bphc enrichment series for grantees: improving cervical cancer screening in health centers through...

BPHC Enrichment Series for Grantees:

Improving Cervical Cancer Screening in Health Centers through PCMH

Thursday, January 24, 20132:00-3:30pm ET

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Cervical Cancer Screening & PCMHLearning Objectives

• Understand the epidemiological basis of cervical cancer and cervical cancer screening

• Identify barriers to improving cervical cancer screening rates

• Analyze how to overcome screening barriers using PCMH

• Describe successful grantee screening programs

• Identify additional TA and resources on PCMH and cervical cancer screening

Widening Perspectives to Improve Outcomes

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Agenda in BriefWelcome

Seiji Hayashi, HRSA

Profile of Cervical Cancer & Cervical Cancer Screening

Jacqueline W. Miller, CDC

Challenges to Improving Cervical Cancer Screening Rates

Nina Brown, HRSA

Using PCMH to Improve Cervical Cancer Screening Rates

Preeta Chidambaran, HRSA

Successful Health Center Cervical Cancer Screening Programs

Rise Phillips, T.H.E. Clinic, Inc.

Chad Hess, Pueblo Community Health Center

Cervical Cancer Overview

CAPT Jacqueline Miller, MD, FACSUS Public Health Service

Medical Director, National Breast and Cervical Cancer Early Detection ProgramProgram Services Branch

National Center for Chronic Disease Prevention and Health Promotion

Division of Cancer Prevention and Control

Cervical Cancer Burden

In 2009,12,357 new cervical cancer cases (7.9/100,000)*3,909 cervical cancer deaths (2.3/100,000)*Over $2 billion per year is spent in the United States on the treatment of cervical cancerNumber of new cases and deaths decreasing

U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2008 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2012. Available at: www.cdc.gov/uscs.

Trend in Cervical Cancer Incidence and Mortality Rates*, 1975-2006

*Incidence source: Surveillance Epidemiology, and End Results Program ( 9 areas) Mortality source: US Mortality Files, National Center for Health Statistics, CDC Rates are per 100,000 and are age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1130).

'76 '78 '80 '82 '84 '86 '88 '90 '92 '94 '96 '98 '00 '02 '04 '060

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Year

Incidence

Death

Crist, Stephanie (HRSA)

Hi Jackie,Can you reformat this chart so that it only shows every other year on the x-axis?Thanks!

Cervical Cancer Incidence Rate by Race, 2009

Source: U.S. Cancer Statistics Available at: http://www.cdc.gov/uscs.

http://apps.nccd.cdc.gov/uscs

http://apps.nccd.cdc.gov/uscs/

Cervical Cancer Incidence Rate by State, 2009

Source: U.S. Cancer Statistics Available at: http://www.cdc.gov/uscs.

http://apps.nccd.cdc.gov/uscs/

Cervical Cancer Mortality Rate by State, 2009

Source: US Cancer Statistics Available at http://www.cdc.gov/uscs

http://apps.nccd.cdc.gov/uscs

Cervical Cancer Screening

Two goals Prevention Early detection

Precancerous lesions can be treated before developing into invasive disease.

Main reason for decline in cervical cancer incidence and mortality.

Cervical Cancer Survival by StageStage 5-year survival rate

0 93%

IA 93%

IB 80%

IIA 63%

IIB 58%

IIIA 35%

IIIB 32%

IVA 16%

IVB 15%

Source: National Cancer Database

USPSTF Screening Guidelines

Recommends screening in women ages 21 to 65 years with cytology (Pap smear) every 3 years or, for women ages 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years. Grade: A Recommendation.

USPSTF Screening Guidelines

Recommends against screening in women younger than age 21 years. Grade: D Recommendation

Recommends against screening in women older than age 65 years who have had adequate prior screening and are not at high risk . Grade: D Recommendation

USPSTF Screening Guidelines Recommends against screening in women

who have had a hysterectomy with removal of the cervix and who do not have a history of a high-grade precancerous lesion or cervical cancer. Grade: D Recommendation

Recommends against screening with HPV testing alone or in combination with cytology in women younger than age 30 years. Grade: D Recommendation

Screening Guidelines

Consistent recommendations from USPSTF, ACS, and ACOG

Only for average risk women

U.S. Cervical Cancer Screening Rates, 2010

Data source: Behavioral Risk Factor Surveillance System

Cervical Cancer Screening Trend

Data source: National Health Interview SurveyHealthy People 2020 goal is 93%.

