Partnering to Improve Colon Cancer Screening Rates Across Wisconsin
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When colon cancer is detected early, in most cases it is a treatable or even curable disease – a fact reflected in the increasing survival rates.
“That survival rate is largely thought to be due to screening,” said Noelle LoConte, MD, a medical oncologist at the UW Carbone Cancer Center who specializes in treating colon and other gastrointestinal cancers.
Any number of screening methods can be used to meet the nationwide goal of screening 80 percent of eligible patients by 2018. Some health centers across the country have exceeded that goal, but many others have not. In Wisconsin and across the country, some of the lowest screening rates are found at federally qualified health centers (FHQCs).
“FQHCs are designated by the federal government, and they are medical homes for the poorest people,” LoConte said. “Several years ago, David Frazer, Associate Director of the Center for Urban Population Heath (CUPH) and I worked on a pilot study with a single FQHC, Progressive Community Health Centers in Milwaukee on improving screening rates, and we were successful in doing so.”
In 2015, LoConte and colleagues at CUPH and the Wisconsin Comprehensive Cancer Control Program were awarded a five-year, $2.5 million grant from the Centers for Disease Control to improve colon cancer screening rates at FQHCs across Wisconsin. Currently, nine health centers across Wisconsin, eight of which are FQHCs, are included in the outreach project. The centers range from urban to rural populations – and range from initial screening rates of 12 to 70 percent, with an average of 34 percent.
Project coordinator Allison Antoine, CHES, initially met with providers, staff and administrators at each FQHC and formed the “colorectal team.” The CUPH team held a series of meetings with the team, where they reviewed policies, set goals and identified the centers’ strengths on which they could build.
“The centers were then given a menu of evidence-based interventions, and they got to pick which method they thought was going to be best for them,” Antoine said. “Pretty much everyone selected the health information technology intervention, which really when you boil that down, it is making sure that electronic health records are optimized. For example, it’s implementing provider reminder systems so that the provider has some type of a reminder that, ‘OK, this patient is between 50 and 75 years old, I should be thinking about colorectal cancer with them.’”
Just over two years into the outreach, screening rates have improved at each of the nine partner health systems, to a combined average of 49 percent. Sarah François, director of fund development and marketing at pilot partner site Progressive Community Health Centers, is excited about the improvement.
“Our partnership dates back to 2010, and thanks to the support from UW-Madison and CUPH, our agency has improved policies and workflows that have led to great improvements in our colorectal cancer screening rates,” Francois said. “We look forward to continuing this important work and sharing best practices with our peers.”
Improved screening is only the first part of improving survival rates. The screening method often used is the FIT test, a take-home test that patients mail back to the center for analysis. Studies have shown that around 40 percent of patients at “safety net” centers who test positive on FIT tests do not go on to receive a diagnostic colonoscopy, the gold standard in diagnosing colon cancer.
“That’s really a big drop-off, and I’m hoping to get additional funding to understand why that happens and to implement strategies within FQHCs to decrease that number,” LoConte said.
With the remaining years and funding, LoConte and Antoine would like to expand their work to all FQHCs in Wisconsin. They are also shifting their focus to sustaining the improvement for years to come.
“It would crush me if 2020 came around and screening rates plummeted,” Antoine said. “I feel like we have a lot of opportunity here to hopefully make a lasting impact, and my long-term goal is to embed these interventions into day-to-day practices.”
Date Published: 02/08/2018