colorectal cancer

When the North Lancaster Primary Care Team B unit-based team decided to work on improving colorectal screening rates, they adapted one from their colleagues at the West Salem Medical Office.

This two-pronged approach included both an outreach system and a plan to ensure team members were delivering a consistent message.

“Our patients are not a number or a statistic, they are a person, and they are looking for us to take care of them,” says department administrator, Primary Care, Phillip Taylor, who was the team’s co-lead at the time the project was underway.

So, team members made it personal.

They told the story of how physicians in the clinic had tested positive, but because the disease was detected early, they got treatment in time and are doing well.

In addition, the team identified its eligible patients between the ages of 50 and 75. When one of those patients came into the clinic, the medical assistant would talk about the importance of the test, give them a FIT kit to take home and return in the mail. When physicians saw patients, they would reiterate the need to do the test.

Nurses also played a role.

They would track the distribution of the kits and follow up with the patient if the kit had not been returned. When they spoke to patients, they would mention the physician was looking for the kit and the importance of returning it.

The combination of methods worked better than hoped—the team shot past its target by nearly seven percentage points.

“We’re looking for early detection,” says labor co-lead and medical assistant, Bill Waters, SEIU Local 49. “Colorectal cancer can hit anybody, and we explain how it’s impacted our own providers at our clinic. We add a personal touch by telling our story, and people respond.”

Various interventions have been implemented to increase the rate of colon cancer screenings, including at-home Fecal-Immunochemical Tests or FIT kits. These kits are mailed or handed to patients identified as age- or risk-appropriate and can be completed in the privacy of the member’s own home.

The FIT kit doesn’t require a doctor’s appointment and is returned directly to the lab in a prepaid envelope. Patients who have positive FIT kit results for occult blood are referred for further testing.

“A long time ago, there was no way to track these people,” Kari Russitano, medical assistant, SEIU UHW, says. “Kaiser has done a lot to improve cancer screenings.”

But getting members to take and return the test remains a problem.

In 2009, the Union City Medical Center fell short of its 71 percent return rate goal for colorectal screenings. Kaiser Permanente routinely mass mails the kits to members identified through the electronic medical records database. But many members either don’t return the tests or the ones they return aren’t legible.

“Thirty percent were thrown away because we couldn’t read their name or the medical record number,” Deborah Hennings-Cook, RN, manager, Internal Medicine, says.

Clinical coordinator, Vimi Chand, Department of Internal Medicine, adds, “Obviously mailing alone wasn’t working, so we decided to contact members by phone or secure email. And it worked.”

Of the 1,754 members contacted, more than 63 were referred for further screening. 

Having the medical assistants and receptionists make the calls was a hard sell at first, but their peers in the unit-based team stressed the preventive nature of the test.

“It didn’t seem like extra work, because we collaborated together and educated each other to think of it as if ‘this could be your family member,’” Sophia Opfermann, receptionist, OPEIU Local 29, says. “A lot of staff didn’t know what the FIT kits were for, so we educated them about that, too.” 

Then frontline staff came up with the idea for the note cards—bright fluorescent notes that read: “This test detects early signs of COLON CANCER.”

“Knowing that many people don’t understand the importance of the test, they made the verbiage strong about ‘saving lives’ and ‘help us help you,’" Hennings-Cook says. "It was something they wanted to do, and it worked.”

One challenge was adding the phone calls and emails to the medical assistants’ existing workload. Lists of patients who hadn’t responded were provided to medical assistants but some had more than others.

“We heard a little bit of flak when the lists first came out and some MAs had huge lists, but they helped each other and just did it,” Chand says. 

In the end, the bottom line was helping patients.

“By collaborating together and educating each other, we are helping to saving lives,” Opfermann says.