HP2020 goal

Cervical Cancer Screening by Demographics, 2010

Characteristics % 95% CI

Race

White 83.4 82.3-84.5

Black 85.0 82.8-87.0

American Indian/Alaska Native 78.7 65.9-87.5

Asian 75.4 71.1-79.3

Ethnicity

Non-Hispanic 83.8 82.6-84.9

Hispanic 78.7 76.3-80.8

US residence

Born 85.0 83.9-86.0

<10 years 67.1 62.3-71.5

10 years or more 77.8 74.6-80.7

CDC. Cancer Screening. MMWR 2012;61:41-45. Data source: National Health Interview Survey

Cervical Cancer Screening by Demographics, 2010

Characteristics % 95% CI

Education

Less than high school 69.4 66.1-72.5

High school graduate 77.7 75.4-79.9

Some college 85.3 83.6-86.8

College graduate 89.0 87.5-90.3

Usual source of care

No 64.9 617-67.9

Yes 86.4 85.4-87.4

Health Insurance

Private 88.7 87.7-89.7

Public 81.9 79.1-84.4

None 63.8 61.1-66.4

CDC. Cancer Screening. MMWR 2012;61:41-45. Data source: National Health Interview Survey

Human Papilloma Virus (HPV)

• Majority of cervical cancer associated with HPV

• High-risk HPV DNA testing added to screening regimen

• No role for low-risk HPV DNA testing• HPV vaccine may decrease disease burden

further, but results too early• Continue screening despite vaccination status• Hopefully begin to monitor national testing

rates

Benefits of Screening

• Usually no early signs• May have vaginal bleeding/discharge,

pelvic pain, or painful intercourse• Cervical cancer is easily detectable and

highly treatable• Prognosis depends of stage of tumor and

patient’s overall health• Screening to look for abnormal cells early

leads to better prognosis

Improving Cervical Cancer Screening

in Health Centers through PCMH

Thursday, January 24, 20132:00-3:30pm ET

BPHC Grantee TA call

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Case Study – Undiagnosed Vaginal Bleeding

The patient is a 34-year-old gravida 3, para 3 woman with a 2-year history of increasingly profuse vaginal bleeding. Over the past two years, the patient had been placed on oral contraceptives, but these had not stanched the bleeding. The patient reported having a Pap smear approximately 18 months earlier, read as "unsatisfactory, obscured by blood." However, she had not had a follow-up study.

Source: http://www.webmm.ahrq.gov/

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A gynecologist had seen her about 6 months earlier, and told her she needed a hysteroscopy and a dilation and curettage (D&C). However, he explained that he did not accept Medicaid, which was her source of health insurance. Her follow-up remained sporadic, and her bleeding continued—profuse enough that she required hospitalization for transfusions twice in the preceding 2 months.


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Her bleeding increased again, and she presented to the emergency department (ED). Physical exam revealed that the patient had an extremely friable exophytic cervical lesion, which was biopsied and confirmed to be invasive cervical cancer. Upon evaluation by a gynecologic-oncologist, she was found to be Stage IIB cancer. After undergoing radiation therapy and chemotherapy, she still has persistent disease. Her prognosis is currently guarded. Her oncologist believes that her delayed diagnosis profoundly affected her prognosis.


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Cervical Cancer Related Malpractice Concerns/Issues in Health Centers

• Over the past 10 years, the majority (58%) of incidents involving cervical cancer have involved the following:• a failure to diagnose • or delay in diagnosis

• Significant payout per closed event

Source: FTCA Claims Data

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Cervical Cancer Screening Trends and Goals in Health Centers

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Patient Survey (2009)

Cancer Screening All Groups

NH Whites

NH Blacks

Hispanic/Latino

Women 21 to 70 years Had Pap Test in past 3 years

85.3 79.6 87.6 87.9

National Health Interview Survey (2010)

Women 24-64 years Had Pap Test in past 3 years

83.5 82.7 85.7 84.9

Cancer Screening Outcomes among Health Cancer Screening Outcomes among Health Center PatientsCenter Patients

Source: 2009 Patient Survey and 2010 NHIS

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BPHC’s Efforts to Support Cervical Cancer Screening

• 811 health centers funded

• $44 million dollars: $55,000 per health center

• Focus on PCMH transformation as a tool to improve clinical quality

• Cervical Cancer Screening Improvement

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Cervical Cancer Clinical Measure

• Current Measure

• Numerator: Number of female patients 24-64 years of age receiving one or more Pap tests during the measurement year or during the two years prior to the measurement year, among those women included in the denominator

• Denominator (Universe): Number of female patients 24-64 years of age as of December 31 of the measurement year who were seen for a medical encounter at least once during the measurement year and were first seen by the grantee before their 65th birthday

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Cervical Cancer Clinical Measure• Cervical Cancer Clinical Measure• Modified for 2013

• Whereas the current measure counts as compliant women age 24 to 64 years with 3 year intervals between screenings, the revision allows 5 year intervals for women age 30 to 64 years with a Pap test accompanied by an HPV test. This change aligns with the 2012 recommendation of the U.S Preventive Services Task Force.

