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PROVIDER ORIENTATION

PROVIDER ORIENTATION. National BCCEDP. Money appropriated by congress to CDC in 1991 (public law 101-354) CDC awards grants to 50 states, District of Columbia, 5 U.S. Territories and 12 tribal organizations - five year term. National BCCEDP. Since 1991, the NBCCEDP has:

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PROVIDER ORIENTATION

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  1. PROVIDERORIENTATION

  2. National BCCEDP • Money appropriated by congress to CDC in 1991 (public law 101-354) • CDC awards grants to 50 states, District of Columbia, 5 U.S. Territories and 12 tribal organizations - five year term

  3. National BCCEDP Since 1991, the NBCCEDP has: • Served 4.2 million women and provided 10.4 million screening exams • Diagnosed 54,276 breast cancers, 144,460 pre-malignant cervical lesions, and 3,113 invasive cervical cancers

  4. NBCCEDP Conceptual Framework

  5. Virginia Every Woman’s Life Program

  6. Every Woman’s Life Mission To provide high-quality breast and cervical screening, diagnostic and health services to low-income, uninsured women in the most cost efficient manner.

  7. Every Woman’s Life ProgramOrganizational Chart Every Woman's Life Christina Benton MPH Cancer Control Supervisor Jewel Wright MPH Comprehensive Cancer Coordinator Vacant Quality Control Coordinator (Data Manager)a Shourilu Nagandla Data Entry Clerk Vacant Clinical Coordinator Beth Miller Admistrative Assitant

  8. Every Woman’s Life Staff • Cancer Control Supervisor- provides leadership and oversight for all program components of the EWL and the comprehensive cancer program. • Comprehensive Cancer Control Coordinator- builds partnerships to reduce the cancer burden in the state through networking, and participation on coalitions, committees, and conferences on the local, state, and national level. • Clinical Coordinator - oversees the case management and quality assurance and improvement components of the program.

  9. Every Woman’s Life Staff • Quality Control Coordinator (Data Manager) - manages the data reporting and collection system known as CaST. • Data Entry Clerk – assists the Quality Control Coordinator with data and reporting needs. • Administrative Assistant - performs a variety of program support tasks to coordinate and support the daily operations of the EWL team.

  10. Virginia’s Comprehensive Cancer Control Program • VACCP works with local communities through pooled resources to: • Promote healthy lifestyles and recommended cancer screenings • Educate people on cancer symptoms • Increase access to quality cancer care • Enhance cancer survivors’ quality of life

  11. EWL Administrative Provider Sites 2014

  12. Women Age 40 -64 Federal

  13. Eligibility Criteria Uninsured or underinsured Virginia women who have income at or below 200% of the Federal Poverty Level (FPL)

  14. Priority Population Women over age 50 Never or rarely screened for cervical cancer Less than 100% of the FPL Minority women

  15. Never/Rarely Screened • Defined as women who have never had a Pap test, or who have not had one in 5 years or more • Goal (20% of new enrollees)

  16. Client Participation Agreement • Clients must read and sign Agreement • Defines the client’s responsibility • Kept in patients chart for observational audits • Does not need to be turned into state office

  17. What A Client Can Expect • Provide brochure “What You Need to Know About Every Woman’s Life” • Explains importance of screening • What screening services are available • What happens if additional tests are needed, etc.

  18. Client Education • Culturally and linguistically appropriate • Importance of regular screenings • Other age appropriate screenings • Information to encourage a healthy lifestyle

  19. Breast ServicesWomen Age 40-64 • Clinical Breast Exam • Screening Mammogram • Self-Breast Exam Demonstration

  20. Cervical ServicesWomen Age 40-64 • Cervical Cytology Screening (Pap Test)/HPV Test • Pelvic Exam

  21. Cervical Cytology Intervals • The screening interval for cervical cancer screening is every three years with cytology alone or every five years with cytology and HPV testing (co-testing).

