Report on CCCP Report on CCCP Implementation Efforts with Implementation Efforts with Health Care ProfessionalsHealth Care Professionals

Overview of PresentationsOverview of Presentations

Speakers: James Early, MD and Judy Johnston, MS, RD/LDSpeakers: James Early, MD and Judy Johnston, MS, RD/LD

Preventive Medicine & Public Health, KU School of Medicine, WichitaPreventive Medicine & Public Health, KU School of Medicine, Wichita

““The Kansas State Cancer The Kansas State Cancer Plan: Practical Ways to Plan: Practical Ways to

Provide Extraordinary Care Provide Extraordinary Care in your Office”in your Office”

Introductory InformationIntroductory Information

The Cancer Problem in KansasThe Cancer Problem in Kansas Development of the Kansas Development of the Kansas

Comprehensive Cancer control and Comprehensive Cancer control and Prevention PlanPrevention Plan

Implementation of the PlanImplementation of the Plan

Prevention: Goals, Strategies, Prevention: Goals, Strategies, Rationale, Action StepsRationale, Action Steps

What can YOU do as a partner in What can YOU do as a partner in this effort?this effort?

Preventive Vital SignsPreventive Vital Signs Provide a “big bang for the buck”Provide a “big bang for the buck” Provide a portal of entry for discussion of Provide a portal of entry for discussion of

cancer preventioncancer prevention Address at least 3 of the 4 strategies set Address at least 3 of the 4 strategies set

forward by the Cancer Planforward by the Cancer Plan Support the recommendations in the Guide to Support the recommendations in the Guide to

Clinical Preventive ServicesClinical Preventive Services Can become part of an overall strategy for Can become part of an overall strategy for

office-based prevention office-based prevention Can stand alone as a powerful message to Can stand alone as a powerful message to

your patients.your patients.

Preventive Vital SignsPreventive Vital Signs

BP___ P___ R___ BMI (or wt.)___BP___ P___ R___ BMI (or wt.)___

Min PA___ F/V___Min PA___ F/V___ Tobacco Y/N Tobacco Y/N

Minutes of weekly Physical Activity = (Min PA)___Minutes of weekly Physical Activity = (Min PA)___

Fruits and Vegetables per dayFruits and Vegetables per day = (F/V)___ = (F/V)___Smoking or tobacco exposure = (Tobacco) Y/NSmoking or tobacco exposure = (Tobacco) Y/N

ResourcesResources Major resources in improving our Major resources in improving our

preventive efforts are:preventive efforts are: Guide to Clinical Preventive ServicesGuide to Clinical Preventive Services from the US from the US

Preventive Services Task ForcePreventive Services Task Force.. www.cancerkansas.orgwww.cancerkansas.org

• Links to American Cancer Society (ACS), Cancer Links to American Cancer Society (ACS), Cancer Information Service (CIS), and other reliable Information Service (CIS), and other reliable resourcesresources

• Aids and materials to help you provide Aids and materials to help you provide consistent information and instruction on cancer consistent information and instruction on cancer prevention (i.e. tobacco use and exposure, prevention (i.e. tobacco use and exposure, nutrition, physical activity, environmental nutrition, physical activity, environmental exposure).exposure).

Preventive Vital Signs

Minutes of weekly Physical Activity = (Min PA) ___

Fruits and Vegetables per day = (F/V) ___

Smoking or tobacco exposure = (Tobacco) Y/N

BP___ P___ R___ BMI (or wt.)___Min PA___ F/V___ Tobacco Y/N

Screening/Early Detection: Screening/Early Detection: Goals, Strategies, Rationale, Goals, Strategies, Rationale,

Action StepsAction Steps

What can YOU do as a partner in What can YOU do as a partner in this effort?this effort?