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Qualitative Study of PCMH Supplemental 2012

Key Barriers to PCMH Transformation to Improve Cervical Cancer Screening

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Patient Level Barriers• Access to care

• Patient Demographics (SES factors) • Geographic Issues• Patient Engagement• Cultural Competency *

• Workflow Issues • Type of providers• Care coordination between multiple providers

• Financial Barriers

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Provider Level Barriers

• Workflow Issues• Disconnect between QI staff and clinicians• Significant gaps between patients identified by registry

and scheduling appointments

• Training and Technical Assistance• Turnover of staff or high growth rate in staff• Software training• Best Practice Guidelines including recent changes to

screening recommendations

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System Level Barriers

• Clinical Process and workflow issues• EHR

• Decision Support systems • Technical and data integrity issues

• Resources for outreach and education programs

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Demographics of Health Center Female Patients

Source: 2009 Patient Survey

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Barriers Related to Cultural Competency

• Need for interpretive services

• Need for special outreach programs

• Need for multilingual patient education materials

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Qualitative Study of PCMH Supplemental 2012

Solutions to PCMH Transformation to Improve Cervical Cancer Screening

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Solutions Targeting Patients• Workflow

• Appropriate matching of patients to providers for first visit• EHR: Patient registries, automatic prompts, Follow up

Reminders, Patient Portal• Patient Education Materials

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Source: FY2012 PCMH Supplemental Application Qualitative Review

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Solutions Targeting Patients

• Outreach• Follow up on referrals, Batch mailings, Appointment

Reminders• Advertisement Media, Women’s health fair

• Finance• Discounted fee for screening (PAP tests, lab fees)• Incentive gift cards, One time cash rewards• Use funds for out of state patients who don’t qualify

for in state programs

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Patient Level Solutions Corresponding NCQA PCMH Domain

Workflow

EHR: Patient Registries PCMH 3: Plan & Manage Care•Element 3b: Identify High Risk Patients

Patient Portals PCMH 1: Enhance Access & Continuity•Element 1c: Electronic Access

Automatic Prompts PCMH 2: Identify & Manage Patient Populations•Element 2d: Use Data for Population Management

Patient Education Materials PCMH 4: Provide Self-Care Support & Community Resources

Outreach

Follow up on referrals PCMH 5: Track & Coordinate Care•Element 5b: Referral tracking & follow-up

Solutions Targeting Patients


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Solutions Targeting Providers

• Workflow• Pre visit planning• Standing orders• Peer review, quarterly data reports

• Access to care• Increase clinic hours, walk ins, bundling approach• Hiring dedicated staff for care coordination, referral follow up • Additional staff resources

• Training• Evidence based guidelines, PCMH, Software, Lab protocols

• Outreach Efforts

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Provider Level Solutions Corresponding NCQA PCMH Domain

Workflow

Pre-Visit Planning PCMH 3: Plan & Manage Care•Element 3b: Identify High Risk Patients

Quarterly Data Reports PCMH 2: Identify & Manage Patient Populations•Element 2d: Use Data for Population Management

Access to Care

Increase Clinic Hours, Walk-Ins PCMH 1: Enhance Access & Continuity•Element 1b: After Hours Access•Element 1a: Access During Office Hours

Hiring Dedicated Staff for Care Coordination

PCMH 1: Enhance Access & Continuity•Element 1g: Practice TeamPCMH 3: Plan & Manage Care•Element 3c: Care Management

Solutions Targeting Providers


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System Based Solutions• Organizational Policy and Procedures

• Identifying cervical cancer screening measure as a Health Center goal

• Leadership commitment to internal policy changes

• Quality Improvement QI• Identifying quality gaps• Pursuing PCMH/ Accreditation • Participating in BPHC quality initiatives

• HIT• EHR system (registries, educational resources, decision support

system)

