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Gupta S, Barnes A, Brenner AT, Campbell J, Davis M, English K, Hoover S, Kim K, Kobrin S, Lance P, Mishra SI, Oliveri JM, Reuland DS, Subramanian S, Coronado GD. Mail-Based Self-Sampling to Complete Colorectal Cancer Screening: Accelerating Colorectal Cancer Screening and Follow-up Through Implementation Science. Prev Chronic Dis 2023; 20:E112. [PMID: 38060411 PMCID: PMC10723083 DOI: 10.5888/pcd20.230083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Introduction Leveraging cancer screening tests, such as the fecal immunochemical test (FIT), that allow for self-sampling and postal mail for screening invitations, test delivery, and return can increase participation in colorectal cancer (CRC) screening. The range of approaches that use self-sampling and mail for promoting CRC screening, including use of recommended best practices, has not been widely investigated. Methods We characterized self-sampling and mail strategies used for implementing CRC screening across a consortium of 8 National Cancer Institute Cancer Moonshot Initiative Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) research projects. These projects serve diverse rural, urban, and tribal populations in the US. Results All 8 ACCSIS projects leveraged self-sampling and mail to promote screening. Strategies included organized mailed FIT outreach with mailed invitations, including FIT kits, reminders, and mailed return (n = 7); organized FIT-DNA outreach with mailed kit return (n = 1); organized on-demand FIT outreach with mailed offers to request a kit for mailed return (n = 1); and opportunistic FIT-DNA with in-clinic offers to be mailed a test for mailed return (n = 2). We found differences in patient identification strategies, outreach delivery approaches, and test return options. We also observed consistent use of Centers for Disease Control and Prevention Summit consensus best practice recommendations by the 7 projects that used mailed FIT outreach. Conclusion In research projects reaching diverse populations in the US, we observed multiple strategies that leverage self-sampling and mail to promote CRC screening. Mail and self-sampling, including mailed FIT outreach, could be more broadly leveraged to optimize cancer screening.
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Affiliation(s)
- Samir Gupta
- University of California, San Diego, 3350 La Jolla Village Dr, MC 111D, PO Box 12194, San Diego, CA 92160
- Jennifer Moreno VA Healthcare System, San Diego, California
| | - Autumn Barnes
- RTI International, Research Triangle Park, North Carolina
| | - Alison T Brenner
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
- Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill
| | - Janis Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City
| | | | - Kevin English
- Albuquerque Area Indian Health Board, Inc, Albuquerque, New Mexico
| | - Sonja Hoover
- RTI International, Research Triangle Park, North Carolina
| | - Karen Kim
- University of Chicago Medicine, Chicago, Illinois
| | - Sarah Kobrin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - Shiraz I Mishra
- University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque
| | - Jill M Oliveri
- The Ohio State University Comprehensive Cancer Center, Columbus
| | - Daniel S Reuland
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
- Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill
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Arena L, Soloe C, Schlueter D, Ferriola-Bruckenstein K, DeGroff A, Tangka F, Hoover S, Melillo S, Subramanian S. Modifications in Primary Care Clinics to Continue Colorectal Cancer Screening Promotion During the COVID-19 Pandemic. J Community Health 2023; 48:113-126. [PMID: 36308666 PMCID: PMC9617236 DOI: 10.1007/s10900-022-01154-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/28/2022]
Abstract
COVID-19 caused significant declines in colorectal cancer (CRC) screening. Health systems and clinics, faced with a new rapidly spreading infectious disease, adapted to maintain patient safety and address the effects of the pandemic on healthcare delivery. This study aimed to understand how CDC-funded Colorectal Cancer Control Program recipients and their partner health systems and clinics may have modified evidence-based intervention (EBI) implementation to promote CRC screening during the COVID-19 pandemic; to identify barriers and facilitators to implementing modifications; and to extract lessons that can be applied to support CRC screening, chronic disease management, and clinic resilience in the face of future public health crises. Nine recipients were selected to reflect the diversity inherent among all CRCCP recipients. Recipient and clinic partner staff answered unique sets of pre-interview questions to inform tailoring of interview guides that were developed using constructs from the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) and Consolidated Framework for Implementation Research (CFIR). The study team then interviewed recipient, health system, and clinic partner staff incorporating pre-interview responses to focus each conversation. We employed a rapid qualitative analysis approach then conducted virtual focus groups with recipient representatives to validate emergent themes. Three modifications that emerged from thematic analysis include: (1) offering mailed fecal immunochemical test (FIT) kits for CRC screening with mail or drop off return; (2) increasing the use of patient education and engagement strategies; and (3) increasing the use of or improving automated patient messaging systems. With improved tracking and automated reminder systems, mailed FIT kits paired with tailored patient education and clear instructions for completing the test could help primary care clinics catch up on the backlog of missed screenings during COVID-19. Future research can assess the effectiveness and cost-effectiveness of offering mailed FIT kits on maintaining or improving CRC screening, especially among people who are medically underserved.
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Affiliation(s)
- Laura Arena
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA.
| | - Cindy Soloe
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709 USA
| | - Dara Schlueter
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | | | - Amy DeGroff
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Florence Tangka
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Sonja Hoover
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709 USA
| | - Stephanie Melillo
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Sujha Subramanian
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709 USA
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Tangka FKL, Subramanian S, Hoover S, Cariou C, Creighton B, Hobbs L, Marzano A, Marcotte A, Norton DD, Kelly-Flis P, Leypoldt M, Larkins T, Poole M, Boehm J. Improving the efficiency of integrated cancer screening delivery across multiple cancers: case studies from Idaho, Rhode Island, and Nebraska. Implement Sci Commun 2022; 3:133. [PMID: 36527147 PMCID: PMC9756516 DOI: 10.1186/s43058-022-00381-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Three current and former awardees of the Centers for Disease Control and Prevention's Colorectal Cancer Control Program launched integrated cancer screening strategies to better coordinate multiple cancer screenings (e.g., breast, cervical, colorectal). By integrating the strategies, efficiencies of administration and provision of screenings can be increased and costs can be reduced. This paper shares findings from these strategies and describes their effects. METHODS The Idaho Department of Health and Welfare developed a Baseline Assessment Checklist for six health systems to assess the current state of policies regarding cancer screening. We analyzed the checklist and reported the percentage of checklist components completed. In Rhode Island, we collaborated with a nurse-patient navigator, who promoted cancer screening, to collect details on patient navigation activities and program costs. We then described the program and reported total costs and cost per activity. In Nebraska, we described the experience of the state in administering an integrated contracts payment model across colorectal, breast, and cervical cancer screening and reported cost per person screened. Across all awardees, we interviewed key stakeholders. RESULTS In Idaho, results from the checklist offered guidance on areas for enhancement before integrated cancer screening strategies, but identified challenges, including lack of capacity, limited staff availability, and staff turnover. In Rhode Island, 76.1% of 1023 patient navigation activities were for colorectal cancer screening only, with a much smaller proportion devoted to breast and cervical cancer screening. Although the patient navigator found the discussions around multiple cancer screening efficient, patients were not always willing to discuss all cancer screenings. Nebraska changed its payment system from fee-for-service to fixed cost subawards with its local health departments, which integrated cancer screening funding. Screening uptake improved for breast and cervical cancer but was mixed for colorectal cancer screening. CONCLUSIONS The results from the case studies show that there are barriers and facilitators to integrating approaches to increasing cancer screening among primary care facilities. However, more research could further elucidate the viability and practicality of integrated cancer screening programs.
