Magdaleno, Angela

Patek, Bonnie, DO

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineIncreasing Patient Awareness, Education andAccess to Improve Completion Rates of ColorectalBonnie Patek DOLehigh Valley Health Network, bonnie.patek@lvhn.orgAngela MagdalenoLehigh Valley Health Network, angela.magdaleno@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/medicinePart of the Medical Sciences CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtPatek, B. Magdaleno, A. (2016,Oct). Increasing Patient Awareness, Education and Access to Improve Completion Rates of Colorectal. PosterPresented at: ACG National conference, Las Vegas, NV.© 2016 Lehigh Valley Health Network•  Colorectal cancer (CRC) is the third most common cancer in both genders in the United States.1 •  Two screening modalities that have been widely studied were utilized in this Quality Improvement project.   –  Colonoscopy being the most accurate in early detection and prevention of CRC2   –  Fecal immunochemical test (FIT) which is less invasive and cost effective2 •  Low income/underserved populations tend to have lower screening rates regardless of the modality (Table 1) and may be associated with certain risk factors making them a higher risk group (Table 2)References:1.  Platz, Elizabeth, Walter Willet, et al. “Proportion of Colon Cancer Risk That Might Be Preventable in a Cohort of Middle Aged US Men.” Cancer Causes and Control 11 (2000): 579-88. 2.  Aniwan, Satimai, et al. “A combination of clinical risk stratification and fecal immunochemical test results to prioritize colonoscopy screening in asymptomatic participants.” Gastrointestinal endoscopy 81.3 (2015): 719-727.3.  McAlearney, Ann Scheck, et al. “Racial differences in colorectal cancer screening practices and knowledge within a low-income population.” Cancer 112.2 (2008): 391-398.4.  Satia JA, Tseng M, Galanko JA, Martin C, Sandler RS. Dietary Patterns and Colon Cancer Risk in Whites and African Americans in the North Carolina Colon Cancer Study. Nutrition and cancer. 2009;61(2):179-193. Quality Improvement Aims•  Understand what barriers our population faced and how to alleviate them •  If increasing patient awareness and education would improve CRC screening completion rates   –  Increase referrals for colorectal screening by 15% with either FIT ordering or colonoscopy referrals   –  Increase completed colorectal screening by 10% with either FIT or colonoscopy    •  Goals to be completed in 3 months in patients between ages 50-75 due for screening •  Create a standard practice of asking or giving information about colorectal screening is not in place in our clinic •  Documentation of colorectal screening is not consistent or standardized in our clinic Department of Medicine, Lehigh Valley Health Network, Allentown, PennsylvaniaIncreasing Patient Awareness, Education and Access to Improve Completion Rates of Colorectal Cancer Screenings in an Underserved PopulationBonnie L. Patek, DO and Angela Magdaleno, DOTable 1. Reasons Low Income/Underserved Populations are not Screened for CRC Literature Review Our Specific Population*  •  Younger age individuals  •  Lack of health insurance  •  Low education level   •  Lack of knowledge about testing  •  Medical mistrust  •  Low income  •  Lack of knowledge about CRC, treatments and cure rates  •  Unaware of reason for screening  •  Unaware of the screening process  •  Do not want to have multiple doctor visits  •  Transportation issues  •  Unaware if they were screened in the past  •  Nervous about a procedure  •  On anticoagulation  •  Language barrier  •  No GI symptoms  •  Never had discussion with a physician  •  No show rates  •  Patient not interested in preventative medicine  •  Unsure where to go for procedure  •  Unsure how to use FITPLAN Week PlanControl (Week 0)  •  Record all patients due to screening  •  Record all referrals and FIT during this week  •  No additional information/education given except what each provider typically ordersWeek 1  •  Record all patients due for screening  •  All patients due for screening to receive letter* (English or Spanish) mailed 1 week prior to appointment  •  Record all referrals and FIT during this week  •  Follow-up completion of screening during a 3 month period  •  Update health maintenance tab in EPICWeek 2   •  Review week to see if physician awareness/staff awareness helps increase compliance.Week 3  •  Record all patients due to screening  •  All patients due for screening to receive letter* (English or Spanish) mailed 1 week prior to appointment  •  Record all referrals and FIT during this week  •  Follow-up completion of screening during a 3 month period  •  Update health maintenance tab in EPIC  •  Reiterate to staff and residents to have discussions with patients about CRC*Letter included general information about CRC, the types of screening and how to perform each at a 2nd - 3rd grade reading levelTable 2. Risk Factors for Development of CRC1 Obesity Lack of physical activityAlcohol consumption Toacco usageLarge amount of red meat consumption Low folic acid intakeFamily history of colon rectal cancerProtective Factors1,4High vegetable intake Aspirin useACT  Barrier Identified Why? Action to ImproveAccess to colonoscopy  •  Long wait lists for both GI and CR surgery clinics  •  Limited spaces  •  Limited providers  •  New GI fellowship  •  Staff to review insurance options for patients to go private  •  FIT offered in patient without CRC risk factorsCRC screening not offered by physician  •  Preventive health can be overlooked  •  Limited time with patients •  “dot phrase” added to follow-up appointmentsNo show rate  •  Transportation, neglect, social/family issues  •  Phone/mail reminders •  Case manager on staffData Analysis  CRC Screening Methods OfferedData Analysis  Show RatesData Analysis  Referrals ScheduledData Analysis  CRC Screening Completion RatesCRC Screening Completion RatesCRC Screening ReferrralsBackgroundResults

Increasing Patient Awareness, Education and Access to Improve Completion Rates of Colorectal

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Increasing Patient Awareness, Education and Access to Improve Completion Rates of Colorectal

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