Continuously update your knowledge of Continuously update your knowledge of accepted screening guidelinesaccepted screening guidelines

Create better office systems to operationalize Create better office systems to operationalize your screening effortsyour screening efforts

Participate in and support research and data Participate in and support research and data collectioncollection

Help in overcoming the financial and social Help in overcoming the financial and social barriers that restrict Kansans ability to barriers that restrict Kansans ability to access early screening and detectionaccess early screening and detection

Obtaining the Latest in Cancer Obtaining the Latest in Cancer Screening GuidelinesScreening Guidelines

The United States Preventive Services Task Force The United States Preventive Services Task Force (USPSTF) (USPSTF) http://www.ahrq.gov/clinic/pocketgd.htmhttp://www.ahrq.gov/clinic/pocketgd.htm

MD Anderson Cancer Center--MD Anderson Cancer Center--The OncoLog Report to The OncoLog Report to PhysiciansPhysicians——www2.mdanderson.org/depts/oncologwww2.mdanderson.org/depts/oncolog and and refer to the refer to the April 06April 06 newsletter newsletter

Memorial Sloan Kettering Cancer Center (includes Memorial Sloan Kettering Cancer Center (includes skin cancer) skin cancer) www.mskcc.org/mskcc/print/65279.cfmwww.mskcc.org/mskcc/print/65279.cfm

American Cancer Society Guidelines for the Early American Cancer Society Guidelines for the Early Detection of Cancer (Detection of Cancer (www.cancer.orgwww.cancer.org))

No specific guidelines are outlined for screening for No specific guidelines are outlined for screening for lung cancer lung cancer

The lack of specific guidelines in no way restricts The lack of specific guidelines in no way restricts providers from recommending screening on other providers from recommending screening on other grounds.grounds.

Operationalizing your Cancer Operationalizing your Cancer screening and follow upscreening and follow up

The key to optimal screening lies in the The key to optimal screening lies in the application of updated guidelinesapplication of updated guidelines

Determine what updated guidelines you Determine what updated guidelines you will primarily followwill primarily follow

Remember to include screening Remember to include screening systems when developing Electronic systems when developing Electronic Health Record (EHR) systems.Health Record (EHR) systems.

Ask yourself “What system is in Ask yourself “What system is in place” to:place” to: Be sure patients receive appropriate Be sure patients receive appropriate

screeningscreening• When they visit your office routinely?When they visit your office routinely?• For those who may not be seen frequently?For those who may not be seen frequently?• For those at high risk?For those at high risk?• For those with economic barriers to care?For those with economic barriers to care?• For follow up of those with positive or For follow up of those with positive or

borderline cancer screenings?borderline cancer screenings?

Ages 18 to 49 Years DATE

AGE 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 Blood Pressure

Serum Cholesterol

Tobacco Weight Td Booster Fecal Occult Blood

Pap Smear Breast Exam Mammogram Osteoporosis EDUCATION Use of Seat Belts

Self Exams Oral, Testes

Breast Self-Exam

Post Menop. Bleeding

Ages 50 to 81 YearsDATE

2 –8

6

3 - 8

7

2 –

88

3 - 9

0

AGE 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 Blood Pressure

Serum Cholesterol

Weight Td Booster Fecal Occult Pap Smear Breast Exam Mammogram Osteoporosis EDUCATION Use of Seat Belts

Self Exams Oral, Testes

Breast Self-Exam

Post Menop. Bleeding

N

QUIT 5-85

HYSTERECTOMY 1987

Frame, P. S. (1992). Health Maintenance in Clinical Practice: Strategies and Barriers. American Family Physician, 45, 1192-1200.

~ Kansas Comprehensive Cancer Control Planhttp://www.kdheks.gov/edw/download/kansas_cancer_control_plan_final_report.pdf

~ www.cancerkansas.org- Links to American Cancer Society (ACS), Cancer

Information Service (CIS), and other reliable resources Aids and materials to help you provide consistent information and instruction on cancer prevention (i.e. tobacco use and exposure, nutrition, physical activity, environmental exposure).

~ The United States Preventive Services Task Force (USPSTF)http://www.ahrq.gov/clinic/pocketgd.htm

~ MD Anderson Cancer Center--The OncoLog Report to Physicianswww2.mdanderson.org/depts/oncolog and refer to the April 06 newsletter

~ Memorial Sloan Kettering Cancer Center (includes skin cancer) www.mskcc.org/mskcc/print/65279.cfm

~ American Cancer Society Guidelines for the Early Detection of Cancer www.cancer.org

Web Resources:

Diagnosis/Treatment: Goals, Diagnosis/Treatment: Goals, Strategies, Rationale, Action Strategies, Rationale, Action

StepsSteps

What can YOU do to improve What can YOU do to improve Diagnosis and Treatment?Diagnosis and Treatment?

