Cancer Screening Office Systems SOS

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Cancer Screening Office Systems (SOS)

• Funded by National Cancer Institute
• RO1 CA 77282-01A2

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Investigators

• Richard Roetzheim, MD, MSPH
• Lisa Christman, B.S.
• Paul Jacobsen, Ph.D
• Jeff Krischer, Ph.D.
• Alan Cantor, Ph. D.
• Thomas Chirikos, Ph.D.

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Patients Likely to have Poor Cancer Outcomes

• African Americans and Hispanics
• Patients having low socioeconomic status
• Patient who are uninsured or insured by Medicaid

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Goal for our project

• Increase rates of cancer screening among
  minorities, low SES, and persons insured by
  Medicaid

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Choosing the setting for our study

• Primary Care Physicians Offices
• Physicians recommendation drives screening
• Primary care physician background
• Most persons have regular source of care (5
  physician office contacts per year)
• Office interventions have fewer barriers to
  wide-spread implementation.

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Recruited 8 clinics participating in the
Hillsborough County Health Plan

• Tampa Community Health Centers
• Saint Josephs Community Care
• Suncoast Community Health Centers
• Tampa General Health Care

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Theoretical Basis for the Intervention

• Theory of Competing Demands

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Focus Groups at USF

• Difficult to track patient screening
• Flow Sheets
• Computerized reminder systems
• Other resources

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There are 3 key elements to the Cancer SOS.

• Checklists
• Patient Brochures
• Chart Stickers

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Checklists

• Used as a ready reminder as to whether patients
  are up-to-date on cancer screening.

Year 1 Ö Ö Ö
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Year 2 Ö Ö Ö
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Patient Brochures
Used to provide patients with information about
each test, the reasons for the tests, and when
they should be done.
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Chart Stickers
Used to indicate what actions, if any, need to be
taken.
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Sticker Flow
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Initial Visit YEAR
2000 WOMENS CANCER SCREENING CHECKLIST NAME
Mary Jones DATE 06/28/2000
Month/Day/Year We are
trying to increase the amount of preventive care
that our patients receive. Would you please
help us by Office Use completing
this form? Only
Action Taken Did you
complete 3 cards at home that check YES
NO for hidden blood in your bowel
movements in the past year? YES
NO Have you had a mammogram in the
past year? YES
NO Have you had a Pap smear in the past year?

Ö
Ö
Ö
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Follow-up Visit YEAR 2000 WOMENS CANCER
SCREENING CHECKLIST NAME Mary Jones DATE
08/28/2000
Month/Day/Year We are trying to increase
the amount of preventive care that our patients
receive. Would you please help us by
Office Use completing this form? Only
Action
Taken Did you complete 3 cards at home that
check YES NO for hidden
blood in your bowel movements in the past
year? YES NO Have you
had a mammogram in the past year?
YES NO Have you had a Pap
smear in the past year?

Ö
Ö
Ö
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Follow-up Visit YEAR 2000 WOMENS CANCER
SCREENING CHECKLIST NAME Mary Jones DATE
10/28/2000
Month/Day/Year We are trying to increase
the amount of preventive care that our patients
receive. Would you please help us by
Office Use completing this form? Only
Action
Taken Did you complete 3 cards at home that
check YES NO for hidden
blood in your bowel movements in the past
year? YES NO Have you
had a mammogram in the past year?
YES NO Have you had a Pap
smear in the past year?

Ö
Ö
Ö
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OVERVIEW

• Nurses identify patients that are eligible for
  the checklist.
• Checklist are reviewed with patient and placed in
  chart.
• Providers remove stickers when appropriate,
  counsel the patients, and order necessary tests.

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Key characteristics of the proposed intervention

• Help track which patients due for screening
• Non-computerized
• Enlist the help of staff, and patients in the
  process

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Cancer Screening Tests Targeted

• Men and women aged 50-75
• Pap Smears
• Mammograms
• FOBT

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Exclusion criteria

• Pap smears
• History of hysterectomy
• Mammograms
• History of breast cancer
• FOBT
• History of colorectal cancer
• Colonoscopy or ACBE in previous 10 years

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Statistical Analysis and Results

• Alan Cantor, Ph.D.

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Conclusions

• SOS system increased cancer screening at one year
• Remaining questions
• Will results persist for a second year?
• Is the system cost-effective?

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Limitations of the study

• Pap smears assessed in previous year, only women
  50-75 targeted
• Other colorectal screening tests not assessed
  (colonoscopy, sigmoidoscopy)
• Prostate screening not assessed

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Contact Information

• Dr. Richard Roetzheim
• USF College of Medicine
• Department of Family Medicine
• 12901 Bruce B. Downs Blvd, MDC 13
• Tampa, FL 33612-4197