Project Name: Increasing Cancer Screening Rates for Improved Outcomes

Project Overview: Adelante Healthcare serves a largely minority population at high risk for colorectal cancer – the 3^rd most prevalent cancer and while, highly preventable, the nation’s 2^nd leading cause of death. The community is also at elevated risk for other cancers that disproportionately affect minority communities.

Building on a successful collaboration with the Arizona State University (ASU) College of Nursing, the health center launched a multi-disciplinary, data-driven, team-based program focused on strengthening the patient care model and embedding preventive screening. The center’s project, initially focused on improving screening, follow-up and ongoing care for colorectal cancer, was subsequently expanded to encompass breast and cervical cancer screening and intervention.

The goals of the project were to reduce the incidence of colorectal and other high-risk cancers, limit the disease burden and improve outcomes for those affected.

Project objectives are to:

• Increase colorectal screening rates, which fell below the Healthy People 2020 target of 70.5%;
• Increase cervical and breast cancer screening rates to achieve benchmarks established by the U.S. Preventive Services Task Force;
• Improve rates of appropriate follow-up care for those with positive screening results;
• Embed preventive screening practices across the health center;
• Strengthen the patient centered medical home model; and
• Identify resources and engage community practitioners to improve services available to uninsured patients who require follow up.

• • 2015-2016 Key Grant Activities
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    • Utilized quality coordinators to oversee outreach, care coordination, patient education, and data collection at the health center’s nine practice sites;
    • Trained clinical staff and providers to identify patients eligible for screening;
    • Trained medical assistants and nurses on the importance of screening and administering fecal immunochemical tests (FIT);
    • Conducted patient outreach to schedule screening visits and promote follow-through;
    • Developed strong local partnerships to make expanded services available to high-risk, uninsured patients who require follow up care such as colonoscopies and biopsies; and
    • Established protocols for results tracking and data analysis to guide interventions.
  • Key 2015-2016 Project Outcomes
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    • Screening rates were improved for colon, cervical and breast cancer across the patient population.
      • Colorectal cancer screening rates increased from 34.3% to 51.4%;
      • Rates for cervical cancer screening improved from 58.6% to 64.3%;
      • Breast cancer screening rates increased from 44% to 57.1%.
    • By establishing partnerships with local providers, Adelante was able to secure follow-up services for uninsured patients. More than 85% of those patients with positive FIT test results received a colonoscopy.
    • The center implemented the i2i population health management application to enhance data capture, analysis and reporting capabilities in support of clinical and program objectives.
  • 2016-2017 Key Grant Activities
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    • Provided colorectal, cervical and breast cancer screening, with high-risk diabetic patients as a defined cohort of focus for colorectal cancer screening;
    • Implemented process improvements and workflow changes, including an expanded role for Medical Assistants to apply standing orders for colorectal and breast cancer screenings, and providing an opportunity for patients to schedule time with an RN or Health Coach on site for FIT kit education;
    • Enhanced patient outreach and education through phone call reminders, letters, and text messages to encourage compliance with recommended follow-up care;
    • Embedded health coaches into the care team to provide patients with motivational interviewing, coaching and goal setting;
    • Maintained and expanded local partnerships to ensure access to follow-up care, including colonoscopies and biopsies;
    • Fostered additional regional collaborations to share best practices; and
    • Expanded data analytics capacity.
  • 2016-2017 Key Project Outcomes:
    • The number of women screened for breast cancer decreased slightly between 2016 and 2017 (from 3,245 to 3,120) while the number of patients screened for cervical cancer increased by 27% (from 4,691 to 5,958) and for colorectal cancer, by 28% (2,563 to 3,285).
    • Colorectal cancer screening rates for Adelante’s high-risk diabetic patients increased from 20% to 48%.
    • A 12-week, data-driven pilot utilizing i2i population health increased the number of eligible patients identified for screening; completed colorectal screenings increased from a baseline of 30.2% to 42.4% at the conclusion of the pilot. Patients with abnormal screening results benefited from improved continuity. The pilot has now been expanded to all of Adelante’s sites.
    • Seventy women received preventive screening for cervical, breast and/or colorectal cancers, many for the first time, as part of the Women’s Health outreach events focused on the community’s uninsured population.
    • Following the implementation of text messaging outreach to encourage screening, the number of FIT kits ordered more than doubled in the first month after its implementation (667 kits ordered, as compared to 295 in the prior month) and completed colorectal cancer screenings increased, from 34.9% to 44.1%.

Project partners: Arizona State University College of Nursing and Health Innovation, Arizona Department of Health Services, The American Cancer Society, Advanced Care Gastroenterology, SimonMed Imaging, LabCorp, and Pinnacle Pathology.

About the Grantee:

Adelante Healthcare is a private, not-for-profit primary health care provider serving more than 40,000 patients in Central Arizona each year. Founded 34 years ago in the cotton fields and citrus groves of rural Maricopa County, Adelante now runs nine community health centers offering family and internal medicine, women’s health, pediatrics, dental, pharmacy, lab and WIC/nutrition services.

Website at http://www.AdelanteHealthcare.com