keys to success stephen taplin md, mph deputy associate director, healthcare delivery research...
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Keys To SuccessStephen Taplin MD, MPH
Deputy Associate Director, Healthcare Delivery Research Program
Division of Cancer Control & Population Sciences, NCI
April 21, 2023
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You miss 100% of the shots you don’t attempt
Wayne Gretzky
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This is the beginning •We listened•We Talked•We planned And now we go home and continue
Screening implementation is a multilevel Problem
State
National
Improved Quality of Cancer Care
Improved Cancer-Related Health Outcomes
Community
PracticeSetting
Provider/Team
Family & Social Supports
IndividualPatient
Family / Social SupportsFamily dynamicsFriends, network support
Individual PatientBiological factorsSocio-demographicsInsurance coverageRisk statusCo-morbiditiesKnowledge, attitudes, beliefsDecision-making preferencesPsychological reaction/coping
Provider / TeamKnowledge, communication skillsPerceived barriers, norms, test efficacyCultural competencyStaffing mix & turnoverRole definitionTeamwork
Local CommunityCommunity Level Resources Medical care offerings Population SES Lay support networks Private cancer organizationsLocal Hospital & Cancer Services Market Level of competition Managed care penetration Percent non-profit Specialty mixLocal Professional Norms MD practice organizations Use of guidelines Practice patterns
National Policy – Affordable Care Act Structure Culture
StatePolicy reimbursement of clinical trials
Stucture
Culture advocacy groups attitued/expectations
Organization / Practice SettingLeadershipOrganizational structure, policies & incentivesDelivery system designClinical decision supportClinical information systemsPatient education & navigation
Taplin & Zapka – JNCI 2010
-- We have to think about all the levels
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Key #1: You are not alone
State Cancer Control Plans
For example
State X – 20% decrease in late-stage disease among African Americans, Asian & Pacific Islanders
by ….2015
Increase affordable & timely Dx colonoscopy and Rx
Education, promotion, advocacy
Primary Care Associations
Technical Assistance
Resources (QI experience, data & reports, grant opportunities)
Federally Qualified Health Centers
Populations at risk, UDS reporting
The People we want to affect!
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Key # 2
This CRC effort is not a unique process
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
Act Plan
Study Do
A. Who?1. Leadership
a. Stateb. Organizationc. Medical team
2. Who else?a. Advisory board?
B. What?1. Multiple activities2. Evidence-based options
a. communicationb. activities in practice
3. Measurement and feedbackC. How?
1. Make a plan2. Assemble a team3. Get Patients screened4. Coordinate
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Key # 3: Build on what you’ve learned and gathered here!1) Complete the plans
Leadership support? Recruit other centers?
Credible data and baseline assessment?
2) Build the team Establish coalitions Recruit gastroenterologists Clarify capabilities, roles, responsibilities within state
Clarify capabilities, roles responsibilities within participating centers
3) Offer patients screening
Systematize the offer
4) Coordinate Care across the screening process Monitor Progress –measurement & feedback
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Key #4: Learn from your failures and your successes Plan/Do/Study/Act cycles
We learn from everything if we pay attention How was the plan received?
A means for improvement?
Who resisted the work and why? Change in emphasis? Clarify roles further? Find /offer data?
Where did the systemization break down? At the outset? When roles got foggy?
Was coordination successful? Adequate data available? Did you seek IT support
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Key # 5: Persist
Screening Measures can be rewarding
….or discouraging
Get more data
Tu et al – Adaptive reserve matters – 4/15/2015
FQHC survey and evaluation of CRC implementation
Corley et al - Adenoma Detection Rate
Effect of single DRE?
Role of Cancer Centers?
Get more help
Plan for consultation and reconvening of the team
Adjust (Act)
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It takes a village…
American Cancer Society
Durado Brooks, MD, MPH
Randy Schwartz, MSPH
Lorrie Graaf, RN
Sarah Shafir, MPH
Todd Tyler, BS
National Cancer Institute
Stephen Taplin, MD, MPH
Cindy Vinson, PhD, MPA
Veronica Chollette, RN, MS
National Association of County and City Officials
Brandie Adams, MPH
Centers for Disease Control and Prevention Nikki Hayes, MPHEna Wanliss, MSAngela Moore, MPHAnne Major, BAFaye Wong, MPH
Health Resources and Services Administration Laura Makaroff, DO
National Colorectal Cancer RoundtableMary Doroshenk, MA
Project ConsultantKerstin Ohlander, MS
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Thank you
References:1.Taplin et al Implementing Colorectal Cancer Screening in Community Health Centers. Medical Care 2008
2.Sarfaty et al Strategies for Expanding Colorectal Cancer Screening at Community Health Centers. CA CANCER J CLIN 2013;63:221–23
www.cancer.gov www.cancer.gov/espanol
References:1.Taplin et al Implementing Colorectal Cancer Screening in Community Health Centers. Medical Care 2008
2. Sarfaty et al Strategies for Expanding Colorectal Cancer Screening at Community Health Centers. CA CANCER J CLIN 2013;63:221–23
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