Baltimore City Colorectal Cancer Screening Demonstration Program

1. Baltimore City Colorectal CancerScreening Demonstration Program Robert Villanueva, MPA Executive Director, Maryland State Council on Cancer Control Maryland Department of Health and Mental Hygiene Baltimore, MD

2. Genesis of the Baltimore City Screening Program

4. The Baltimore City Screening Program Model

5. Baltimore City = COLONOSCOPY ONLY

6. Organizational Chart

7. Baltimore City Colorectal Cancer Collaborative Screening Sites Sinai Union Memorial Johns Hopkins St. Agnes Harbor Hospital

8. FY 07 Program Screening Goals CANCER PLAN Total Patients Screened in FY 07: 27* * Six months of screening time due to start up.

9. FY 08 Program Screening Goals CANCER PLAN Total Patients Screened in FY 08: 75

10. The Baltimore City CRC Screening Program Progress

11. Colonoscopies in Baltimore City CRC Screening Demonstration Project by Month 2006 2007

12. Harbor Hospital: Colonoscopies by Month

13. Union Memorial Hospital: Colonoscopies by Month

14. Harbor And Union Hospitals Challenges: • Expectation: Once program was set up within 6 months, it would be smooth sailing • Challenge: Not as many women from the BCCP programs were interested as expected

15. Sinai Hospital: Colonoscopies by Month

16. Sinai Hospital Challenges: • Expectation: Once program was set up within 6 months, it would be smooth sailing • Challenge: Billing issues that caused us to halt their screening until problem was rectified • Challenge: Site had turnover in program- one staff person left and site had to start the search for a Patient Services Coordinator again

17. Johns Hopkins: Colonoscopies by Month

18. Johns Hopkins Challenges: • Expectation: Once program was set up within 6 months, it would be smooth sailing • Challenge: Site had difficulty getting internal clearance/space for pre-screening physicals • Challenge: Site had turnover in program- one staff person left and site had to start to replace the Program Coordinator

19. St. Agnes Hospital: Colonoscopies by Month

20. St. Agnes Hospital Challenges: • Expectation: DHMH would not allow sites to start without having contracts signed • Challenge: Because of contract negotiations with provider, site did not start screening until October 2006 • Expectation: Once program was set up within 6 months, it would be smooth sailing • Challenge: Site coordinator has been ill and missed a lot of work

21. The Baltimore City CRC Screening Program Findings

22. Gender and Minority Status of People Screened, Baltimore City CRC Screening Demonstration Project as of March 2007 80% minority men and women screened

23. Findings Among 88 ColonoscopiesBaltimore City, July 2006 -March 2007

24. The Baltimore City CRC Screening Program Programmatic Challenges

25. Baltimore City Colorectal Program Challenges – Funding • Expectation: Ample funds would exist to pay for technical components. • Challenge: No funds in budget to build the Client database, so Comp Caner Funds were used. • Challenge: Staffing funds were limited • Expectation: Funds for staff would be adequate • Challenge: Staffing funds were limited • Challenge: Outreach efforts were hampered by lack of staff so other funding sources were needed for outreach

26. Baltimore City Colorectal Program Challenges – Bureaucratic • Expectation: CDC and DHMH would agree on all policies, procedures, etc. • Challenge: Exclusionary symptom debate (CPT Codes, complications, etc.) Led to backlog in getting contracts signed with sites • Challenge: Symptomatic people who need screening are not getting screened • Expectation: Getting paperwork signed would be the easy part • Challenge: Contracts with sites took months to get signed • DHMH did not allow sites to start without having contracts signed and this led to staggered start dates among sites

27. Baltimore City Colorectal Program Challenges – Screening Site • Expectation: Five screening sites would be similar in construction and implementation • Challenge: DHMH set up five individual, highly differentiated screening sites with very different cultures, staffing, and resources. • Expectation: Reporting requirements and data collection would be manageable • Challenge: Reporting requirements can be overwhelming to existing staff and training any new staff at this late date is nearly impossible.

28. Baltimore City Colorectal Program Challenges – Staffing • Expectation: Program was “do-able” with existing staff • Challenge: Program is no one’s full time job; Program takes much more time than anyone expected • Challenge: Receiving data needed for reports is difficult because site coordinators have other job demands • Expectation: Site coordinators could and/or would do outreach • Challenge: Case managers/nurse coordinators at sites are not outreach staff.

