CPCRN Collaboration with CDC Office of Colorectal Cancer Programs

Roshan Bastani and Matt Kreuter CPCRN Meeting Boston, Nov 1-2, 2007

CDC’s Colorectal Cancer Screening Demonstration Program

Laura Seeff MD Associate Director for Office of Colorectal Cancer Programs Division of Cancer Prevention and Control, CDC September 7, 2007

Number of People Requiring Colorectal Cancer Screening Procedures (in millions), 2000

Total Population Ages 50+ 76.5 million Average Risk Population 70.1 million Need Screening General population: 41.8 million 50-64 years of age, uninsured, <250% FPL: 2.7 million

Seeff LC, Manninen D, Dong F, Chattapodhyay, Nadel MR, Tangka F, Molinari N. Is there endoscopic capacity to provide colorectal cancer screening to the unscreened Population in the United States? Gastroenterology 2004; 127: 1661-1669

Context of CRC Demonstration Screening Program

• National Breast and Cervical Cancer Early Detection Program (NBCCEDP) – Begun in 1991 through congressional legislation • Current colorectal cancer screening in US – Opportunistic – Distinct public and private sector screening programs • States • Health Care Systems • CDC designed CRC demonstration screening program – To determine feasibility of establishing organized screening program for underserved population using federal funds – To learn how best to implement CRC screening at community level – To explore NBCCEDP model – To inform current and future organized CRC screening efforts

Process to Establish Program

• Summer 2004: two stakeholder meetings held – Clinical experts and health scientists from screening programs (states, health systems and other countries), other federal health agencies and partner organizations • Key decisions from meetings – Applicants from any non-profit medical entity that offered services to low income persons underinsured for CRC • State or county health departments • Hospital systems • NBCCEDP program – Applicants must show collaboration with CDC-funded CCC Program in state – Focus on average-risk persons 50+ – Priority given to programs ready to begin screening within 6 months • Programs selected August 2005, funded through August 2008

Program components

        Provision of screening and diagnostic services Patient support Data collection and tracking Program management Public education and outreach Establishment of quality services standards Maintenance of relevant partnerships Evaluation of program process and effectiveness  Case studies   Clinical Data Assessment Cost Assessment  **Treatment**

Clallam County Jefferson County King County Nebraska St. Louis

CRC Demonstration Screening Sites 2005-2008

Suffolk County Baltimore City

Demonstration Program Sites

• Maryland Department of Health and Mental Hygiene – City-based (Baltimore) working with 5 hospitals – Primary screening with colonoscopy • Missouri Department of Health and Senior Services – City-based (St Louis) working with provider network and FQHCs – Focus on African American population – Screening with FOBT; colonoscopy for follow-up and for primary screening for high-risk clients • Nebraska Department of Health and Human Services – State-wide program using NBCCEDP framework – Screening with FOBT; colonoscopy for follow-up and for primary screening for high-risk clients

Demonstration Program Sites

• Public Health - Seattle & King County – County based (King, Clallam and Jefferson counties) using NBCCEDP framework – Focus on American Indian, Alaska Native and African American population – Screening with FOBT; colonoscopy for follow-up and for primary screening for high-risk clients • Stony Brook University Medical Center/SUNY – County based-Suffolk County – University hospital collaborating with county health departments – Primary screening with colonoscopy

Clients Enrolled (n=2,245), FY 07

American Indian/Alaska Native 4% Asian/PI 2% Multiple 1%

Male 16%

Black 20%

Female 82%

White 72% By Gender By Race

Screening Tests Performed by Test Type, FY 07 (n=1,386)

Other Screening Test, n=5

42% Colonoscopy n=583 58% FOBT n=798

800 700 600 500 400 300 200 100 0

Status of FOBT Kits Distributed (n=1,492)

Not Returned, 745 Pending, 8 Positive, 73 Negative, 666 Kits Not Returned Kits Returned

Results of FOBT Kits Returned, FY 07 (n=794)

Positive

10% 90%

Negative

Colonoscopy Results, FY 07 Screening (n=472)

1% Cancer n=4 1% Other n=2

17% Polyps n=55 81% Negative n=269

Client Final Diagnosis All Tests Combined, FY 07 (n=1,322)

1%

Cancer n=7

19%

Polyps n=253

80%

Negative n=1062

CDC’s Screen for Life Campaign Materials

• Patient Fact Sheets/Brochures • Posters • Public Service Announcements • Available in English and Spanish • Web Site: www.cdc.gov/screenforlife

A Call to Action: Prevention and Early Detection of Colorectal Cancer

• Provider education learning tool in a PowerPoint presentation • Developed to generate a greater awareness among primary care providers about colorectal cancer screening • Publicly available at: http://www.cdc.gov/cancer/colorectal/publications/slide_sets.htm

What Are We Evaluating?

• Program implementation (process) • Cost and cost-effectiveness (efficiency) • Program effectiveness (outcomes)

Key Evaluation Questions

How have grantees implemented the CRC screening program? What are the costs of the varied program models implemented by grantees?

What are the screening outcomes for clients served through the CRCSDP?

What are the changes in screening rates for the priority population and general population?

CRCSDP Evaluation Methods

• Analysis of patient level screening data • Cost Analysis • Multiple Case Studies

CPCRN Collaboration with CDC Office of Colorectal Cancer Programs

1. Participation on advisory committees, etc of the Office of Colorectal Cancer Programs • possible input into higher level decisions re: how to craft future demonstrations, what models might be most efficient and effective, etc 2. Evaluation • existing demonstrations • Planning evaluations to build into future demonstrations 3. Technical assistance being sought by state and local health departments re: their CRC screening programs/plans

CPCRN Collaboration with CDC Office of Colorectal Cancer Programs

4.

Plan a conf call to include additional persons from the CDC CRC program to learn details about the evaluations built into the current demonstrations 5.

Develop a document that lists scientific areas of expertise reflected in the CPCRN network.

• E.g., evaluation, health communications, cultural tailoring of materials, outcomes research, cost-effectiveness assessment, etc. including sub-categories within some of the broader areas.

• This would help Laura's office understand in what ways we might be able to collaborate.

CPCRN Collaboration with CDC Office of Colorectal Cancer Programs Other possible multi-site projects:

• Assess endoscopy capacity in program catchment areas or CPCRN site catchment areas • Interventions to increase male participation • Interventions to increase return rate of FOBT kits • Rigorous assessment of program effectiveness