More people screened for colon cancer thanks to easy, at-home program
Oregon Health Authority Transformation Center and Public Health Division support PrimaryHealth CCO’s work to increase colorectal cancer screening rates
GRANTS PASS – A Southern Oregon coordinated care organization serving nearly 10,000 Oregon Health Plan members increased its colorectal cancer screening rate by 9.2 percent in 2016–the biggest improvement in the state. And PrimaryHealth CCO is on track to improve on those numbers in 2017.
It was made possible with an evidence-based intervention, strong partnership with clinics, and technical assistance from the Oregon Health Authority Transformation Center.
“It was important that we focus on colorectal cancer screening because it’s one of the most preventable cancers with early screening,” says Jen Johnstun, health strategy officer at PrimaryHealth.
About half of colorectal cancers in Oregon continue to be diagnosed at late stages, when they’re harder to treat, according to the Oregon State Cancer Registry’s latest figures (2014). The good news is that those late stage cancers are declining because of routine screening, which can also include removal of precancerous polyps.
The Transformation Center in spring 2016 worked with the Oregon Health Authority Public Health Division to offer CCOs technical assistance for increasing colorectal cancer screening, a CCO incentive metric. The support included webinars and consultations about best practices and quality improvement processes with Melinda Davis, PhD, Oregon Health & Science University, and Gloria Coronado, PhD, Kaiser Permanente Center for Health Research.
“The technical assistance from the Transformation Center was so helpful for moving this project along,” Johnstun says.
First, Johnstun’s team invited their clinic partners to listen to the webinar series with them.
“It was loud and clear from the medical research that a FIT campaign would be the most effective way to increase screening rates,” said Johnstun.
“Fecal immunochemical tests (FITs) provide an excellent non-invasive option for screening patients ages 50-75 who are at average risk for colon cancer,” says OHSU’s Davis. A FIT kit is used yearly to collect a small stool sample, which is returned to a primary care clinic or lab. A FIT looks for hidden blood in the stool, which can be a sign of cancer. If anything looks unusual, a doctor will recommend a follow-up colonoscopy.
“For every 100 patients who complete the FIT, we’d expect about 10 to have abnormal screens and be referred for colonoscopies,” Davis says. “Among those, we’d expect about one cancer would be detected or prevented.”
Three clinics volunteered to participate when PrimaryHealth launched a direct-mail FIT campaign.
“The most important thing we did to make this intervention successful was tailoring the process to each clinic’s needs,” Johnstun says.
PrimaryHealth coordinated the introduction letters, kits and reminder postcards, while providers maintained their role with patients, including communicating screening results.
In fall 2016 PrimaryHealth mailed FIT kits to nearly 400 members, and 32 percent completed them. In one clinic, the number of members who completed a FIT jumped from 18 to 108.
“The most rewarding part was that we were able to get a lot of patients who had previously declined colonoscopies to participate,” says Spencer Countiss, MD, primary care internist at Grants Pass Clinic.
“We knew colorectal cancer screening was important, but I don’t think we’d have gone in this direction without having the technical assistance in front of us and consultations to know how to implement it,” Johnstun says.
PrimaryHealth has kicked off its 2017 FIT campaign, and this time an additional clinic is participating. Johnstun has also helped other CCOs implement FIT programs — sharing innovation across CCOs remains a key aspect of Oregon’s transformation efforts to improve health while lowering costs.
“We always try to pay it forward,” said Johnstun. “And we’re always more effective when the CCOs in our region work together.”
In the case of colorectal cancer screening, that means cancer prevented and lives saved.
2016 Metric Performance Overview
PrimaryHealth leads Oregon’s Coordinated Care Organizations in a recent report of outcomes on Quality and Performance Measures. PrimaryHealth received the top score statewide on 5 measures, more than any other CCO. Also, PrimaryHealth achieved the highest number of measures and benchmarks of Oregon’s CCOs, meeting 16 of the 18.
PrimaryHealth’s performance is the outcome of hard work and dedication by our provider community and our staff.
Access to care, based on a CAHPS member survey •*
Alcohol and drug misuse screening (SBIRT) •
Ambulatory care ED utilization •*
Assessments for children in DHS custody •*
Childhood immunization status ••
Cigarette smoking prevalence (EHR) ••
Colorectal cancer screening •
Controlling high blood pressure (EHR) ••
Dental sealants for children •
Depression screening and follow up (EHR) •
Developmental screening •*
Diabetes HbA1c poor control (EHR) ••
Effective contraceptive use (ages 18-50) ••
Follow up after hospitalization for mental illness •
Prenatal and postpartum care: Prenatal care••
Patient-Centered Primary Care Home (PCPCH) enrollment •*
PrimaryHealth achieved OHA Benchmark in 2016 •
PrimaryHealth achieved Improvement Target in 2016 ••
Top performing CCO in measure *