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Affiliation(s)
- Florence K. L. Tangka
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop S107-4, Atlanta, GA 30341-3717 USA
| | - Sujha Subramanian
- grid.62562.350000000100301493RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452-8413 USA
| | - Sonja Hoover
- grid.62562.350000000100301493RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452-8413 USA
| | - Charlene Cariou
- Southwest District Health, 13307 Miami Lane, Caldwell, ID 83607 USA
| | - Becky Creighton
- grid.280384.50000 0004 0394 4525Idaho Comprehensive Cancer Control Program, Division of Public Health, Idaho Department of Health and Welfare, 450 W State Street, Boise, ID 83702 USA
| | - Libby Hobbs
- grid.280384.50000 0004 0394 4525Bureau of Community and Environmental Health, Division of Public Health, Idaho Department of Health and Welfare, 450 W State Street, Boise, ID 83702 USA
| | - Amanda Marzano
- WellOne Primary Medical and Dental Care, 35 Village Plaza Way, North Scituate, RI 02857 USA
| | - Andrea Marcotte
- WellOne Primary Medical and Dental Care, 35 Village Plaza Way, North Scituate, RI 02857 USA
| | - Deirdre Denning Norton
- WellOne Primary Medical and Dental Care, 35 Village Plaza Way, North Scituate, RI 02857 USA
| | - Patricia Kelly-Flis
- WellOne Primary Medical and Dental Care, 35 Village Plaza Way, North Scituate, RI 02857 USA
| | - Melissa Leypoldt
- grid.280417.80000 0004 0420 6102Women’s and Men’s Health Programs, Lifespan Health Unit, Public Health, Nebraska Department of Health and Human Services, 301 Centennial Mall S, Lincoln, NE 68508 USA
| | - Teri Larkins
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop S107-4, Atlanta, GA 30341-3717 USA
| | - Michelle Poole
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop S107-4, Atlanta, GA 30341-3717 USA
| | - Jennifer Boehm
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop S107-4, Atlanta, GA 30341-3717 USA
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Soloe C, Arena L, Schlueter D, Melillo S, DeGroff A, Tangka F, Hoover S, Subramanian S. Factors that support readiness to implement integrated evidence-based practice to increase cancer screening. Implement Sci Commun 2022; 3:106. [PMID: 36199117 PMCID: PMC9535984 DOI: 10.1186/s43058-022-00347-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In 2015, the Centers for Disease Control and Prevention (CDC) funded the Colorectal Cancer Control Program (CRCCP), which partners with health care systems and primary care clinics to increase colorectal cancer (CRC) screening uptake. We interviewed CRCCP stakeholders to explore the factors that support readiness for integrated implementation of evidence-based interventions (EBIs) and supporting activities to promote CRC screening with other screening and chronic disease management activities in primary care clinics. METHODS Using the Consolidated Framework for Implementation Research (CFIR), we conducted a literature review and identified constructs to guide data collection and analysis. We purposively selected four CRCCP awardees that demonstrated ongoing engagement with clinic partner sites, willingness to collaborate with CDC and other stakeholders, and availability of high-quality data. We gathered background information on the selected program sites and conducted primary data collection interviews with program site staff and partners. We used NVivo QSR 11.0 to systematically pilot-code interview data, achieving a kappa coefficient of 0.8 or higher, then implemented a step-wise process to identify site-specific and cross-cutting emergent themes. We also included screening outcome data in our analysis to examine the impact of integrated cancer screening efforts on screening uptake. RESULTS We identified four overarching factors that contribute to clinic readiness to implement integrated EBIs and supporting activities: the funding environment, clinic governance structure, information sharing within clinics, and clinic leadership support. Sites reported supporting clinic partners' readiness for integrated implementation by providing coordinated funding application processes and braided funding streams and by funding partner organizations to provide technical assistance to support efficient incorporation of EBIs and supporting activities into existing clinic workflows. These actions, in turn, support clinic readiness to integrate the implementation of EBIs and supporting activities that promote CRC screening along with other screening and chronic disease management activities. DISCUSSION The selected CRCCP program sites supported clinics' readiness to integrate CRC EBIs and supporting activities with other screening and chronic disease management activities increasing uptake of CRC screening and improving coordination of patient care. CONCLUSIONS We identified the factors that support clinic readiness to implement integrated EBIs and supporting activities including flexible funding mechanisms, effective data sharing systems, coordination across clinical staff, and supportive leadership. The findings provide insights into how public health programs and their clinic partners can collectively support integrated implementation to promote efficient, coordinated patient-centered care.