Utilize the map of Cancer Treatment Utilize the map of Cancer Treatment Locations in the State of Kansas for the Locations in the State of Kansas for the best and closest referralbest and closest referral Post the MAP in your office Post the MAP in your office

Enroll patients in clinical trials whenever Enroll patients in clinical trials whenever possiblepossible Be sure you are able to access timely Be sure you are able to access timely

information through information through www.cancerkansas.orgwww.cancerkansas.org Be sure your patients have the support Be sure your patients have the support

they needthey need Patient advocatePatient advocate Case managerCase manager

Wichita CCOPWichita CCOP Main location: Wichita, KSMain location: Wichita, KS Satellite locations:Satellite locations:

- Chanute- Chanute - Dodge City - Dodge City

- El Dorado- El Dorado - Kingman - Kingman

- Liberal- Liberal - Pratt - Pratt

- Newton- Newton - Salina - Salina

- Wellington- Wellington - Winfield- Winfield

Kansas Cancer Treatment Locations

Survivorship/End of Life: Survivorship/End of Life: Goals, Strategies, Rationale, Goals, Strategies, Rationale,

Action StepsAction Steps

What can YOU do as a partner in What can YOU do as a partner in this effort?this effort?

Be sure that every cancer survivor has a planBe sure that every cancer survivor has a plan Use a cancer survivor checklistUse a cancer survivor checklist Be sure that provision for adequate follow-up is in placeBe sure that provision for adequate follow-up is in place

Be familiar with your local hospice and palliative Be familiar with your local hospice and palliative servicesservices

Investigate your local hospice resourcesInvestigate your local hospice resources Become more educated on palliation and know where Become more educated on palliation and know where

resources are locatedresources are located

Make advanced directives available to your patientsMake advanced directives available to your patients—especially your cancer patients facing an —especially your cancer patients facing an uncertain futureuncertain future

Living willsLiving wills Healthcare durable power of attorney documentsHealthcare durable power of attorney documents

Cancer Survivor ChecklistCancer Survivor Checklist List of diagnostic tests performed and List of diagnostic tests performed and

resultsresults Dates of treatment initiation and Dates of treatment initiation and

completioncompletion Full contact information on treating Full contact information on treating

institutions and key providers institutions and key providers A description of recommended cancer A description of recommended cancer

screening and other periodic testing screening and other periodic testing and examinations and the schedule on and examinations and the schedule on which they should be performedwhich they should be performed

Information on any possible late and Information on any possible late and long term effects of treatment and long term effects of treatment and symptoms of such effects.symptoms of such effects.

Information on possible signs of Information on possible signs of recurrence and second tumors.recurrence and second tumors.

Information on the potential insurance, Information on the potential insurance, employment, and financial employment, and financial consequences of cancer and referral to consequences of cancer and referral to resources when necessary.resources when necessary.

Information on possible social/emotional Information on possible social/emotional effects of cancer, including effects of cancer, including marital/partner relationships, work, marital/partner relationships, work, parenting, and the need for psychosocial parenting, and the need for psychosocial support.support.

Specific recommendations for healthy Specific recommendations for healthy behaviors, such as diet, exercise, healthy behaviors, such as diet, exercise, healthy weight, sunscreen use, smoking weight, sunscreen use, smoking cessation, etc. to help prevent any cancer cessation, etc. to help prevent any cancer recurrence. recurrence.

As appropriate, information on known As appropriate, information on known effective chemo preventive strategies for effective chemo preventive strategies for secondary prevention (Tamoxifen in secondary prevention (Tamoxifen in women at high risk for breast cancer; women at high risk for breast cancer; aspirin for colorectal cancer prevention).aspirin for colorectal cancer prevention).

Referrals to specific follow-up care Referrals to specific follow-up care providers, support groups, and/or the providers, support groups, and/or the patient’s primary care provider. patient’s primary care provider.

