Foundational Strategies

 

 

Find more information on VHAN’s quality measure process in the Quality Measure Toolkit, available on the VHAN Hub.

If your practice needs assistance with chart review to identify patients who would benefit from outreach, contact the VHAN Quality Impact Specialist Team at info@vhan.com.

Promoting Cancer Screenings in the Primary Care Setting

Annual check-ups are an opportune time to educate your patients about cancer screening options and encourage them to schedule their appointments. Start by assigning a clinic staff member and physician as champions of educational and promotional initiatives. Here are some ideas:

• Use visual management boards in the primary care clinic to educate staff and patients on national cancer campaigns, such as Breast Cancer Awareness Month in October.
• Display data on cancer screening rates to build awareness of how early detection saves lives.
• Create a friendly competition between teams or other practices and offer prizes to incentivize staff to schedule screenings and improve completion rates.

 

NATIONAL CANCER AWARENESS MONTHS

OCTOBER
Breast Cancer Awareness Month

MARCH
National Colorectal Cancer Screening Awareness Month

JANUARY
Cervical Cancer Awareness Month

 

Increase Colorectal Cancer Screenings With Shared Decision Making

When patients participate in decisions and understand their options, they are more likely to follow through with recommended care. Discussing Colorectal Cancer Screening (CRCS) with patients has been shown in studies to increase compliance:

• According to CA: A Cancer Journal for Clinicians, in comparing two studies, 74.7% of patients who discussed CRCS with their provider completed the screening. In contrast, only 23.8% completed the screening when no discussion took place.
• The Colorectal Cancer Screening Messaging Guidebook states that 68% of unscreened people name their doctor as the most trusted source of screening information, yet 60%o f them do not recall discussing CRCS with their doctor.
• A study in Archives of Internal Medicine found that offering two screening options, including a stool-based screening, can increase compliance over a colonoscopy by 81%.

How to Incorporate Shared Decision Making in Your Practice

• Incorporate a tool with a standard menu of CRCS options and educate providers on how to use it.
• Add a menu of CRCS options within the practice EMR with a Best Practice Advisory to prompt shared decision making.
• Encourage providers to be flexible when explaining CRCS options: Every patient is different.
• If resources are limited, prioritize decision support for non-compliant patients.

Source: Inadomi JM, Vijan S, Janz NK, et al. Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies. Arch Intern Med. 2012;172(7):575-582.

From the VHAN Front Lines:
Increase Scheduled Mammograms With Creative Process Improvements

One VHAN practice added pink postcards to their clinic workflow to improve the rate of scheduled mammograms. In each exam room, the practice puts a stack of pink cards with clear directions for how to schedule a mammogram and a list of locations.

When patients are due for a mammogram, their provider gives them a card and instructs them to take it to the front desk to schedule their appointment. The scheduler completes the flip side of the card with appointment information. If the patient fails to schedule at check out, the pink card is still a reminder for them to self-schedule when they’re ready.

 

Cancer Screening Guidelines

Intermediate Strategies

 

Increase Colorectal Cancer Screenings With the FluFIT Program

The American Cancer Society’s FluFIT Program is an innovative way to increase colorectal cancer screenings in primary care settings. When patients come in for their annual flu shot, clinic staff provide a Fecal Immunochemical Test (FIT) kit to those who are also due for colorectal cancer screening. FITs look for hidden blood in the stool, an indicator of colorectal cancer. A study conducted at San Francisco General Hospital showed a dramatic increase in colorectal cancer screenings after implementing a FluFIT Campaign. At the conclusion of flu season, participants in the intervention group who received both a flu vaccine and FIT kit showed an increase in colorectal cancer screening rates from 54.5% at baseline to 84.3% at the conclusion of the study (Phengrasamy et al., 2009). Steps to implementation:

□  Select a FluFIT Champion.

□  Establish buy-in from providers, staff and patients.

□  Create a clinic work-flow process and data capture plan.

□  Plan a kick-off date for fall to align with flu campaigns.

□  Order FIT kits in advance.

□  Train staff on FIT instructions and FluFIT process.

□  Strongly consider reminder outreach to patients.

□  Assist all FIT-positive patients with colonoscopy completion.

□  Assess data after completion of campaign.

 

 

Advanced Strategies

Creative Patient Outreach

Consider innovative techniques to encourage patients to get their annual cancer screenings. Here
are some general ideas, with more targeted to specific cancer screenings on the following pages:

• Set up automated reminders to be sent via text or phone.
• Promote self-scheduling via the EMR patient portal.
• Provide bulk reminder messaging to patients via the EMR patient portal.
• Send reminder letters with a QR code that directs the patient to schedule via a phone line, website or self-scheduling portal.
• Use the VHAN quality measure and AWV opportunity reports to call patients in need of a screening. The VHAN Quality Impact Specialist team can assist with phone outreach as well

Ways to Encourage Breast Cancer Screenings: Mammo Mondays Increase breast cancer screenings with creative
Increase outreach programs such as Mammo Mondays, which combines an annual mammogram with a spa-like environment to make the experience more pleasant.

