Colorectal Cancer Screening Pilot Program 110563006

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Colorectal Cancer Screening Pilot Program
(1/1/05-6/30/06)

• A Collaboration between
• the Rockland County Cancer Institute
• of the Rockland County Department of Health,
• Good Samaritan Hospital and
• Rockland County Gastroenterologists
• October 27, 2006

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Ronda Rosman, RN, MS Coordinator, Rockland County
Cancer Institute Rockland County Department of
Health Pomona, New York
C. Scott Vanderhoef Joan Facelle, MD, MPH
County Executive
Commissioner of Health
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The Rockland County Cancer Institute (RCCI)
An outreach, education, screening and referral
program targeting the four most prevalent cancers
in Rockland County breast, colorectal, prostate
and lung.
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Background of the RCCI

• In 1984, County Legislature created Rockland
  County Special Commission on Womens Issues.
• Breast Cancer Task Force was created to raise
  awareness about breast cancer and promote early
  detection.
• Several legislators, themselves prostate cancer
  survivors, also wanted to address the issue of
  prostate cancer in Rockland County.

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• Legislature designated funds to address the
  issue of cancer in Rockland County.
• In 2001, County Executive C. Scott Vanderhoef
  asked the Health Department to develop an
  initiative to educate county residents and
  promote early detection of cancer through
  screening.
• A Medical Advisory Committee was convened and
  came up with recommendations which led to the
  formation of the Rockland County Cancer
  Institute.

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• Health Department worked together with the
  Medical Advisory Committee, Good Samaritan and
  Nyack Hospitals, ACS and other local community
  agencies to develop programs to expand cancer
  services in the county.
• In 2005, new programs were initiated through
  RCCI funding and became operational.

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Colorectal Cancer Screening Pilot Program

• Developed based on the
• Medical Advisory Committee Recommendations
• NYSDOH Colorectal Cancer Screening Program and
  Breast Health Partnership Program
• Rockland County Community Health Assessment
  2005-2010

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• Rockland County
  Community Health Assessment
  2005-2010

• Diverse population
• Pockets of uninsured, underserved residents
• Pockets of poverty despite low overall poverty
  rates
• Substantial growth in the newly-immigrated,
  foreign-born population, and in the number of
  non-English speakers

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Rockland County Community Health Assessment
2005-2010

• Cancer is the leading cause of death for
  Rockland residents aged 45-64, second leading
  cause for ages 65 and older.
• County has a higher incidence rates for
  colorectal cancer than New York State.

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Colorectal Cancer Screening Pilot Program

• GOAL

Provide 100 free screening colonoscopies,
follow-up and treatment to eligible uninsured and
underinsured county residents.
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• Key players identified
• Health Commissioner
• Local American Cancer Society Director
• Gastroenterologist
• Surgeon
• Pathologist
• Anesthesiologist
• Hospital Administrator
• RCCI Staff

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Our lead gastroenterologist encouraged his
colleagues to participate in the program. 13 out
of 14 local gastroenterologists agreed to
participate.
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• The gastroenterologists agreed to
• provide office consultation visits in-kind.
• accept greatly reduced fees for performing the
  colonoscopies.

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• Good Samaritan Hospital and participating doctors
  (representing the following specialties) also
  agreed to accept greatly reduced fees
• Anesthesiology
• Pathology
• Surgery
• Oncology

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Funds for treatment were included in the grant
for patients diagnosed with colorectal cancer.
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Program Steps

• Program flyer was developed and translated
  by RCCI staff.
• Flyer was mailed by ACS to Breast Health
  Partnership participants and families.
• RCCI staff promoted the program in the
  community.

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RCCI staff scheduled appointments for the
patients office consultation with the
gastroenterologist. provided frequent
reminders (phone and mail). assisted with
translation and transportation. referred
patients to facilitated enrollers for health
insurance.
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• RCCI staff also
• translated the colonoscopy prep and
• post-colonoscopy instructions into Creole,
  Spanish and Russian.
• purchased Fleet Phospho-Soda prep.
• put together prep kits to include prep
  instructions, two 1.5 ounce bottles of Fleet
  Phospho-Soda, and county HIPPA form, and
  distributed to each office.

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Office Consultation

• The gastroenterologists
• examined patients
• obtained more extensive medical history
• educated patients about the colonoscopy
  procedure and prep instructions

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After office consultation, medically eligible
individuals were scheduled for colonoscopy at
Good Samaritan Hospital on an outpatient basis.
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Due to our efforts, clients kept their
colonoscopy appointments 97 of the time.
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Keys to Success
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RCCI staff developed and maintained strong
working relationships with the health care
providers and office staff.

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RCCI staff developed and maintained an effective
system of communication.
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RCCI developed and maintained a successful
system for vouchering and reimbursement.
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Colonoscopy Results 100 People Screened
No colorectal cancer was detected. 18
patients had precancerous polyps identified
and removed during their colonoscopies. 12
patients had hyperplastic polyps (not
generally considered precancerous) identified
and removed during their colonoscopies. Other
diagnoses included internal hemorrhoids,
diverticulosis, and other common findings.
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• Using This Model In Your Community
• Look at your community needs assessment to
  demonstrate need
• Encourage buy in from key players
• Form partnerships with the medical community
• Advocate for funding - early detection saves
  lives . and money!
• Start small, show success, then expand

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Thank you
Ronda Rosman, RN, MS Coordinator, Rockland County
Cancer Institute Rockland County Department of
Health 50 Sanatorium Road Building J Pomona,
New York 10970 845-364-3857 rosmanr_at_co.rockland.n
y.us