• Training 44


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Systems Based Solutions Corresponding NCQA PCMH Domain

Organizational Policy and Procedures

Cervical Cancer Screening as a Health Center Goal

PCMH 6: Measure & Improve Performance•Element 6c: Implement Continuous Quality Improvement

Quality Improvement

Identify Quality Gaps PCMH 6: Measure & Improve Performance•Element 6c: Implement Continuous Quality Improvement•Element 6d: Demonstrate Continuous Quality Improvement

Health Information Technology (HIT)

EHR System (registries, educational resources, decision support system)

PCMH 6: Measure & Improve Performance•Element 6g: Use Certified EHR Technology

Systems Based Solutions


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Solutions Related to Cultural Competency*

• Multi lingual patient education materials

• Interpretive services for appointments and front desk

• Multi lingual patient education classes

• Culturally competent events ex: Hmong Tea Ceremony

• Training staff on cultural competency

* Corresponding NCQA PCMH Domain

PCMH 1: Enhance Access and Continuity- Element 1f: Culturally and Linguistically Appropriate Services

PCMH 2: Identify and Manage patient Populations - Element 2a: Patient Information

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The patient is a 34-year-old (Automatic prompt for preventive

care service- PAP) gravida 3, para 3 woman with a 2-year history of increasingly profuse vaginal bleeding. Over the past two years, the patient had been placed on oral contraceptives, but these had not stanched the bleeding. The patient reported having a Pap smear approximately 18 months earlier, read as "unsatisfactory, obscured by blood." However, she had not had a follow-up study.(Protocol for appropriate follow up on lab result)

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A gynecologist had seen her about 6 months earlier,(Missed opportunity to repeat PAP, better care coordination and

documentation between providers) and told her she needed a hysteroscopy and a dilation and curettage (D&C).

However, he explained that he did not accept Medicaid, which was her source of health insurance. Her follow-up remained sporadic, (Adequate follow up on referral) and her bleeding continued—profuse enough that she required hospitalization for transfusions twice in the preceding 2 months. (Consolidated records from multiple providers)

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Her bleeding increased again, and she presented to the emergency department (ED). Physical exam revealed that the patient had an extremely friable exophytic cervical lesion, which was biopsied and confirmed to be invasive cervical cancer.

Upon evaluation by a gynecologic-oncologist, she was found to be Stage IIB cancer. After undergoing radiation therapy and chemotherapy, she still has persistent disease.

Her prognosis is currently guarded. Her oncologist believes that her delayed diagnosis profoundly affected her prognosis.

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FY12 Supplemental Important Dates and Reminders

• Survey Submission for at least 1 site or Site Visit Scheduling• June 1, 2013

• Interim Report Due: Including proof of submission or schedules site visit• June 3, 2013

• Achieve PCMH Recognition• September 30, 2013

• Final Reports Due: Including Proof of PCMH Recognition• November 1, 2013

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CHCs and CDC Working Together to Improve Outcomes

CAPT Jacqueline Miller, MD, FACSUS Public Health Service

Medical Director, National Breast and Cervical Cancer Early Detection Program

Program Services Branch



CHC’s and CDC’s National Breast and Cervical Cancer Early Detection

Program

• NBCCEDP target population are never screened and rarely screened women

• 60% of invasive cervical cancer occurs in this population

• Contract with many CHC’s across the U.S. to provide clinical services


Program

• NBCCEDP eligible population– Low income (< 250% FPL)– Women aged 21 to 64 years– Uninsured or underinsured


Program

• Outreach• In-reach• Public education• Patient navigation• Case management

Crist, Stephanie (HRSA)

does your program have any pictures we could insert into this slide?


Program

• Quality assessment and quality improvement

• Using data to monitor quality indicators• Completeness of care

– 90% of abnormal screens must get final diagnosis

• Timeliness of care– 90 days for final diagnosis– 60 days to begin treatment

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333

Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348

E-mail: [email protected] Web: http://www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.



Thank [email protected]

Cervical Cancer Screening for Success: T.H.E. (To Help

Everyone) Clinic

Risë K. Phillips, MPH, MBAPresident and CEOT.H.E. Clinic, Inc.