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Affiliation(s)
- Cindy Soloe
- grid.62562.350000000100301493RTI International, 3040 E. Cornwallis Road, Durham, NC 27709 USA
| | - Laura Arena
- grid.62562.350000000100301493RTI International, 3040 E. Cornwallis Road, Durham, NC 27709 USA
| | - Dara Schlueter
- grid.416781.d0000 0001 2186 5810Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Stephanie Melillo
- grid.416781.d0000 0001 2186 5810Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Amy DeGroff
- grid.416781.d0000 0001 2186 5810Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Florence Tangka
- grid.416781.d0000 0001 2186 5810Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Sonja Hoover
- grid.62562.350000000100301493RTI International, 3040 E. Cornwallis Road, Durham, NC 27709 USA
| | - Sujha Subramanian
- grid.62562.350000000100301493RTI International, 3040 E. Cornwallis Road, Durham, NC 27709 USA
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Subramanian S, Tangka FKL, Hoover S, DeGroff A. Integrated interventions and supporting activities to increase uptake of multiple cancer screenings: conceptual framework, determinants of implementation success, measurement challenges, and research priorities. Implement Sci Commun 2022; 3:105. [PMID: 36199098 PMCID: PMC9532830 DOI: 10.1186/s43058-022-00353-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/19/2022] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Screening for colorectal, breast, and cervical cancer has been shown to reduce mortality; however, not all men and women are screened in the USA. Further, there are disparities in screening uptake by people from racial and ethnic minority groups, people with low income, people who lack health insurance, and those who lack access to care. The Centers for Disease Control and Prevention funds two programs-the Colorectal Cancer Control Program and the National Breast and Cervical Cancer Early Detection Program-to help increase cancer screenings among groups that have been economically and socially marginalized. The goal of this manuscript is to describe how programs and their partners integrate evidence-based interventions (e.g., patient reminders) and supporting activities (e.g., practice facilitation to optimize electronic medical records) across colorectal, breast, and cervical cancer screenings, and we suggest research areas based on implementation science. METHODS We conducted an exploratory assessment using qualitative and quantitative data to describe implementation of integrated interventions and supporting activities for cancer screening. We conducted 10 site visits and follow-up telephone interviews with health systems and their partners to inform the integration processes. We developed a conceptual model to describe the integration processes and reviewed screening recommendations of the United States Preventive Services Task Force to illustrate challenges in integration. To identify factors important in program implementation, we asked program implementers to rank domains and constructs of the Consolidated Framework for Implementation Research. RESULTS Health systems integrated interventions for all screenings across single and multiple levels. Although potentially efficient, there were challenges due to differing eligibility of screenings by age, gender, frequency, and location of services. Program implementers ranked complexity, cost, implementation climate, and engagement of appropriate staff in implementation among the most important factors to success. CONCLUSION Integrating interventions and supporting activities to increase uptake of cancer screenings could be an effective and efficient approach, but we currently do not have the evidence to recommend widescale adoption. Detailed multilevel measures related to process, screening, and implementation outcomes, and cost are required to evaluate integrated programs. Systematic studies can help to ascertain the benefits of integrating interventions and supporting activities for multiple cancer screenings, and we suggest research areas that might address current gaps in the literature.
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Affiliation(s)
- Sujha Subramanian
- grid.62562.350000000100301493RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452-8413 USA
| | - Florence K. L. Tangka
- grid.416781.d0000 0001 2186 5810Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Sonja Hoover
- grid.62562.350000000100301493RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452-8413 USA
| | - Amy DeGroff
- grid.416781.d0000 0001 2186 5810Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
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Schlueter D, DeGroff A, Soloe C, Arena L, Melillo S, Tangka F, Hoover S, Subramanian S. Factors That Support Sustainability of Health Systems Change to Increase Colorectal Cancer Screening in Primary Care Clinics: A Longitudinal Qualitative Study. Health Promot Pract 2022:15248399221091999. [PMID: 35582930 DOI: 10.1177/15248399221091999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND From 2015 to 2020, the Centers for Disease Control and Prevention's Colorectal Cancer Control Program (CRCCP) supported 30 awardees in partnering with primary care clinics to implement evidence-based interventions (EBIs) and supporting activities (SAs) to increase colorectal cancer (CRC) screening. This study identified factors that facilitated early implementation and sustainability within partner clinics. METHODS We conducted longitudinal qualitative case studies of four CRCCP awardees and four of their partner clinics. We used the Consolidated Framework for Implementation Research (CFIR) to frame understanding of factors related to implementation and sustainability. A total of 41 semi-structured interviews were conducted with key staff and stakeholders exploring implementation practices and facilitators to sustainability. Qualitative thematic analysis of interview transcripts identified emerging themes across awardees and clinics. RESULTS Qualitative themes related to six CFIR inner setting constructs-structural characteristics, readiness for implementation, networks and communication, culture, and implementation climate-were identified. Themes related to early implementation included conducting readiness assessments to tailor implementation, providing moderate funding to clinics, identifying clinic champions, and coordinating EBIs and SAs with existing clinic practices. Themes related to sustainability included the importance of ongoing electronic health record (EHR) support, clinic leadership support, team-based care, and EBI and SA integration with clinic policies, workflows, and procedures. IMPLICATIONS Findings help to inform future scale-up of and decision-making within CRC screening programs and other chronic disease prevention programs implementing EBIs and SAs within primary care clinics and also highlight factors that maximize sustainability within these programs.
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Affiliation(s)
- Dara Schlueter
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cindy Soloe
- RTI International, Research Triangle Park, NC, USA
| | - Laura Arena
- RTI International, Research Triangle Park, NC, USA
| | | | - Florence Tangka
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sonja Hoover
- RTI International, Research Triangle Park, NC, USA
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Hoover S, Subramanian S, Sabatino SA, Khushalani JS, Tangka FKL. Late-Stage Diagnosis and Cost of Colorectal Cancer Treatment in Two State Medicaid Programs. J Registry Manag 2021; 48:20-27. [PMID: 34170892 PMCID: PMC10846594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION To assess timing of Medicaid enrollment with late-stage colorectal cancer (CRC) diagnosis and estimate treatment costs by stage at diagnosis. METHODS We analyzed 2000-2009 California and Texas Medicaid data linked with cancer registry data. We assessed the association of Medicaid enrollment timing with late-stage colorectal cancer and estimated total and incremental 6-month treatment costs to Medicaid by stage using a noncancer comparison group matched on age group and sex. RESULTS Compared with Medicaid enrollment before diagnosis, enrolling after diagnosis was associated with late-stage diagnosis. Incremental per-person treatment costs were $31,063, $39,834, and $47,161 for localized, regional, and distant stage in California, respectively; and $28,701, $38,212, and $49,634 in Texas, respectively. DISCUSSION In California and Texas, Medicaid enrollment after CRC diagnosis was associated with later-stage disease and higher treatment costs. Facilitating timely and continuous Medicaid enrollment may lead to earlier stage at diagnosis, reduced costs, and improved outcomes.
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Hardin V, Tangka FKL, Wood T, Boisseau B, Hoover S, DeGroff A, Boehm J, Subramanian S. The Effectiveness and Cost to Improve Colorectal Cancer Screening in a Federally Qualified Homeless Clinic in Eastern Kentucky. Health Promot Pract 2020; 21:905-909. [PMID: 32990049 DOI: 10.1177/1524839920954165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The objective of this study was to analyze the effectiveness and cost of patient incentives, together with patient navigation and patient reminders, to increase fecal immunochemical test (FIT) kit return rates and colorectal cancer screening uptake in one federally qualified health center (FQHC) in Appalachia. This FQHC is a designated homeless clinic, as 79.7% of its patient population are homeless. We collected process, outcome, and cost data from the FQHC for two time periods: usual care (September 2016-August 2017) and implementation (September 2017-September 2018). We reported the FIT kit return rate, the increase in return rate, and the additional number of individual screens. We also calculated the incremental cost per additional screen. The patient incentive program, with patient navigation and patient reminders, increased the number of FIT kits returned from the usual care period to the implementation period. The return rate increased by 25.9 percentage points (from 21.7% to 47.6%) with an additional 91 people screened at an incremental cost of $134.61 per screen. A patient incentive program, together with the assistance of patient navigators and supplemented with patient reminders, can help improve CRC screening uptake among vulnerable and homeless populations.