  22. Hysterectomy • Reason for hysterectomy determines need for cervical screening • Hysterectomy performed for cervical neoplasia (precursors to cervical cancer) or invasive cervical cancer • cervical screening needed • Hysterectomy for other non-cancer gynecological reasons • cervical screening not needed

  23. Re-Screening ServicesWomen Age 40-64 • Return Visit – At Least 12-18 Months Apart • Services - CBE - Screening mammogram - Pelvic exam - Pap test/HPV Test, when indicated • Follow-Up & Tracking • Inactivate, when indicated

  24. Client Referrals • For 40-64 women – set screening mammogram appointment • Provide referrals or appointments for diagnostic procedures • Provide referral to QuitNow phone line to tobacco users • Provide other medical, social and supportive referrals

  25. WomenAge18-39 STATE

  26. Eligibility Criteria Uninsured or underinsured Virginia women who have income at or below 200% of the Federal Poverty Level (FPL)

  27. MUST BE SYMPTOMATIC

  28. Client Participation Agreement • Clients must read and sign Agreement • Defines the client’s responsibility

  29. Client Education • Culturally and linguistically appropriate • Age appropriate screenings • Information to encourage a healthy lifestyle • Other health education information

  30. Cervical ServicesWomen Age 18-39 • Cervical diagnostic services for abnormal cervical result of (in order of priority): • Squamous Cell Carcinoma • Atypical Glandular Cells (AGC) • High-Grade SIL (HSIL) • Atypical Squamous Cells - Cannot Exclude High Grade Squamous Intraepithelial Lesion (ASC-H)* • Atypical Squamous Cells – Cannot Exclude High Grade SIL (ASC:H) and High Grade Squamous Intraepithelial Lesion (HSIL) in women 21-24 • Low-Grade Squamous Intraepithelial Lesion (LSIL) for women with no HPV test or +HPV* • Atypical Squamous Cells of Undetermined Significance (ASCUS) with +HPV* • Women age 30 and older with a negative cytology screening result and +HPV 16/18 • Women age 30 and older with an unsatisfactory screening result and +HPV

  31. Breast ServicesWomen Age 18-39 • Breast diagnostic services for symptoms of: • Discrete Palpable Mass • Bloody or Serous Nipple Discharge • Nipple or AreolarScaliness • Breast Skin Dimpling, Retraction or Inflammation • Self-referred clients will need clinical breast exam

  32. Breast ServicesWomen Age 18-39 • Diagnostic services for abnormal breast imaging result of: • Screening Mammogram or Ultrasound - BIRADS 5 – Highly suggestive of malignancy - BIRADS 4 – Suspicious abnormality

  33. Breast ServicesWomen Age 18-39 • Do not cover routine breast screening for this age group, even if the woman is high-risk: • Personal/family history • Test positive for BRCA1 or 2 • First degree relative with breast cancer

  34. Breast & Cervical Services for Women Age 65 and Older • Encourage enrollment into Medicare • Not Medicare eligible - client may be enrolled into EWL • Submit as a state screen • Women 65 and over are NOT eligible for Medicaid Treatment Act

  35. Client Referrals • Provide referrals or appointments for diagnostic procedures • Provide referral to QuitNow phone line to tobacco users • Provide other medical, social and supportive referrals

  36. Clinical Algorithms

  37. Abnormal Screening Result BREAST • NCCN Breast Cancer Screening and Diagnosis Guidelines, 2013 • www.nccn.org CERVICAL • ASCCP Guidelines 2013 • www.asccp.org

  38. Medical Advisory Committee

  39. Medical Advisory Committee Medical Advisory Committee: • Composed of clinical experts • Review guidelines annually • Consultation on special cases • Recommend professional development topics/strategies

  40. Case Management

  41. Case Management Two Purposes: • Identify client barriers • Overcome client barriers RESULT Women receive timely and appropriate diagnostic and treatment services

  42. Case Management Major Components include: • Assessment • Planning • Service Coordination • Monitoring • Advocacy/Self Sufficiency • Evaluation

  43. Tracking System The system must be able to: • Track client’s receipt of screening and diagnostic services • Ensure confidentiality (this includes emailing EWL patient information) • Be effective

  44. Tracking & Follow-Up NOTIFICATION: • Normal Screening Results • Abnormal Screening Results FOLLOW-UP • Diagnostic Services • Rescreening

  45. Core Performance Indicators

  46. Clinical Indicators • Work Up Completed • Timeliness from Screening to Diagnosis • Timeliness from Diagnosis to Treatment • Treatment Started

  47. Recruitment Indicators • Mammograms over age 50 • Never/Rarely Screened for Cervical Cancer • Rescreen (non-core) • Very Low-Income Women (non-core) • Minority Women (non-core)

  48. Quality Assurance

  49. Quality Assurance • Monitoring Quality • Track core performance indicators • Analyze client/program data • Conduct regular site visits • Providers internal QA processes

  50. Observational Site Visit • Routine – every two years • Purpose: • Assess accessibility and quality of services provided • Evaluate clinic flow and efficiency • Compare actual care to outcomes reported • Provide technical assistance & solicit feedback

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