A listing of cancer-related resources and A listing of cancer-related resources and information (Internet based sources and information (Internet based sources and telephone listings for major cancer telephone listings for major cancer support organizations.support organizations.

~ Source: Institute of Medicine Fact Sheet, November 2005: Cancer Survivorship Care Planning

Hospice ResourcesHospice Resources LIFE Project has resources on Hospice, including finding a hospice program, LIFE Project has resources on Hospice, including finding a hospice program,

information on paying for hospice, palliative care, and advanced directives.information on paying for hospice, palliative care, and advanced directives.

LIFE Project, www.lifeproject.orgLIFE Project, www.lifeproject.org

Caring Connections, Caring Connections, www.caringinfo.orgwww.caringinfo.org

Advanced DirectivesAdvanced Directives A living will allows the patient to document A living will allows the patient to document

their wishes concerning medical treatments their wishes concerning medical treatments at the end of life. at the end of life.

A medical power of attorney (or health care A medical power of attorney (or health care proxy) allows the patient to appoint a person proxy) allows the patient to appoint a person they trust as their health care agent (or they trust as their health care agent (or surrogate decision maker), who is authorized surrogate decision maker), who is authorized to make medical decisions on their behalf. to make medical decisions on their behalf.

Kansas Life Project, Caring Connections, www.lifeproject.org/home

Advanced Directives and Hospice Resources

•Caring Connections, a program of the National Hospice and Palliative Care Organization (NHPCO), is a national consumer engagement initiative to improve care at the end of life, supported by a grant from The Robert Wood Johnson Foundation. They offer resources on hospice and palliative care, state specific advanced directives forms, care giving, etc.

www.caringinfo.org

•The Life Project is a collaborative effort whose mission is to help all Kansans with advanced chronic and terminal illnesses live with dignity comfort and peace. The project is a coalition of many organizations working together to improve end-of-life care.

www.lifeproject.org

•Kansas Health Ethics (KHE) is a nonprofit educational organization formed in 1992. KHE wants to help all Kansans understand the importance of ethics in healthcare planning and decision making, and equip them to make good healthcare and quality of life decisions. KHE provides Living Wills, Health Care Powers of Attorney, "Do Not Resuscitate" and other advance directives documents and information about their use to individuals as well as to facilities and institutions across Kansas.

www.kansashealthethics.org

SummarySummary

The Kansas Comprehensive Cancer The Kansas Comprehensive Cancer Control and Prevention Plan is a Control and Prevention Plan is a blueprint for the development of the blueprint for the development of the future of cancer care in Kansasfuture of cancer care in Kansas

It represents a major effort in trying to It represents a major effort in trying to create a “system” that can increase create a “system” that can increase availability, fairness, quality and availability, fairness, quality and optimal outcomes in the field of cancer optimal outcomes in the field of cancer care.care.

What we want YOU to take homeWhat we want YOU to take home

First we want you to appreciate the scope First we want you to appreciate the scope and importance of this major focus on all and importance of this major focus on all areas of cancer care and the time and areas of cancer care and the time and money that have been and will be money that have been and will be dedicated to the effortdedicated to the effort

Secondly, and possibly more importantly, Secondly, and possibly more importantly, we want you to take home and USE any of we want you to take home and USE any of the suggestions and/or materials the suggestions and/or materials presented here.presented here.

Summary of toolsSummary of tools Concept of “Preventive Vital Signs”Concept of “Preventive Vital Signs” Ideas and resources for selecting and Ideas and resources for selecting and

implementing screening in your implementing screening in your officeoffice

The Map of Cancer Resources The Map of Cancer Resources throughout Kansasthroughout Kansas

The The www.cancerkanses.orgwww.cancerkanses.org website website Listing of hospice and palliation Listing of hospice and palliation

resources resources Advance directive materialsAdvance directive materials

Additional Opportunity: Point of Additional Opportunity: Point of Care (POC) CMECare (POC) CME

New system to address clinical New system to address clinical questions and/or care that arise in your questions and/or care that arise in your practicepractice