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T.H.E. Clinic

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Relevant Facts concerning T.H.E and its Patient Population

• T.H.E. (To Help Everyone) Clinic was founded in 1974 as a women’s clinic

• Expanded to serve families within a decade• Serves over 12,500 patients with over

36,000 visits in six sites throughout South and Southwest Los Angeles

• Staff speak over 12 languages

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T.H.E. Patient Demographics

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T.H.E. Patient Demographics

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Target Patient Demographics (continued)

• Female population ages 21 to 64 composed of N=5,752 representing 47.5% of total clinic population

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T.H.E. Clinic Female Population Ages 21 to 64 as of Dec. 31, 2011

Age Interval Number Percent

21-24 592 10.3

25-29 771 13.4

30-34 616 10.7

35-39 564 9.8

40-44 655 11.4

45-49 739 12.8

50-54 779 13.5

55-59 590 10.3

60-64 446 7.8

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T.H.E. Clinic Cervical Cancer Risk Factors

• High rates of sexually transmitted infection (STIs including HPV and HIV)

• Lack of regular Pap tests

• Weakened immune systems

• Age over 40 – represent 55.8% of total female patient population

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T.H.E. Clinic Cervical Cancer Risk Factors (continued)

• Sexual history – many partners or partner with many partners

• High percentage of cigarette smokers

• High percentage using birth control pills for 5 or more years

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Cervical Cancer Screening Challenges

• Women without a regular primary care provider and medical home less likely to have reported a recent Pap test

• Transient populations

-- Homeless, Hard-to-reach

• Patients not knowing or understanding their risk for cervical cancer

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Screening Challenges (continued)

• Cultural and language barriers to cervical cancer screening

-- Mistrust of medical care providers

-- Lack of culturally sensitive screening & treatment environments

-- Modesty, fatalism, cultural prohibitions against examinations by male providers

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Overcoming Cervical Cancer Screening Challenges

• Developed a patient-centered Women’s Health practice with a cervical cancer screening initiative

-- Identify all eligible female patients between ages 21 to 64

-- Assess pap test records via electronic medical records (EMR)

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Overcoming Cervical Cancer Screening Challenges (cont.)

• Formed Women’s Health Teams with Health Coaches to reinforce positive sexual health and behavioral goals by patients

-- Assess and create screening plan for all target female patients

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• Women’s Health Team

-- Report measures and outcomes regularly during medical quality improvement meetings

-- Discuss ways to enhance the patient experience and how to communicate difficult test results

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• Performance measures generated through EMR and patient tracking systems

-- Team benefits by being able to adjust strategies to impact and enhance the patient experience at all sites

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• Non-clinical activities to support patient-centered outreach

-- Patients receive “Happy Birthday” telephone calls with a reminder to come to the clinic for their annual exam

-- Social media & other community outreach

-- Patient satisfaction surveys

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How Quality Incentives from BPHC May Have Been Used to Help Achieve Results

• Behavioral change prevention strategies discussed with patients

-- Avoidance of STIs (including HPV) by modifying sexual behavior

-- Avoidance of cigarette smoking

-- Better family planning

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(continued)

• Risks and benefits of cervical cancer screening discussed with each individual patient-- individual risk

-- fear of diagnosis

-- harm from screenings/treatments

-- cultural influences

-- values

-- perceived barriers to screening

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Results/Data of Screenings

• 85.7% or higher of eligible patients ages 21 to 64 received a Pap Test

-- 2% had abnormal cervical findings• 2012/2013 goals set for 90% or higher

screening goals• Enhanced communication between patient and

Women’s Health Team leads to better patient experience

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Lessons Learned

• Know your patient population and tailor patient-centered screening strategies

• Develop Team approach with Health Coaches to reinforce patient behaviors

• Analyze patient outcome data regularly and change strategies to enhance quality, patient experience & satisfaction

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Successful Private/Public Partnerships Helping Cervical

Cancer Screening Program

• Partnership with LA County Health Services for referrals/specialty care

• Shared clinical best practices within the Community Clinic Association of LA County

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Contact Information

Ms. Risë K. Phillips, MPH, MBA

President and CEO

(213)730-1920 ext. 3053

[email protected]

www.theclinicinc.org

Cervical Cancer Screening

Chad Hess PA-C, RN, MBADirector of Nursing Services

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About Pueblo Community Health Center

Since 1983, Pueblo Community Health Center’s mission has been to provide primary health care to those in need.

