Assessing Colorectal Cancer Screening in Appalachia PA

1. Assessing Colorectal Cancer Screening in Appalachia PA William Curry, MD, MS Mark Dignan, PhD Gene Lengerich, VMD Alan Adelman, MD, MS

2. Colorectal Cancer • Second leading cause of cancer deaths • 150,000 new cases annually • 57,000 annual deaths • In Pennsylvania • 8,600 new cases annually • 3,300 annual deaths

3. Colorectal Cancer Screening • Screening options recommended by USPSTF • Fecal Occult Blood Test (FOBT) qYr • Flexible Sigmoidoscopy (FS) q5Yr • Annual FOBT plus FS q5Yr • Colonoscopy q10Yr • Double Contrast Barium Enema q5Yr

4. Colorectal Cancer Screening • Screening of population is less than optimal • 53% in US • 49% in PA • 44% in Appalachian PA Only 32% of colorectal cancers are found at local stage in rural Appalachia.

5. Colorectal Cancer Screening • Factors influencing cancer screening • Patient/population factors • Physician factors • Medical environment factors

6. Colorectal Cancer Screening • Interventions • Audit & Feedback • CME • Provider reminders • Despite these efforts, CRC screening rates remain lower than breast, cervical and prostate cancer screenings.

7. Colorectal Cancer Screening • Academic Detailing • One-on-One interaction between provider and trained educator • Interactive information presentation • Handouts • Educational materials for provider, staff, patients • Evidence for Academic Detailing? • Reduced inappropriate and over-prescribing • Tobacco cessation • Improved rural diabetes care • Increased mammography use • Decreased inappropriate PSA ordering

8. Colorectal Cancer Screening • Academic Detailing • One study that showed improved follow-up of positive FOBT • Mixed evidence about effectiveness with CRC screening • Physician recommendation is an important factor in patient willingness to be screened

9. Colorectal Cancer Screening • Study design • 4 practices

10. Colorectal Cancer Screening • Study Design • Baseline Provider Survey • Current CRC screening practices • Follow-up practices • Referral patterns • Practice Assessment • Key informant interviews • Assess current screening practices

11. Colorectal Cancer Screening • Study Design • Medical Record Abstraction • Patients 50 and older • Seen in practice in the previous 2 months • Estimate number of patients offered screening and who had screening completed • Exclusion criteria • History of colon cancer, polyps • Symptoms of colon cancer • Acute visit

12. Colorectal Cancer Screening • Study Design • Academic Detailing • Visit 1 – Lunch and Learn • Visit 2 & 3 – Tailored intervention based on practice assessment and Visit 1 • Visit 4 – Follow-up and final physician assessment • Post-intervention Provider survey • Post-intervention medical record abstraction

13. Colorectal Cancer Screening • Study Design • Post-intervention Key-informant interviews • Qualitative assessment

14. Colorectal Cancer Screening • Data Collection with caBIG • Working with Univ of Minnesota, will capture chart abstraction via web to NCI database • caBIG™ Goal: To create a virtual web of interconnected data, individuals, and organizations redefining how research is conducted, care is provided, and patients/ participants interact with the biomedical research enterprise • CDEs under development at present • Output will be SAS datafile to research team

15. Colorectal Cancer Screening Questions?