Practices who implemented such programs experienced a 17% average increase in breast cancer screening rates.

How to implement Mammo Mondays:

• Provide patients with
  items such as light refreshments and beverages, complimentary shoulder massages, free valet parking, and goodie bags that include masks, water bottles, coupons or donated skin care samples.
• Arrange for imaging centers to extend hours on Mondays during Breast Cancer Awareness Month in October.
• Send reminders to women on practice gaps lists who need a mammogram and assist them in scheduling.
• Track data to report on outcomes after completion of program.

 

Ways to Encourage Colorectal Cancer Screenings: FIT Outreach Programs

Fecal Immunochemical Tests (FITs) are safe and convenient home tests that look for hidden blood in the stool, an indicator of colorectal cancer. A FIT outreach program allows health systems to screen thousands of patients who would otherwise go unscreened—and helps practices achieve colorectal screening performance measures.

FIT has shown promising results in prompting patients to complete a colonoscopy, which remains the gold standard. Kaiser Permanente Northern California conducted a longitudinal study on an organized CRCS outreach program they implemented using FIT kits. The study found:

• Patients who received colonoscopy following FIT increased from 41% to 83%.
• The overall up-to-date status in screening increased from 39% in 2000 to 83% in 2015.
• Reduction of annual CRC incidence was 25.5%, and the reduction in cancer mortality was 52%.

Ways to Encourage Colorectal Cancer Screenings: Cologuard Home Tests

Cologuard is a home test kit that screens for colorectal cancer by detecting altered DNA and the presence of blood in stool. A practice’s quality measure is met for three years with the completion of a Cologuard screening.

Cologuard has a high sensitivity rate for cancer at 92.3%. Specificity rate is 86.6%. In one 12-month study, 393 patients ages 50-85 who were non-compliant with colorectal cancer screening had an 88.3% compliance rate when offered Cologuard. Out of the 51 patients who were positive, 96.1% were compliant with a follow-up diagnostic colonoscopy.

 

Partner With a Vendor for Mailed FIT Outreach

Some practices partner with preferred VHAN vendor Polymedco to target patients due for CRCS with a FIT test. Polymedco mails patients a FIT test with practice branding, a letter with education on the importance of the test, instructions in multiple languages, and a label with a barcode that includes the patient’s name, date of birth and reference account number. The kit comes with pre-addressed and postage prepaid return mailers to make it easy for the patient to return.

The practice’s lab of choice receives the kit and processes the test. Results are uploaded to the practice EMR. Polymedco provides a reminder call and text to patients who have
not returned their kit.

 

Partner With a Vendor for Mailed Cologuard Outreach

Some practices partner with preferred VHAN vendor Exact Sciences to target patients due
for CRCS with Cologuard test.

After receiving an order from a practice, Exact Sciences mails a Cologuard kit to the patient’s home. The patient then ships the completed kit back to Exact Sciences at no additional cost. The program features a 24/7 patient support line and reminder phone calls and letters. Results are faxed or mailed to the provider, or they can be uploaded to the practice EMR.

 

Ways to Encourage General Cancer Screenings: Optimizing Your Practice’s EMR

Put your EMR to work for you to help alert you to patients who need cancer screenings. Here are a few best practices:

• Set up automated flags within the patient’s chart to alert providers that a test is needed. A resource like the Health Endeavors EMR Connector Tool can also alert providers
  about open measures for the Medicare population.
• Create best practice advisories to remind providers about preferred guidelines. Train providers and care team members to view outpatient whiteboard health maintenance indicators.
• Build benchmark reports to organize outreach and track outcomes.
• Use bulk-ordering capabilities for home test kit campaigns.
• Build self-scheduling options within the patient portal.
• Establish data exchange with payors. Incorporate automated coding within the EMR to alert payors that a test has been completed or excluded.

 

Payor Attestation Opportunities

VHAN facilitates payor portal access and training to help practices attest quality measures that are showing as completed in the practice EMR but the payor data shows as incomplete. Our VHAN Quality Impact Specialty Team is available to assist with attestation within the requested payor portals. Contact the team at info@vhan.com.

 

 

Next Steps

• Complete the online practice assessment to benchmark your current performance. Your responses will be reviewed by your VHAN team and used to offer specific recommendations.
• Review your practice’s dashboard and reports located in your Box folder. If your practice needs assistance with chart review to identify patients in need of outreach, contact the VHAN Quality Impact Specialist Team at info@vhan.com.
• Visit the VHAN Hub to review both provider- and patient-facing resources, including payor cancer screening incentives. The VHAN quality team is constantly working to update those tools and resources to provide you with the latest information.