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Affiliation(s)
| | | | - Teri Wood
- Kentucky Department for Public Health, Frankfort, KY, USA
| | - Brian Boisseau
- Kentucky Department for Public Health, Frankfort, KY, USA
| | | | - Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Boehm
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Kim KE, Tangka FKL, Jayaprakash M, Randal FT, Lam H, Freedman D, Carrier LA, Sargant C, Maene C, Hoover S, Joseph D, French C, Subramanian S. Effectiveness and Cost of Implementing Evidence-Based Interventions to Increase Colorectal Cancer Screening Among an Underserved Population in Chicago. Health Promot Pract 2020; 21:884-890. [PMID: 32990041 DOI: 10.1177/1524839920954162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
With funding from the Centers for Disease Control and Prevention's Colorectal Cancer Control Program, The University of Chicago Center for Asian Health Equity partnered with a federally qualified health center (FQHC) to implement multiple evidence-based interventions (EBIs) in order to improve colorectal cancer (CRC) screening uptake. The purpose of this study is to determine the effectiveness and cost of implementing a provider reminder system entered manually and supplemented with patient reminders and provider assessment and feedback. The FQHC collected demographic characteristics of the FQHC and outcome data from January 2015 through December 2015 (preimplementation period) and cost from January 2016 through September 2017 (implementation period). Cost data were collected for the implementation period. We report on the demographics of the eligible population, CRC screening order, completion rates by sociodemographic characteristics, and, overall, the effectiveness and cost of implementation. From the preimplementation phase to the implementation phase, there was a 21.2 percentage point increase in CRC screens completed. The total cost of implementing EBIs was $40908.97. We estimated that an additional 283 screens were completed because of the interventions, and the implementation cost of the interventions was $144.65 per additional screen. With the interventions, CRC screening uptake in Chicago increased for all race/ethnicity and demographic backgrounds at the FQHC, particularly for patients aged 50 to 64 years and for Asian, Hispanic, and uninsured patients.
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Affiliation(s)
| | | | | | | | - Helen Lam
- University of Chicago, Chicago, IL, USA
| | | | | | | | | | | | - Djenaba Joseph
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia French
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Conn ME, Kennedy-Rea S, Subramanian S, Baus A, Hoover S, Cunningham C, Tangka FKL. Cost and Effectiveness of Reminders to Promote Colorectal Cancer Screening Uptake in Rural Federally Qualified Health Centers in West Virginia. Health Promot Pract 2020; 21:891-897. [PMID: 32990048 DOI: 10.1177/1524839920954164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The purpose of this study is to evaluate the effectiveness of the West Virginia Program to Increase Colorectal Cancer Screening in implementing patient reminders to increase fecal immunochemical test (FIT) kit return rates in nine federally qualified health centers (FQHCs). Using process measures and cost data collected, the authors examined the differences in the intensity of the phone calls across FQHCs and compared them with the return rates achieved. They also reported the cost per kit successfully returned as a result of the intervention. Across all FQHCs, 5,041 FIT kits were ordered, and the initial return rate (without a reminder) was 41.1%. A total of 2,201 patients received reminder phone calls; on average, patients received 1.61 reminder calls each. The reminder interventions increased the average FIT kit return rate to 60.7%. The average total cost per FIT kit returned across all FQHCs was $60.18, and the average cost of only the reminders was $11.20 per FIT kit returned. FQHCs achieved an average increase of 19.6 percentage points in FIT kit return rates, and costs across clinics varied. Clinics with high-quality health information systems that enabled tracking of patients with minimal effort were able to implement lower cost reminder interventions.
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Affiliation(s)
| | | | | | - Adam Baus
- West Virginia University, Morgantown, WV, USA
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Barajas M, Tangka FKL, Schultz J, Tantod K, Kempster YM, Omelu N, Hoover S, Thomas M, Richmond-Reese V, Subramanian S. Examining the Effectiveness of Provider Incentives to Increase CRC Screening Uptake in Neighborhood Healthcare: A California Federally Qualified Health Center. Health Promot Pract 2020; 21:898-904. [PMID: 32990046 DOI: 10.1177/1524839920954166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
As an awardee of the Centers for Disease Control and Prevention's Colorectal Cancer Control Program, the California Department of Public Health partnered with Neighborhood Healthcare to implement evidence-based interventions and provider incentives (incentives offered to support staff, e.g., medical assistants, phlebotomists, front office staff, lab technicians) to improve colorectal cancer screening uptake. The objective of this study was to evaluate the effectiveness and cost of the provider incentive intervention implemented by Neighborhood Healthcare to increase colorectal cancer screening uptake. We collected and analyzed process and cost data to assess fecal immunochemical test (FIT) kit return rates to the health centers and the number of completed FIT kits. We estimated the costs of the preexisting interventions and the new interventions. Analyses were conducted for two time periods: preimplementation and implementation. Most Neighborhood Healthcare health centers experienced an increase in the percentage of FIT kit returns (average of 3.6 percentage points) and individuals screened (an average increase of 111 FIT kits per month) from the baseline period through the implementation period. The cost of the incentive intervention for each additional screen was $66.79. In conclusion, the results indicate that incentive programs can have an overall positive impact on both the percentage of FIT kits returned and the number of individuals screened.
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Affiliation(s)
| | | | | | | | | | - Ndukaku Omelu
- California Department of Public Health, Sacramento, CA, USA
| | | | - Melonie Thomas
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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12
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Tangka FKL, Subramanian S, Hoover S, DeGroff A, Joseph D, Wong FL, Richardson LC. Economic Evaluation of Interventions to Increase Colorectal Cancer Screening at Federally Qualified Health Centers. Health Promot Pract 2020; 21:877-883. [PMID: 32990042 DOI: 10.1177/1524839920954168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Centers for Disease Control and Prevention (CDC) has a long-standing commitment to increase colorectal cancer (CRC) screening for vulnerable populations. In 2005, the CDC began a demonstration in five states and, with lessons learned, launched a national program, the Colorectal Cancer Control Program (CRCCP), in 2009. The CRCCP continues today and its current emphasis is the implementation of evidence-based interventions to promote CRC screening. The purpose of this article is to provide an overview of four CRCCP awardees and their federally qualified health center partners as an introduction to the accompanying series of research briefs where we present individual findings on impacts of evidence-based interventions on CRC screening uptake for each awardee. We also include in this article the conceptual framework used to guide our research. Our findings contribute to the evidence base and guide future program implementation to improve sustainability, increase CRC screening, and address disparities in screening uptake.
