Transcript Improved Colorectal Cancer Screening in the Indian Health

Improved Colorectal Cancer Screening in the Indian Health System
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MD ;
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MBA ;
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MD ;
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EdD ;
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RN ;
Ty Reidhead,
Cindy Hupke, RN,
Bruce Finke,
Patricia Lundgren, RN,
Lisa Dolan-Branton,
Lindsay Hunt; Kedar Mate, MD2; Tracy Jacobs, RN2; Nathaniel Cobb, MD, MPH1; Don Goldmann, MD2; Gerald Langley2
1 Indian
• The US Preventive Services
Task Force (USPSTF) has
estimated that attainment of
population-level goals for
CRC screening could save
18,800 lives annually.2
• Despite widespread
availability of these screening
techniques, CRC screening
remains woefully inadequate
with only 52% of Americans
screened annually.3
• In the Indian Health System
(federal, tribal, and urban
Indian health programs) the
screening rate for CRC is
29%.4
1Ries
Innovations in Planned Care (IPC) Collaborative
• Indian Health Service (IHS) partnered with the Institute for
Healthcare Improvement (IHI).
• Fourteen pilot Indian Health facilities responded to a
request for participation and were enrolled in a
Breakthrough Series Collaborative from March 2007 to
August 2008.5
• Within each facility, a group of providers and their patients
were identified as a clinical “microsystem.”
• The microsystem teams used rapid cycle improvement
methods (plan-do-study-act cycles) as well as process
mapping to identify, test and implement a variety of
strategies to improve CRC screening.
• Best practices were communicated to improvement teams
in other facilities in the Collaborative to facilitate adoption
and replication.
• Individual microsystem screening rates as well as
aggregate collaborative-wide screening rates were tracked
using web-based monthly reporting tools (extranet).
LA. SEER Cancer Statistics Review, 1975-2005. Bethesda, MD: National Cancer Institute; 2007.
2USPSTF Screening for Colorectal Cancer Recommendation Statement. 10/08. Also: Maciosek MV, Solberg LI, Coffield AB, Edwards NM, Goodman MJ. Colorectal cancer
screening: health impact and cost effectiveness. Am J Prev Med 2006;31:80-9
3Agency for Healthcare Research and Quality (AHRQ). National Healthcare Quality Report and National Healthcare Disparities Report. 2006
4Indian Health Service Quality of Care Website: Colorectal Cancer Screening. http://www.ihs.gov/NonMedicalPrograms/quality/index.cfm?module=gpra_cancer3 Accessed 1/14/09
5The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement;
2003. (Available on www.IHI.org)
Results
• CRC screening rates increased over the 18 month-period from a
weighted average of: 32.4% (min 8.5%, max 74.3%) to 57.8% (min
29.7%, max 89.8%)
Weighted Average Colorectal Cancer Screening: IPC
100
80
60
Results
• At the outset only 14.3% of
microsystems (n =2) had rates
of CRC screening above 50%.
• By August 2008, 42.8% of
sites (n=6) had screening rates
above 50%.
Limitations
40
• Participating sites self selected
to participate and were
motivated to improve.
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• Colorectal cancer (CRC) kills
an estimated 50,000
Americans annually.1
Methods
Percent Screened
Background
Health Service, Rockville, MD, 2Institute for Healthcare Improvement, Cambridge, MA
Specific changes that led to these improvements in CRC screening
rates:
• Empanelment of patients
• Development of care teams
• Optimization of the roles of and communication among members of
the care team
• Standardization of protocols
• Testing, referral, and follow-up orders
• Utilization of the electronic clinical information system for planning,
screening reminders, and feedback
• Identification of opportunities for improvement
• Partnerships with Community Health Representatives and other non
traditional care team members
• There was no control group to
compare findings.
Conclusions
• Breakthrough Series
Collaborative methods,
process mapping and rapid
cycle improvement
improved CRC screening
rates among participating
microsystems within Indian
Health sites.
• Further follow-up will be
needed to ascertain the
durability and spread potential
of these improvements.