•PCHC served 23,104 individual patients with 106,927 medical, dental and mental health visits in 2011

•PCHC has grown by 45% since 2003

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About Pueblo Community Health Center (cont’d)

• Uninsured = 33%; Medicaid = 43%; Public/Private Insurance = 9%; and Medicare = 15%

• Nearly 40% of Pueblo County is Latino/a• Over 60% of PCHC’s patients represent ethnic

minority populations

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Cervical Cancer Screening Outreach

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Cervical Cancer Screening Outreach-In-Reach and Challenges-2000

• Send Patient Reminder Card• Provider\MA to identify patients (tickler system) • Free Pregnancy Tests• Provision of OB & GYN Services • No Electronic Data base

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Patient Focus Group(Barrier’s)

• Provider-Gender Preference• Appointment Availability • Patient’s not assigned to a PCP• Evening Clinics (reserved for Acute Care Only)• Patient Perceived Need of Service• Patient Concern of Cost For Screening • Lack of Specialty Care if abnormality is found

User

You may want to include in the "Notes" section below that I'm assuming these were what patients noted as barriers to receiving a screening

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• Outreach- modeled from Well Women’s Connection program (WWC)

• Designed a Cancer Screening Clinic• Provide Patient Reminders• Provide Preventative Health Education• Schedule Appointments• Monitor Compliance• Coordinates Patient Care• Patient Advocate

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• Bilingual Case Managers • Cultural Sensitivity Competence• Patient’s Word of Mouth • Radio PSA’s –Women Cancer Screening

Clinics• Community Health Fair Participation• Organization’s Web Page (Women’s Cancer

Screening)• Close Collaboration with Community Partners

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Cervical Cancer Screening In-reach by Medical & Nursing Staff

• Patient emphasis on Preventative Health • Health Care Maintenance Flow Sheet• Provide Updates for Nursing Staff • PCP-Continuity of Medical Care• Acute Care Visit Opportunities• Nurse Visit Opportunities

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Cervical Cancer Screening Rates

• 31% of women age 40-64 are screened annually

• 29% of women age 21-39 are screened annually

• 13% abnormal findings

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Where Screening Takes Place

• 40% -Women’s Cancer Screening Clinic

• 55%-Primary Care Provider

• 5%-Evening Clinic Option

* Patient Preference

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• Identify Patients who are currently not following ACOG Screening Guidelines

• Medical and Nursing Staff-ACOG Guidelines

• Patient’s ability to pay for Screening if not eligible for WWC

• Patient compliance with scheduled appointments

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• Patient Perspective on Preventative Health

• HPV vaccine-uninsured

• Myths and taboo of why Cervical Cancer Screening is necessary

• Database inefficiencies in support of case management

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How Cervical Cancer Screening Challenges Were Overcome

• Patient education of current ACOG screening recommendations

• Provide Medical and Nursing Staff updates of ACOG screening recommendations

• Quality Improvement Activities

• Medical Peer Review

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• Develop Cervical Cancer Screening database

• Plan to duplicate within E HR

• Generate Patient Compliance Reports

• Provider\Nurse-Patient Chart Flag

• Cost of Service Information

• HPV Vaccine Subsidy Program

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Cervical Cancer Screening Rates

• 87% of Women between 21-39 are screened every 3 yrs if previous Pap Smear\HPV has been nl\neg.

• 91% of Women between 40-64 are screened every 3 yrs if previous Pap Smear\HPV has been nl\neg.

* 2020 Healthy People Goal is 93% for Women 21-65 yrs

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Lessons Learned

• Understand Patient Needs

• Centralize case management (Patient ID, Scheduling, Tracking)

• Design Cervical Cancer Screening Clinics within a Family Practice Model

• Provide Female Medical Provider

• Provide training to nursing and medical staff

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Lessons Learned

• Remove cultural and language barriers

• Standing Medical Director orders

• Monitor “Missed Opportunities”

• Gynecologist onsite

• Develop Electronic Database

• Measure and Report Outcomes

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Successful Private/Public Partnerships Helping Cervical Cancer Screening Program

• Well Women’s Connection Contract• Colorado Community Health Network (CCHN) • CCHN-WWC Advisory Committee Member• Colorado Dept of Public Health & Environment

(CDPHE) WWC Quality Indicators • CDPHE Monthly Health Improvement Team Calls

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Contact InformationBernadette Lujan MA (WWC CM)

[email protected]

Linda Thurman-Sanchez BSN, RN

(Clinical Programs Nursing Manager)

[email protected]

www.PuebloCHC.org

bphc enrichment series for grantees: improving cervical cancer screening in health centers through...

Documents

cervical cancer survival

cervical cancer deaths

cervical cancer burden

cervical cancer mortality

cervical cancer incidence

new cervical cancer

national cancer institute

national cancer database