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Affiliation(s)
| | | | | | - Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Djenaba Joseph
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Faye L Wong
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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13
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Subramanian S, Tangka FKL, Hoover S. Role of an Implementation Economics Analysis in Providing the Evidence Base for Increasing Colorectal Cancer Screening. Prev Chronic Dis 2020; 17:E46. [PMID: 32584756 PMCID: PMC7316416 DOI: 10.5888/pcd17.190407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose and Objectives Since 2005 the Centers for Disease Control and Prevention (CDC) has funded organizations across the United States to promote screening for colorectal cancer (CRC) to detect early CRC or precancerous polyps that can be treated to avoid disease progression and death. The objective of this study was to describe how findings from economic evaluation approaches of a subset of these awardees and their implementation sites (n = 9) can drive decision making and improve program implementation and diffusion. Intervention Approach We described the framework for the implementation economics evaluation used since 2016 for the Colorectal Cancer Control Program (CRCCP) Learning Collaborative. Evaluation Methods We compared CRC interventions implemented across health systems, changes in screening uptake, and the incremental cost per person of implementing an intervention. We also analyzed data on how implementation costs changed over time for a CRC program that conducted interventions in a series of rounds. Results Implementation of the interventions, which included provider and patient reminders, provider assessment and feedback, and incentives, resulted in increases in screening uptake ranging from 4.9 to 26.7 percentage points. Across the health systems, the incremental cost per person screened ranged from $18.76 to $144.55. One awardee’s costs decreased because of a reduction in intervention development and start-up costs. Implications for Public Health Health systems, CRCCP awardees, and CDC can use these findings for quality improvement activities, incorporation of information into trainings and support activities, and future program design.
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Affiliation(s)
- Sujha Subramanian
- RTI International, 307 Waverley Oaks Rd, Ste 101, Waltham, MA 02452.
| | - Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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14
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Nyambe N, Hoover S, Pinder LF, Chibwesha CJ, Kapambwe S, Parham G, Subramanian S. Differences in Cervical Cancer Screening Knowledge and Practices by HIV Status and Geographic Location: Implication for Program Implementation in Zambia. Afr J Reprod Health 2019; 22:92-101. [PMID: 30632726 DOI: 10.29063/ajrh2018/v22i4.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The knowledge and perceptions of cervical cancer among HIV negative and positive women, aged 25-49 years, from rural and urban locations in Zambia was systematically accessed in this study to determine any differences. Data were coded and analyzed using NVivo software. Compared to HIV negative women, HIV positive women had more accurate information about cervical cancer. They were more likely to cite male circumcision as the best approach to cervical cancer prevention. HPV infection was more commonly mentioned as a risk factor among HIV positive women. However, HIV positive women displayed little knowledge about HPV being the major cause of cervical cancer. Among HIV positive women, lack of time was the major screening barrier cited while HIV negative women mentioned being symptomatic as a determinant for early detection. Compared to rural residents, urban residents cited a wider range of cervical cancer information sources, including media and workplace although all of the participants who stated that they had no knowledge of cervical cancer were urban residents. Overall, knowledge and perceptions of cervical cancer among study participants was high, although differences exist between subgroups. Sharing accurate and standardized information on cervical cancer would improve participation in cervical cancer screening services.
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Affiliation(s)
| | | | - Leeya F Pinder
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill
| | - Carla J Chibwesha
- UNC Global Projects- Zambia.,Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill
| | | | - Groesbeck Parham
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill
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15
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Tangka FKL, Subramanian S, Hoover S, Cole-Beebe M, DeGroff A, Joseph D, Chattopadhyay S. Expenditures on Screening Promotion Activities in CDC's Colorectal Cancer Control Program, 2009-2014. Prev Chronic Dis 2019; 16:E72. [PMID: 31172915 PMCID: PMC6583814 DOI: 10.5888/pcd16.180337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction The Centers for Disease Control and Prevention (CDC) established the Colorectal Cancer Control Program (CRCCP) in 2009 to reduce disparities in colorectal cancer screening and increase screening and follow-up as recommended. We estimate the cost for evidence-based intervention and non–evidence-based intervention screening promotion activities and examine expenditures on screening promotion activities. We also identify factors associated with the costs of these activities. Methods By using cost and resource use data collected from 25 state grantees over multiple years (July 2009 to June 2014), we analyzed the total cost for each screening promotion activity. Multivariate analysis was used to assess the factors associated with screening promotion costs reported by grantees. Results The promotion activities with the largest allocation of funding across the years and grantees were mass media, patient navigation, outreach and education, and small media. Across all years of the program and across grantees, the amount spent on specific promotion activities varied widely. The factor significantly associated with promotion costs was region in which the grantee was located. Conclusion CDC’s CRCCP grantees spent the largest amount of the screening promotion funds on mass media, which is not recommended by the Community Preventive Services Task Force. Given the large variation across grantees in the use of and expenditures on screening promotion interventions, a systematic assessment of the yield from investment in specific promotion activities could better guide optimal resource allocation.
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Affiliation(s)
- Florence K L Tangka
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, 4770 Buford Hwy, NE, MS F-76, Atlanta, GA 30341-3717.
| | | | | | | | - Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Djenaba Joseph
- Centers for Disease Control and Prevention, Atlanta, Georgia
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16
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Abstract
Introduction We developed a web-based cost assessment tool (CAT) to collect cost data as an improvement from a desktop instrument to perform economic evaluations of the Centers for Disease Control and Prevention’s (CDC’s) Colorectal Cancer Control Program (CRCCP) grantees. We describe the development of the web-based CAT, evaluate the quality of the data obtained, and discuss lessons learned. Methods We developed and refined a web-based CAT to collect 5 years (2009–2014) of cost data from 29 CRCCP grantees. We analyzed funding distribution; costs by budget categories; distribution of costs related to screening promotion, screening provision, and overarching activities; and reporting of screenings for grantees that received funding from non-CDC sources compared with those grantees that did not. Results CDC provided 85.6% of the resources for the CRCCP, with smaller amounts from in-kind contributions (7.8%), and funding from other sources (6.6%) (eg, state funding). Grantees allocated, on average, 95% of their expenditures to specific program activities and 5% to other activities. Some non-CDC funds were used to provide screening tests to additional people, and these additional screens were captured in the CAT. Conclusion A web-based tool can be successfully used to collect cost data on expenditures associated with CRCCP activities. Areas for future refinement include how to collect and allocate dollars from other sources in addition to CDC dollars.
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Affiliation(s)
- Sonja Hoover
- RTI International, Waltham, Massachusetts.,307 Waverley Oaks Rd, Suite 101, Waltham, MA 02452. E-mail:
| | | | - Florence Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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17
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McLeod A, Leung S, Yuh J, Ghorbani A, Ramanuj R, Hoover S. A chimeric approach to purifying lentiviral vectors for CAR-T. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Subramanian S, Tangka FKL, Hoover S, Cole-Beebe M, Joseph D, DeGroff A. Comparison of Program Resources Required for Colonoscopy and Fecal Screening: Findings From 5 Years of the Colorectal Cancer Control Program. Prev Chronic Dis 2019; 16:E50. [PMID: 31022371 PMCID: PMC6513474 DOI: 10.5888/pcd16.180338] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction Colonoscopy and guaiac fecal occult blood tests and fecal immunochemical tests (FOBT/FIT) are the most common colorectal cancer screening methods in the United States. However, information is limited on the program resources required over time to use these tests. Methods We collected cost data from 29 Centers for Disease Control and Prevention Colorectal Cancer Control Program (CRCCP) grantees by using a standardized data collection instrument for 5 program years (2009–2014). We created a panel data set with 124 records and assessed differences by screening test used. Results Forty-four percent of all programs (N = 124) offered colonoscopy (55 of 124), 32% (39 of 124) offered FOBT/FIT, and 24% (30 of 124) offered both. Overall, total cost per person was higher in program year 1 ($3,962), the beginning of CRCCP than in subsequent program years ($1,714). The cost per person was $3,153 for programs using colonoscopy and $1,291 for those using FOBT/FIT with diagnostic colonoscopy. The average clinical cost per person was $1,369 for colonoscopy and $280 for FOBT/FIT during the program (these do not reflect cost of repeated FOBT/FIT screens). Programs serving a large number of people had lower per-person costs than those serving a small volume, probably because of fixed costs related to nonclinical expenses. Conclusion Colorectal cancer screening programs incur costs in addition to the clinical cost of the screening procedures to support planning and management, contracting with providers, and tracking patients. Because programs can achieve potential economies of scale, partnerships among smaller programs for screening delivery could decrease overall costs.
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Affiliation(s)
- Sujha Subramanian
- RTI International, 307 Waverley Oaks Rd, Ste 101, Waltham, MA 02452.
| | | | | | | | - Djenaba Joseph
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, Georgia
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19
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Tangka FKL, Subramanian S, Hoover S, Lara C, Eastman C, Glaze B, Conn ME, DeGroff A, Wong FL, Richardson LC. Identifying optimal approaches to scale up colorectal cancer screening: an overview of the centers for disease control and prevention (CDC)'s learning laboratory. Cancer Causes Control 2019; 30:169-175. [PMID: 30552592 PMCID: PMC6382575 DOI: 10.1007/s10552-018-1109-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 11/29/2018] [Indexed: 02/07/2023]
Abstract
Use of recommended screening tests can reduce new colorectal cancers (CRC) and deaths, but screening uptake is suboptimal in the United States (U.S.). The Centers for Disease Control and Prevention (CDC) funded a second round of the Colorectal Cancer Control Program (CRCCP) in 2015 to increase screening rates among individuals aged 50-75 years. The 30 state, university, and tribal awardees supported by the CRCCP implement a range of multicomponent interventions targeting health systems that have low CRC screening uptake, including low-income and minority populations. CDC invited a select subset of 16 CRCCP awardees to form a learning laboratory with the goal of performing targeted evaluations to identify optimal approaches to scale-up interventions to increase uptake of CRC screening among vulnerable populations. This commentary provides an overview of the CRCCP learning laboratory, presents findings from the implementation of multicomponent interventions at four FQHCs participating in the learning laboratory, and summarizes key lessons learned on intervention implementation approaches. Lessons learned can support future program implementation to ensure scalability and sustainability of the interventions as well as guide future implementation science and evaluation studies conducted by the CRCCP learning laboratory.
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Affiliation(s)
- Florence K L Tangka
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop F-76, Atlanta, GA, 30341-3717, USA.
| | | | - Sonja Hoover
- RTI International, Research Triangle Park, NC, USA
| | - Christen Lara
- Colorado Department of Public Health & Environment, Denver, CO, USA
| | - Casey Eastman
- Washington State Department of Health, Olympia, WA, USA
| | | | | | - Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Faye L Wong
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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20
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Lara CL, Means KL, Morwood KD, Lighthall WR, Hoover S, Tangka FKL, French C, Gayle KD, DeGroff A, Subramanian S. Colorectal cancer screening interventions in 2 health care systems serving disadvantaged populations: Screening uptake and cost-effectiveness. Cancer 2018; 124:4130-4136. [PMID: 30359479 DOI: 10.1002/cncr.31691] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND The objectives of the current study were to assess changes in colorectal cancer (CRC) screening uptake and the cost-effectiveness of implementing multiple evidence-based interventions (EBIs). EBIs were implemented at 2 federally qualified health centers that participated in the Colorado Department of Public Health and Environment's Clinic Quality Improvement for Population Health initiative. METHODS Interventions included patient and provider reminder systems (health system 1), provider assessment and feedback (health systems 1 and 2), and numerous support activities (health systems 1 and 2). The authors evaluated health system 1 from July 2013 to June 2015 and health system 2 from July 2014 to June 2017. Evaluation measures included annual CRC screening uptake, EBIs implemented, funds received and expended by each health system to implement EBIs, and intervention costs to the Colorado Department of Public Health and Environment and health systems. RESULTS CRC screening uptake increased by 18 percentage points in health system 1 and 10 percentage points in health system 2. The improvements in CRC screening uptake, not including the cost of the screening tests, were obtained at an added cost ranging from $24 to $29 per person screened. CONCLUSIONS In both health systems, the multicomponent interventions implemented likely resulted in improvements in CRC screening. The results suggest that significant increases in CRC screening uptake can be achieved in federally qualified health centers when appropriate technical support and health system commitment are present. The cost estimates of the multicomponent interventions suggest that these interventions and support activities can be implemented in a cost-effective manner.
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Affiliation(s)
- Christen L Lara
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Kelly L Means
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Krystal D Morwood
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | | | - Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cynthia French
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Krystal D Gayle
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy DeGroff
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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21
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Dacus HLM, Wagner VL, Collins EA, Matson JM, Gates M, Hoover S, Tangka FKL, Larkins T, Subramanian S. Evaluation of patient-focused interventions to promote colorectal cancer screening among new york state medicaid managed care patients. Cancer 2018; 124:4145-4153. [PMID: 30359473 DOI: 10.1002/cncr.31692] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/18/2018] [Accepted: 05/21/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The objective of this study was to evaluate an ongoing initiative to improve colorectal cancer (CRC) screening uptake in the New York State (NYS) Medicaid managed care population. METHODS Patients aged 50 to 75 years who were not up to date with CRC screening and resided in 2 NYS regions were randomly assigned to 1 of 3 cohorts: no mailed reminder, mailed reminder, and mailed reminder + incentive (in the form of a $25 cash card). Screening prevalence and the costs of the intervention were summarized. RESULTS In total, 7123 individuals in the Adirondack Region and 10,943 in the Central Region (including the Syracuse metropolitan area) were included. Screening prevalence in the Adirondack Region was 7.2% in the mailed reminder + incentive cohort, 7.0% in the mailed reminder cohort, and 5.8% in the no mailed reminder cohort. In the Central Region, screening prevalence was 7.2% in the mailed reminder cohort, 6.9% in the mailed reminder + incentive cohort, and 6.5% in the no mailed reminder cohort. The cost of implementing interventions in the Central Region was approximately 53% lower than in the Adirondack Region. CONCLUSIONS Screening uptake was low and did not differ significantly across the 2 regions or within the 3 cohorts. The incentive payment and mailed reminder did not appear to be effective in increasing CRC screening. The total cost of implementation was lower in the Central Region because of efficiencies generated from lessons learned during the first round of implementation in the Adirondack Region. More varied multicomponent interventions may be required to facilitate the completion of CRC screening among Medicaid beneficiaries.
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Affiliation(s)
- Heather L M Dacus
- Division of Chronic Disease Prevention, New York State Department of Health, Albany, New York
| | - Victoria L Wagner
- Office of Quality and Patient Safety, New York State Department of Health, Albany, New York
| | - Elisè A Collins
- Division of Chronic Disease Prevention, New York State Department of Health, Albany, New York
| | - Jacqueline M Matson
- Office of Quality and Patient Safety, New York State Department of Health, Albany, New York
| | - Margaret Gates
- Division of Chronic Disease Prevention, New York State Department of Health, Albany, New York.,Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, New York
| | | | - Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Teri Larkins
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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22
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Subramanian S, Hoover S, Tangka FKL, DeGroff A, Soloe CS, Arena LC, Schlueter DF, Joseph DA, Wong FL. A conceptual framework and metrics for evaluating multicomponent interventions to increase colorectal cancer screening within an organized screening program. Cancer 2018; 124:4154-4162. [PMID: 30359464 DOI: 10.1002/cncr.31686] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Multicomponent, evidence-based interventions are viewed increasingly as essential for increasing the use of colorectal cancer (CRC) screening to meet national targets. Multicomponent interventions involve complex care pathways and interactions across multiple levels, including the individual, health system, and community. METHODS The authors developed a framework and identified metrics and data elements to evaluate the implementation processes, effectiveness, and cost effectiveness of multicomponent interventions used in the Centers for Disease Control and Prevention's Colorectal Cancer Control Program. RESULTS Process measures to evaluate the implementation of interventions to increase community and patient demand for CRC screening, increase patient access, and increase provider delivery of services are presented. In addition, performance measures are identified to assess implementation processes along the continuum of care for screening, diagnosis, and treatment. Series of intermediate and long-term outcome and cost measures also are presented to evaluate the impact of the interventions. CONCLUSIONS Understanding the effectiveness of multicomponent, evidence-based interventions and identifying successful approaches that can be replicated in other settings are essential to increase screening and reduce CRC burden. The use of common framework, data elements, and evaluation methods will allow the performance of comparative assessments of the interventions implemented across CRCCP sites to identify best practices for increasing colorectal screening, particularly among underserved populations, to reduce disparities in CRC incidence and mortality.
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Affiliation(s)
| | | | - Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy DeGroff
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Dara F Schlueter
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Djenaba A Joseph
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Faye L Wong
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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23
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Kemper KE, Glaze BL, Eastman CL, Waldron RC, Hoover S, Flagg T, Tangka FKL, Subramanian S. Effectiveness and cost of multilayered colorectal cancer screening promotion interventions at federally qualified health centers in Washington State. Cancer 2018; 124:4121-4129. [PMID: 30359468 DOI: 10.1002/cncr.31693] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/25/2018] [Accepted: 06/15/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND It has been demonstrated that fecal immunochemical test (FIT) mailing programs are effective for increasing colorectal cancer (CRC) screening. The objectives of the current study were to assess the magnitude of uptake that could be achieved with a mailed FIT program in a federally qualified health center and whether such a program can be implemented at a reasonable cost to support sustainability. METHODS The Washington State Department of Health's partner HealthPoint implemented a direct-mail FIT program at 9 medical clinics, along with a follow-up reminder letter and automated telephone calls to those not up-to-date with recommended screening. Supplemental outreach events at selected medical clinics and a 50th birthday card screening reminder program also were implemented. The authors collected and analyzed process, effectiveness, and cost measures and conducted a systematic assessment of the short-term cost effectiveness of the interventions. RESULTS Overall, 5178 FIT kits were mailed with 4009 follow-up reminder letters, and 8454 automated reminder telephone calls were made over 12 months. In total, 1607 FIT kits were returned within 3 months of the end of the implementation period: an overall return rate of 31% for the mailed FIT program. The average total intervention cost per FIT kit returned was $39.81, and the intervention implementation cost per kit returned was $18.76. CONCLUSIONS The mailed FIT intervention improved CRC screening uptake among HealthPoint's patient population. This intervention was implemented for less than $40 per individual successfully screened. The findings and lessons learned can assist other clinics that serve disadvantaged populations to increase their CRC screening adherence.
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Affiliation(s)
| | | | | | | | - Sonja Hoover
- RTI International, Waltham, Massachusetts, North Carolina
| | - T'Ronda Flagg
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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24
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Kim KE, Randal F, Johnson M, Quinn M, Maene C, Hoover S, Richmond-Reese V, K L Tangka F, Joseph DA, Subramanian S. Economic assessment of patient navigation to colonoscopy-based colorectal cancer screening in the real-world setting at the University of Chicago Medical Center. Cancer 2018; 124:4137-4144. [PMID: 30359474 DOI: 10.1002/cncr.31690] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND This report details the cost effectiveness of a non-nurse patient navigation (PN) program that was implemented at the University of Chicago Medical Center to increase colonoscopy-based colorectal cancer (CRC) screening. METHODS The authors investigated the impact of the PN intervention by collecting process measures. Individuals who received navigation were compared with a historic cohort of non-navigated patients. In addition, a previously validated data-collection instrument was tailored and used to collect all costs related to developing, implementing, and administering the program; and the incremental cost per patient successfully navigated (the cost of the intervention divided by the change in the number who complete screening) was calculated. RESULTS The screening colonoscopy completion rate was 85.1% among those who were selected to receive PN compared with 74.3% when no navigation was implemented. With navigation, the proportion of no-shows was 8.2% compared with 15.4% of a historic cohort of non-navigated patients. Because the perceived risk of noncompletion was greater among those who received PN (previous no-show or cancellation, poor bowel preparation) than that in the historic cohort, a scenario analysis was performed. Assuming no-show rates between 0% and 50% and using a navigated rate of 85%, the total incremental program cost per patient successfully navigated ranged from $148 to $359, whereas the incremental intervention-only implementation cost ranged from $88 to $215. CONCLUSIONS The current findings indicate that non-nurse PN can increase colonoscopy completion, and this can be achieved at a minimal incremental cost for an insured population at an urban academic medical center.
