Recorded presentation

Benjamin Chu, MD MPH, Van H. Dunn, MD MPH, Benjamin Mojica, MD MPH, Ashley Williams, and Mari Carlesimo, JD. New York City Health and Hospitals Corporation, 125 Worth Street, Room 507, New York, NY 10013, 212 788-3330, chubmd@nychhc.org

Background: Colorectal cancer can be cured if detected early. Studies have demonstrated that screening for colorectal cancer with fecal occult blood testing, sigmoidoscopy, or colonoscopy can reduce mortality. Despite these facts, only half of New Yorkers 50 years and older report having undergone a sigmoidoscopy or colonoscopy. New York City Health and Hospitals Corporation (HHC) treats 1.3 million individuals each year of which 38% are uninsured. We serve an ethnically diverse patient base (42% Hispanic, 37% African American, 6% Asian, 8% Other Minority and 7% Caucasian). Our colorectal cancer screening rates were well below the goals of Healthy People 2010. We performed only 7000 colonoscopies in 2002. Less than 30% of patients with colorectal cancer were being diagnosed in the early stage. We identified four barriers to screening; 1) lack of culturally/linguistically appropriate patient information; 2) limited access to preventive services; 3) providers failing to screen patients; and 4) lack of an information system to identify and track patients who should be screened. Our hypothesis was by eliminating these barriers we would increase the number of adults 50 years and older screened for colorectal cancer, increase the number of colonoscopies and increase percentage of cancers diagnosed at early stage.

Methods: A quality improvement program was put in place ensure that all patients age 50 and over would be screened. HHC, in partnership with the NYC Department of Health and the American Cancer Society, launched a multi-cultural/multi-lingual campaign to increase the number of African Americans, Hispanics and Asians screened for colorectal cancer. Patients and providers were educated on the importance of early detection of colorectal cancer. Patients were offered colonoscopy as the screening test of choice. An electronic surveillance system was put in place to track patients 50 years and older. Data was collected on the percentage of patients screened for colorectal cancer; the number of colonoscopies; the number of colorectal cancers identified and the stage of the colorectal cancer.

Results: In 2003, 70% of patients were screened for colorectal cancer. The number of colonoscopies increased from 7000 to 11,732. The colorectal cancer detection rate was 17.5 cancer identified per 1,000 patients screened. Of the colorectal cancers identified on screening colonoscopies, 78% were either stages 0 or 1.

Conclusions: By using the quality improvement process, HHC was able to increase the number of patients 50 years and older screened for colorectal cancer and identify cancer at an early stage.

Learning Objectives: At the conclusion of this presentation, participants will be available to

• Understand the importance of colorectal cancer screening in communities of color;
• identify intervention strategies to increase colorectal cancer screening in communities of color; and
• develop effective community outreach and educational collaborative partnerships.

Keywords: Cancer Screening, Quality Improvement

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation