Online Program

An innovative, multidisciplinary public health model for increasing colorectal cancer screening rates in low income, multicultural patients receiving primary care from a large urban public health department

Monday, November 4, 2013 : 3:10 p.m. - 3:30 p.m.

Winnie M Tse, Community Oriented Primary Care, San Francisco Department of Public Health, San Francisco, CA
Lisa Golden, MD, Ambulatory Care, Department of Public Health, San Francisco, San Francisco, CA
Andrea Scobi, Community Oriented Primary Care, San Francisco Department of Public Health, San Francisco, CA
San Francisco Department of Public Health (SFDPH) provides primary care services for a multicultural, low income, predominantly under/uninsured patient population. Its network of 12 community-based primary care health centers serves 39,000 patients and provides 116,000 medical visits annually. In 2012, medical assistants, health workers, nurses, and clerical staff from 8 health centers were engaged in an innovative, cost effective multistage model to improve cancer screenings starting with colorectal cancer screening (CRCS). Staff received "just in time" trainings on: using an electronic registry for mail outreach, CRCS guidelines, and using scripts to effectively engage patients in screening. Then, staff immediately practiced the new skills by sending 4800 postcards and conducting same day (as the training) phone outreach with 2400 calls in over 4 languages during a two week period. An electronic registry was used to identify patients for outreach, match patients with language concordant staff, and track monthly screening rates pre/post intervention. Participant evaluations and video interviews chronicle the experience of the medical assistants and health workers. Pocket tool cards with scripts were also developed. Four months after the trainings, CRCS rates improved from 43.6% to 50.4% (n=14,000). Staff use the acquired skills and scripts for both proactive outreach and initiating CRCS with patients during clinic visits. This model has been successful in engaging multidisciplinary staff in system-wide, multi-clinic efforts to improve CRCS and can be applied to other preventive and health maintenance screenings. SFDPH plans to apply this model for the second stage on cervical cancer screening in 2013.

Learning Areas:

Chronic disease management and prevention
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs

Learning Objectives:
Describe a cost effective training and quality improvement model for improving colorectal cancer screening in a public health care setting. List the steps needed to implement a centrally driven training model for multiple clinics with immediate application and measurement. Identify ways to apply this model and change concepts to other preventive screenings through population management strategies.

Keyword(s): Cancer Screening, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have served as project manager of multiple quality improvement initiatives focusing on improving the quality of patient care in a network of 12 community based primary care clinics. I have led curriculum development and trainings for clinic staff on the use of registries for panel management, and also developed measures and tools to support data-driven quality improvement.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.