29. Baltimore City Colorectal Program Challenges – Outreach • Expectation: Sites would keep a steady stream of patients coming through each month • Challenge: With no dedicated outreach staff and insufficient funds for additional staff, there weren’t many patients • Expectation: If we advertised or spread word too far, program would be flooded with calls and we wouldn’t be able to meet the demand • Challenge: Didn’t advertise the program; end result is people didn’t know about it

30. Baltimore City Program High Points • 99 people screened who would have otherwise not been screened • 2 cancers detected that would have otherwise gone undetected • Partnerships within the community- hospitals, clinics, ACS, Collaborative, Local & State Health Departments, Providers, Linkage with BCCP, Community Health Centers • Increased awareness in Baltimore City about CRC and CRC screening

31. The Baltimore City CRC Screening Program Additional Activities to Increase Enrollment

32. Additional Outreach efforts in FY 07 Partnered with Baltimore Medical Systems to recruit a portion of their 7200 clients who meet initial eligibility requirements. Baltimore Medical System (BMS) serves patients in many of the neediest communities within Baltimore City - communities with high rates of unemployment and poverty, low levels of education and job skills and few or no health services.

33. Additional Outreach efforts in FY 07 Participated in “Manic Monday”- WJZ Channel 13, Baltimore Met on cold March morning at 5:30 a.m. to sing the song Manic Monday and share info about our program and Colon Cancer Awareness Month Ron Matz, newscaster

34. Outreach efforts in FY 07 • Started distributing new flyer for sites to distribute at Colon Cancer Awareness Month events (and beyond) • CRC workshop for physicians • Maryland county programs (reaching out to other counties for word-of-mouth, clients that live in the city but calls a county number, partnerships) • Employing The law of large numbers… FREE colorectal cancer screening for Baltimore City residents • You may be eligible for FREE colon cancer screening with colonoscopy if you are: • A resident of Baltimore City • Age 50 or older, or less than 50 with family history of colon cancer • Uninsured or your insurance is limited, or if you have Medicare part A only (Medicare part B covers screening) • Have low family income (for example, less than $25,525 per year for one person, or $51,625 for a family of four) • You do not have symptoms of colon cancer • A colonoscopy: • Can find cancer at an early stage • May remove early cancer before it spreads to other organs • Is done while you are sedated so it should not hurt • Is done as an outpatient in one day Baltimore City Colorectal Cancer Screening Program partners are: American Cancer Society, South Atlantic Division, Harbor Hospital, Johns Hopkins Medical Institutions, St. Agnes Hospital, Sinai Hospital & Union Memorial Hospital Call 1-888-ACS-NEED (1-888-227-6333) TODAY to see if you are eligible. Funded by the Centers for Disease Control and Prevention, Atlanta, GA

35. And the results of our additional outreach efforts….

36. Colonoscopies in Baltimore City CRC Screening Demonstration Project by Month 2007 2006 * Month In Progress ** Scheduled

37. If we could do things differently…. • If you advertise, they will come… • Hire staff for case management or outreach, not both • Partner with community health centers or healthcare providers as early as possible • Realize sooner that there is no free lunch • Employ the law of large numbers when conducting outreach • Don’t suffer paralysis by analysis

38. Acknowledgements • Centers for Disease Control and Prevention • Research Triangle Institute • Information Management Services, Inc. • Ciber, Inc. • Baltimore City CRC Collaborative (includes many community groups) • American Cancer Society, South Atlantic Division: Alva Hutchison • Harbor Hospital: Linda Wieczynski, Candace Shaffer • Johns Hopkins: Michael Farrier, Christine Hendrix, Eden Stotsky, Nancy Goldstein • St. Agnes: Mary Austin, Jennie Boyer • Sinai Hospital: Linda Rogers, Eileen Marks, Myra James • Union Memorial Hospital: Marylu Manning, Candace Shaffer • Endoscopists • Drs. Baum, Dutta, Kalloo, Kowdley, Mathieson, Somerville • Baltimore City Clinics • Baltimore Medical Systems, Chase Brexton Health Center, Shepherd's Clinic, etc. • Maryland DHMH • Vicki Varsalone, Marsha Bienia, Diane Dwyer, Barbara Andrews, Carmela Groves, • Eileen Steinberger, IT Division

39. Thank You! Contact Info: Robert M. Villanueva, MPA Center for Cancer Surveillance and Control Maryland Dept of Health and Mental Hygiene 410-767-1617 VillanuevaR@dhmh.state.md.us