed cancer (excluding skin cancers) and second leading cause of cancer deaths for men and women combined. An estimated 135,430 new cases and 50,260 deaths are expected in 2017, many of which are preventable through timely screening. Patients at increased risk for not undergoing CRC screening include individuals of lower socioeconomic status, uninsured and racial and ethnic minority groups. Oftentimes, these same individuals access medical care at Community Health Centers (CHCs). Nationally in 2012, CRC screening rates within CHCs was 30.2%. In New England, rates ranged from 32.3% (RI) to 52.6% (VT).

Purpose: This pilot was designed to increase CRC screening rates among participating CHCs and determine how the American Cancer Society can support quality improvement (QI) activities of CHCs to increase cancer screening and other activities.

Methods/Approach: The pilot was based on the Institute for Health Care Improvement (IHI) Breakthrough Series Collaborative. This framework incorporated The Model for Improvement, which guided the tests of change implemented by CHCs. The ACS Steps for Improving Colorectal Cancer Screening Rates: A Manual for Community Health Centers guided the evidence-based changes. Plan-Do-Study-Act (PDSA) learning cycles served as the primary drivers of improvement.

Results: Participating CHCs increased their aggregate median CRC screening rates by an average of 6.3%; with one as much as 25 percentage points (34% to 59%).

Conclusions/Implications: The learning collaborative model demonstrated how ACS can support QI activities of CHCs and other primary care systems to increase cancer screening.

West Virginia Colorectal Cancer Screening Learning Collaborative for Community Health Centers

Authors:

Morgan Daven (Presenter)
American Cancer Society

Kevin Tephabock, American Cancer Society
Rebecca Cowens-Alvarado, American Cancer Society

Public Health Statement: West Virginia has the third highest cancer mortality rate in the United States. Colorectal Cancer Screening rates in West Virginia are some of the lowest in the country at 63%. In 2014, reported colorectal screening at Federally Qualified Health Centers was just 32.9%. Factors contributing to the low screening rate include access to care issues for rural communities, shortages of gastroenterologists and surgeons in the state, and wait time of six months or more for colonoscopies.

Purpose: The purpose of the project was to improve colorectal cancer screening rates in West Virginia by engaging Community Health Centers to sign the 80% by 2018 pledge and participate in training, peer learning, and Quality Improvement through the learning collaborative. The design of the learning collaborative was based on the IHI Model for Improvement.

Methods/Approach: The learning collaborative began with an in-person meeting of participating Community Health Centers with the American Cancer Society and the West Virginia Primary Care Association. The initial meeting included training focused on colorectal cancer screening improvement strategies. A series of peer learning and partnerships meetings was designed with NCQA PCMH concepts for team meetings. The ACS Steps for Improving Colorectal Cancer Screening Rates: A Manual for Community Health Centers guided the evidence-based changes, with Quality Improvement support from ACS staff.

Results: The colorectal cancer screening rate for Community Health Centers in West Virginia increased from 32.9% in 2014 to 39.9% in 2015. Relationships with ACS staff developed and deepened, and conversation among Community Health Centers increased.

Conclusions/Implications: The learning collaborative was an effective and sustainable strategy to increase cancer screening among Community Health Centers and to strengthen relationships among Community Health Centers and with the American Cancer Society.

The American Cancer Society’s Maintenance of Certification QI Pilot to Increase HPV Vaccination

Authors:

Marcie Fisher-Borne (Presenter)
American Cancer Society

Molly Black, American Cancer Society
Morgan Daven, American Cancer Society

Public Health Statement: Each year 30,700 men and women receive a diagnosis of cancer caused by HPV. In addition to cancers, each year over 330,000 women undergo treatment for pre-cancerous, high-grade cervical dysplasia. The HPV vaccine is the most effective cancer prevention for many cancers, but vaccination rates remain extremely low.

Purpose: The purpose of the MOC pilot is to decrease missed opportunities for HPV vaccination through quality improvement coaching and increase Community Health Center capacity to vaccinate when the vaccine is most effective, before a child’s 13th birthday.

Methods/Approach: The project focuses on increasing the impact of ACS quality improvement coaches through a peer-to-peer learning collaborative on helping Community Health Centers reduce missed opportunities for HPV vaccination. Value is added for participating Community Health Centers by piloting the addition of Maintenance of Certification credits to quality improvement projects. Community Health Centers participating in the pilot are located in Alabama, Louisiana, Missouri, Oklahoma and Texas.

Results: To date, ACS has recruited 11 Community Health Center partners, assessed their HPV vaccination capacity, provided Quality Improvement coaching, and helped the Community Health Centers set vaccination rate baselines. ACS staff and the Community Health Centers have followed a structured protocol to ensure providers receive Maintenance of Certification credits.

Conclusions/Implications: Assessing capacity of partnering Community Health Centers and providing a structured peer-to-peer learning collaborative for ACS Quality Improvement Coaches empowers them to facilitate key quality improvement strategies to increase HPV vaccination and expedite implementation of new protocols.