New Links to Colorectal Cancer Prevention

1. New Links to ColorectalCancer Prevention American Cancer Society Wellmark Foundation

2. Program Goal • Increase age appropriate colorectal cancer screenings through collaboration with medical providers. • Our primary care practices are located in 15 counties in Iowa and South Dakota. These counties exceed state and national incidence for colorectal cancer.

3. Colorectal Cancer Incidence Age-adjusted rates per 100,000 Iowa Incidence Rate: 62.9 S Dakota Incidence Rate: 61.9 U.S. Incidence Rate: 53.1 Source: CDC National Program of Cancer Registries Cancer Surveillance System (NPCR-CSS) 2006 data and SEER United States Cancer Statistics 2003.

4. Project Plan • Education • Health professionals • Patients • Public Awareness • Increase age and risk appropriate colorectal cancer screening by health care providers in targeted practices

5. Process to increase colorectal cancer screening by health care providers • Query software programs for patients ages 50-85 • Audit records to determine screening status of each patient. • Send letter from primary care physician requesting patients call their office to schedule an appointment for screening.

6. Process to increase colorectal cancer screening by health care providers • Identify patients requiring earlier colorectal cancer screening due to family medical history. • Send high risk letter to patient ; request family health history. • Place screening status reminder on patient record for each patient without screening. • Place American Cancer Society/Clinic ads in the local newspapers.

8. Reporting Measures • Increased colorectal cancer screening rates over baseline rates by at least 10% per provider • Numbers of patients identified and letters sent from primary care practice • Number of colonoscopies scheduled • Results from colonoscopy reports • Number of patients at high risk for genetic colorectal cancer identified

9. Process Results: Akron Mercy Medical Clinic • Number of letters sent: 736 • Number of additional colonoscopies since project initiated: 276 • Increase over baseline: 92%

10. Colonoscopy Results: Akron Mercy Medical Clinic • Number of abnormal colonoscopies: 66 • Number of colon cancers detected: 0 • Number of high risk surveys: 19

11. Akron (Plymouth County)Results to date:Program-Initiated Colonoscopies Based on 175 colonoscopy reports received to date

12. Process Results: Primghar Mercy Medical Clinic • Number of letters sent: 214 • Number of additional colonoscopies since project initiated: 148 • Percent increase over baseline: 80%

13. Colonoscopy Results: Primghar Mercy Medical Clinic • Number of abnormal colonoscopies: 67 • Number of colon cancers detected: 3 • Number of high risk surveys: 2

14. Primghar (O’Brien County)Results to date: Program-Initiated Colonoscopies Based on 129 colonoscopy reports received to date

15. Process Results: Hartley Mercy Medical Clinic • Number of letters sent: 300 • Number of additional colonoscopies since project initiated: 59 • Percent increase over baseline: 30%

16. Colonoscopy Results: Hartley Mercy Medical Clinic • Number of abnormal colonoscopies: 20 • Number of colon cancers detected: 0 • Number of high risk surveys: 0

17. Results to date: Program-Initiated Colonoscopies Based on 52 colonoscopy reports received to date

18. Benefits • Early screening • Reduces incidence • Detects colon cancer at an earlier, more treatable stage • Identifies and educates families at high risk of colon cancer due to genetic mutations

19. Increase in Colonoscopy ScreensGoal: 10% over baseline

20. Results to date: Program-Initiated Colonoscopies Based on 391 colonoscopy reports received to date

21. Barriers to Colorectal Screening • Anxiety • Lack of education • No insurance • High deductibles

22. The Colossal Colon:Seeing is Believing