Rhode Island Prevention Connection
Your resource for optimizing the use of your electronic health record (EHR) system to improve the quality and frequency of preventive health care services |
Sometimes It Takes a Village AND a Champion
SCUP: SCREENING COLONOSCOPY IN THE UNDERSERVED POPULATION
Dr. Joseph DiMase's innovative approach to Screening Colonoscopy in the Underserved Population (SCUP) has been receiving ever widening attention. SCUP's mission is to provide free colonoscopies for uninsured patients between 50 and 64 years of age. The RI Department of Health currently estimates the state's uninsured underserved population between 50 and 65 years old to be at 9000.
The concept is to match uninsured persons with local volunteer gastroenterologists and surgeons willing to perform pro bono screening colonoscopies. A Public Health Briefing, linked below and published last August, cited the program's goal of connecting these services for over 30 Rhode Island Community Health Association Clinics and the Rhode Island Free Clinic. At that publication date, seven Community Health Centers (CHC's) were engaged in SCUP.
Click here to read this article in its entirety. For further information on this successful program, click here. |
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Doctor's Corner
by Christopher Campanile, MD, PhD
Timing of Follow-Up Colonoscopy
 We all are aware that colonic polyps are a common finding. About half of patients over the age of 60 have at least one polyp. This means we are often faced with colonoscopy pathology reports for patients who will need their next colonoscopy in less than 10 years, the interval recommended for patients with no polyps and no family history of colon cancer, inflammatory bowel disease or polyposis syndromes. Though ideally the primary care physician would receive a recommendation from the colonoscopist regarding timing of the next colonoscopy, this is not always forthcoming, and so it is incumbent upon PCPs to be knowledgeable of this area of GI medicine.
To review, there are four types of colonic polyps: adenomatous, hyperplastic, inflammatory, and hamartomatous. Structurally, they are also classified as pedunculated or sessile. Small hyperplastic polyps and inflammatory polyps do not have any significant malignant potential, and so do not require more frequent surveillance than every 10 years. Most hamartomatous do not become cancerous except for those associated with Peutz-Jehgers syndrome and juvenile polyposis, and in these cases I would rely on the recommendation from the endoscopist. Adenomatous polyps, on the other hand, are precursors to colon cancer and call for a repeat colonoscopy in less than 10 years.
Adenomatous polyps can be classified histologically as villous, tubular, or tubulovillous. The risk for eventual cancer is proportional to the size of a tubular adenoma and the degree to which it is villous. The histology has been simplified to low and high grade dysplasia. Sessile polyps have a greater risk of harboring high grade dysplasia or frank malignancy compared to pedunculated polyps. Fifty percent of patients will have more than one adenomatous polyp so a thorough examination of the entire colon is called for. Twenty to fifty percent of patients with an adenomatous polyp will have a new adenoma found within 5 years.
Click here to view the rest of the article including a table summarizing recommmended surveillance of colon polpys. |
In the News
SPRING INTO ACTION ON CRC
According to the ACS, a recommendation from a physician is consistently found to be the most influential factor in determining whether a patient is screened for colorectal cancer.
In early February of this year, the National Institutes of Health (NIH) hosted a State-of-the-Science Conference on "Enhancing Use and Quality of Colorectal Cancer Screening" and found that screening rates nationally continue to fall short of desirable levels. They identified six priority areas to be addressed:
1. Elimination of financial barriers
2. Implementation of proven patient interventions (i.e.
reminder systems, patient navigation)
3. Research to assess programs tailored to specific
population groups
4. Systemizing follow-up to positive results for
colorectal cancer
5. Systemizing quality measures
6. Comparison studies on effectiveness of screening
methods
Interventions that have been shown to increase patient compliance with recommendations for screening:
1. Alerts and reminders within your electronic health
record comprise one part of the equation
2. Patient education and personal contact throughout
the process, by means of a systemized patient
navigation process, is the other
Click here to read this article in its entirety.
The American Cancer Society has available online a recent comprehensive review of this topic and CME credits are available.
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Prevention Update
BENCHMARKED DATA ACROSS PROJECT
Quarter 6 Data (Nov., Dec., Jan.) is now available! Do you have a meeting scheduled to review your practice data and benchmarked de-identified data across the Power Up for Prevention project? If not, please contact us. Now that we have collected at least 2 quarters of data beyond baseline, we can more easily identify opportunities for process improvements. |
Sharing Best Practices
MEANINGFUL USE & PATIENT-CENTERED MEDICAL HOME
Do you realize the work you are doing in this project aligns with some elements of meaningful use and Patient-Centered Medical Home(PCMH)? Meaningful Use (MU)requires providers to not only use their electronic medical record to track preventive care, but to also provide reminders to patients and utilize alerts and reminders in clinical decision support to name a few. Many of these are the same principles found in PCMH. NCQA is in the process of creating a cross-walk between PCMH and MU as a tool for the providers working to acheive this recognition. Congratulations on being part of the cutting edge of healthcare evolution!
Please contact us with your best practices and we will share your successes in our newsletter. |
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Tip of the Month
The Rhode Island Foundation has awarded Shape Up RI a $250,000 three year grant through the Fund for a Healthy Rhode Island to enable and empower physicians to prescribe wellness for their patients. With a mission to support and enhance primary care in RI, this grant will help them provide physicians with a simple and effective tool to encourage their patients to pursue a healthy lifestyle through physical activity, nutrition, and weight management.
Over 100 doctors from the Rhode Island Primary Care Physicians Corporation are already on board, and the Rhode Island State Nurses Association have engaged in this program. To learn how you can provide this free service to your patients, click here. | |
This material was prepared by Quality Partners of Rhode Island, the Quality Improvement Organization for Rhode Island, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. | |
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Quote of the Month
Your current safe boundries were once unknown
~Unknown
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Events
Colon Cancer Alliance Tues., March,16
5:00-8:00 p.m.
Friendly's Restaurant Warwick & Wakefield
W&I Center for Women's GI Services and the ACS
Tues., March 16
11:30 a.m. -3:00 p.m.
Center for Women's Gastrointestinal Services, 100 Dudley Street, 2nd Floor -Free
Balloon Release
Sat., March 13
11:00 a.m.
Sat., March 27
6:30 p.m. - 11:00 p.m.
Gillette Stadium
RI Breast Cancer Coalition
Sat., March 20
11:15 a.m.
RI State House
What's Going On?
Campaign for Safe Cosmetics
Sat., March 13
4-5:30 p.m. -Free
Thurs., April 29
7:00 a.m. Grand Ballroom
Providence Marriott
One Orms Street |
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Tools
Patient Education Brochures
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Medicare Quick References
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EHR Tools
eClinicalWorks
EpiChart
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Feedback Requested
Thank you for your commitment to quality.
If you have questions or comments or require technical assistance on the Power Up for Prevention Project, please contact
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