Web based resource designed to Web based resource designed to provide practice based learningprovide practice based learning

Self directed, on-line learning at the Self directed, on-line learning at the "point of care" i.e., your office"point of care" i.e., your office

POC StepsPOC Steps Identify practice-based knowledge needs Identify practice-based knowledge needs Complete extensive background research on Complete extensive background research on

a clinical questions a clinical questions Reinforce clinical decisions through review Reinforce clinical decisions through review

of published evidenceof published evidence Learn new information related to clinical Learn new information related to clinical

practice practice Improve patient care by utilizing current Improve patient care by utilizing current

published evidencepublished evidence

University of Kansas AHECsUniversity of Kansas AHECs Will provide:Will provide:

Provide individual orientation on the processProvide individual orientation on the process TrackingTracking Document activity Document activity Identify appropriate evidence-based medical databasesIdentify appropriate evidence-based medical databases Meet with professionals participating in the pilot project Meet with professionals participating in the pilot project

periodically to obtain your feedback.periodically to obtain your feedback. Grant CME and Nursing CEGrant CME and Nursing CE

Physicians may claim up to 20 AMA PRA Category 1 Physicians may claim up to 20 AMA PRA Category 1 credits per yearcredits per year

Nurses (through American Nurses Credentialing Center Nurses (through American Nurses Credentialing Center or ANCC)or ANCC)

Pilot in a maximum of 20 locations throughout Kansas Pilot in a maximum of 20 locations throughout Kansas

funded by UKSM-W through a contract with KDHEfunded by UKSM-W through a contract with KDHE

University of Kansas AHECsUniversity of Kansas AHECs AHECs are finalizing the POC steps to AHECs are finalizing the POC steps to

encourage physicians to design or encourage physicians to design or update cancer screening guidelines in update cancer screening guidelines in their practice. Hopefully, the ability to their practice. Hopefully, the ability to claim CME and the recognition of the claim CME and the recognition of the importance of screening guidelines importance of screening guidelines based on their own patients will based on their own patients will increase the number of physicians increase the number of physicians with routine screening protocols in with routine screening protocols in their office practices.their office practices.

Department of Preventive Department of Preventive Medicine & Public Health, Medicine & Public Health, KUSM-W PVS Pilot StudyKUSM-W PVS Pilot Study

One busy primary care office will be trained One busy primary care office will be trained on the protocol for implementation of on the protocol for implementation of Preventive Vital Signs and implement Preventive Vital Signs and implement protocol for one monthprotocol for one month

Interviews with physicians and staff will Interviews with physicians and staff will provide feedback to revise protocolprovide feedback to revise protocol

Additional practices will implement the Additional practices will implement the revised protocol for one monthrevised protocol for one month

Interviews will be used to evaluate processInterviews will be used to evaluate process

In a world where we too often see In a world where we too often see human life undervalued, we have a human life undervalued, we have a chance to fight back. It is our job as chance to fight back. It is our job as health care providers to prove through health care providers to prove through the quality and comprehensiveness of the quality and comprehensiveness of our effort that every human life is our effort that every human life is extraordinary. That is what the Kansas extraordinary. That is what the Kansas Cancer Plan is all about. Cancer Plan is all about.

James Early, M.D.James Early, M.D.KUSM-WKUSM-W

Dissemination StatisticsDissemination Statistics 6 presentations statewide:6 presentations statewide:

Chanute, KSChanute, KS Colby, KSColby, KS Dodge City, KSDodge City, KS Hutchinson, KSHutchinson, KS McPherson, KSMcPherson, KS Pittsburg, KSPittsburg, KS

Presentations for AHEC, Presentations for AHEC, KAFP Meeting, and KU KAFP Meeting, and KU Continuing EducationContinuing Education

46 physicians, nurse 46 physicians, nurse clinicians and physicians clinicians and physicians assistants visited in 11 assistants visited in 11 clinicsclinics

147 CME packets mailed out147 CME packets mailed out 186 people attended 186 people attended

presentationspresentations CME packets available at CME packets available at

AHEC offices statewideAHEC offices statewide

Kansas Dissemination by CountyKansas Dissemination by County