February 3-5, 2016 | Lansdowne Resort, Leesburg, VA

Celette Sugg Skinner, Ph.D.

Professor and Interim Chair Department of Clinical Sciences, UT Southwestern Medical Center

Associate Director for Cancer Control & Population Sciences Harold C. Simmons Comprehensive Cancer Center

“IT WORKS! WHAT’S NEXT?"

Interventions with demonstrated effectiveness

We used to develop and test interventions . . .

and that was the end of the research

Best hope was to get into The Community Guide

Multi-factorial

• Lack of funding mechanisms

• Non-disseminable interventions

Progress in funding options (examples)

NCI Division of Cancer Control & Pop Science

• Implementation Science

• Healthcare Delivery Research

Evidence-based prevention grants

David Chambers

Deputy Director

Ann Geiger

Interim Director

Breast Screening & Patient Navigation (BSPAN)

• CDC BCCS program

• Theoretically available to all but must have a

program contractor. For bureaucratic reasons re:

Medicaid eligibility, only 1/3 of TX counties had

BCCS contractor (2007)

• CPRIT funding to evaluate de-centralized regional

delivery model for rural underserved

Phase I – 5 counties; Phase II – 12 additional

Coalition of > 40 community-

based providers and organizations

In Phase I, noticed differential

capacities for 3 program

components

• Outreach

• Navigation

• Reimbursement

High Capacity:

Navigation

Outreach

Medium Capacity:

Outreach only

Low Capacity:

Components

provided by Hub

Hub:

Centralized Reimbursement

Readiness Assessment Criteria (RAC) Tool

“Hub and Spoke”

Parkland Health & Hospital System

Dallas County safety-net

serves > 1M under-served

Fully integrated system linking

electronic medical records (EMR)

• 825-bed hospital

• 165 specialty clinics

• 12 community-based adult and pediatrics clinics

• 12 public school-based clinics

• 12 women’s clinics

Even within an integrated system . . .

Variation and challenges @ multiple levels:

Patient Provider Clinic

Patient-level variation (examples)

Health status, risk factors, preferences

• “FIT-first” strategy for colorectal cancer screening not right for all

Variation in eligibility and coverage

• Dx procedures following breast/cervical abnormal screens paid for by

BCCS program if legal citizens, by Parkland Health Plus Dallas County

plan if not

Clinic-level variation

Logistic capabilities

• All pediatrics, but not all women’s clinics, have HPV vaccine

storage and capabilities for Vaccines for Children’s program

• Not all clinics use same FIT kit; implications for

processing, & notification

Practices and “work-arounds”

• We’ve learned to code it this way to get it covered

• We also fax a copy

Beckman/Coulter v. Polymedco

Electronic medical records haven’t solved all problems

EMR – The of clinical data

Variation in practice of recording data (by clinic or provider)

• Mixed-methods often necessary to discern practices

Even if standardized, not always analyzable (e.g., scanned pdfs)

Promise of natural language processing over-stated for data

collection; not feasible for intervention

Interventions built into EMR are not sharable

Insert text here

Skinner et al., JAMIA, 2015

Summary

Interventions now designed more for dissemination

Dissemination & implementation science and funding

Idiosyncratic factors at multiple levels in local settings influence

D & I success; qualitative and quantitative methods often

necessary to elucidate these

Must find a way to share effective interventions built into

proprietary systems (e.g., electronic medical records)

Thank you