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Affiliation(s)
- Karen E Kim
- Center for Asian Health Equity, The University of Chicago, Chicago, Illinois
| | - Fornessa Randal
- Center for Asian Health Equity, The University of Chicago, Chicago, Illinois
| | - Matt Johnson
- Center for Asian Health Equity, The University of Chicago, Chicago, Illinois
| | - Michael Quinn
- Center for Asian Health Equity, The University of Chicago, Chicago, Illinois
| | - Chieko Maene
- Center for Asian Health Equity, The University of Chicago, Chicago, Illinois
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Subramanian S, Kaganova Y, Zhang Y, Hoover S, Nyambe N, Pinder L, Chibwesha C, Kapambwe S, Parham G. Patient Preferences and Willingness to Pay for Cervical Cancer Prevention in Zambia: Protocol for a Multi-Cohort Discrete Choice Experiment. JMIR Res Protoc 2018; 7:e10429. [PMID: 30045833 PMCID: PMC6083044 DOI: 10.2196/10429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although most countries in southern Africa have cervical cancer screening programs, these programs generally fail to reach a significant majority of women because they are often implemented as pilot or research projects, and this limits their scope and ability to scale up screening. Some countries have planned larger-scale programs, but these have either never been implemented or have not been successfully scaled up. Most of the global burden of cervical cancer is experienced in countries with limited resources, and mortality from cervical cancer is the most common cause of cancer-related deaths among women in Sub-Saharan Africa. OBJECTIVE The purpose of this study is to learn about preferences for cervical cancer screening in Zambia, to identify barriers and facilitators for screening uptake, and to evaluate willingness to pay for screening services to support the scaling up of cervical cancer screening programs. METHODS We will conduct a discrete choice experiment by interviewing women and men and asking them to choose among constructed scenarios with varying combinations of attributes relevant to cervical cancer screening. To inform the discrete choice experiment, we will conduct focus groups and interviews about general knowledge and attitudes about cervical screening, perception about the availability of screening, stigma associated with cancer and HIV, and payment for health care services. For the discrete choice experiment, we will have a maximum design of 120 choice sets divided into 15 sets of 8 tasks each with a sample size of 320-400 respondents. We will use a hierarchical Bayesian estimation procedure to assess attributes at the following two levels: group and individual levels. RESULTS The model will generate preferences for attributes to assess the most important features and allow for the assessment of differences among cohorts. We will conduct policy simulations reflecting potential changes in the attributes of the screening facilities and calculate the projected changes in preference for choosing to undergo cervical cancer screening. The findings from the discrete choice experiment will be supplemented with interviews, focus groups, and patient surveys to ensure a comprehensive and context-based interpretation of the results. CONCLUSIONS Because willingness to pay for cervical cancer screening has not been previously assessed, this will be a unique and important contribution to the literature. This study will take into account the high HIV prevalence in Sub-Saharan Africa and prevailing gender attitudes to identify an optimal package of interventions to reduce cervical cancer incidence. This simulation of women's decisions (and men's support) to undergo screening will lay the foundation for understanding the stated preferences and willingness to pay to help design future screening programs. REGISTERED REPORT IDENTIFIER RR1-10.2196/10429.
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Affiliation(s)
| | | | | | | | | | | | - Carla Chibwesha
- University of North Carolina, Chapel Hill, NC, United States
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Tangka FK, Subramanian S, Mobley LR, Hoover S, Wang J, Hall IJ, Singh SD. Racial and ethnic disparities among state Medicaid programs for breast cancer screening. Prev Med 2017; 102:59-64. [PMID: 28647544 PMCID: PMC5840870 DOI: 10.1016/j.ypmed.2017.06.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/02/2017] [Accepted: 06/18/2017] [Indexed: 11/15/2022]
Abstract
Breast cancer screening by mammography has been shown to reduce breast cancer morbidity and mortality. The use of mammography screening though varies by race, ethnicity, and, sociodemographic characteristics. Medicaid is an important source of insurance in the US for low-income beneficiaries, who are disproportionately members of racial or ethnic minorities, and who are less likely to be screened than women with higher socioeconomic statuses. We used 2006-2008 data from Medicaid claims and enrollment files to assess racial or ethnic and geographic disparities in the use of breast cancer screening among Medicaid-insured women at the state level. There were disparities in the use of mammography among racial or ethnic groups relative to white women, and the use of mammography varied across the 44 states studied. African American and American Indian women were significantly less likely than white women to use mammography in 30% and 39% of the 44 states analyzed, respectively, whereas Hispanic and Asian American women were the minority groups most likely to receive screening compared with white women. There are racial or ethnic disparities in breast cancer screening at the state level, which indicates that analyses conducted by only using national data not stratified by insurance coverage are insufficient to identify vulnerable populations for interventions to increase the use of mammography, as recommended.
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Affiliation(s)
- Florence K Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS F-76, Atlanta, GA 30341-3717, United States.
| | - Sujha Subramanian
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452-8413, United States
| | - Lee Rivers Mobley
- School of Public Health and Andrew Young School of Policy Studies, Georgia State University, 1 Park Place, Suite 700, Atlanta, GA 30341, United States
| | - Sonja Hoover
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452-8413, United States
| | - Jiantong Wang
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452-8413, United States
| | - Ingrid J Hall
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS F-76, Atlanta, GA 30341-3717, United States
| | - Simple D Singh
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS F-76, Atlanta, GA 30341-3717, United States
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Subramanian S, Kibachio J, Hoover S, Edwards P, Amukoye E, Amuyunzu–Nyamongo M, Abbam G, Busakhala N, Chakava A, Dick J, Gakunga R, Gathecha G, Hilscher R, Husain MJ, Kaduka L, Kayima J, Karagu A, Kiptui D, Korir A, Meme N, Munoz B, Mwanda W, Mwai D, Mwangi J, Munyoro E, Muriuki Z, Njoroge J, Ogola E, Olale C, Olwal–Modi D, Rao R, Rosin S, Sangoro O, von Rège D, Wata D, Williams P, Yonga G. Research for Actionable Policies: implementation science priorities to scale up non–communicable disease interventions in Kenya. J Glob Health 2017. [PMCID: PMC5441449 DOI: 10.7189/jogh.07.010204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Gisela Abbam
- GE Healthcare, Chalfont St Giles, UK
- Global Diagnostic Imaging, Healthcare IT & Radiation Therapy Trade Association, Arlington, Virginia, USA
| | - Naftali Busakhala
- Moi University, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | - Jonathan Dick
- Moi University, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | | | | | | | - Lydia Kaduka
- Kenya Medical Research Institute, Nairobi, Kenya
| | - James Kayima
- Makerere University, Uganda Heart Institute, Kampala, Uganda
| | | | | | - Anne Korir
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Nkatha Meme
- Makerere University, Uganda Heart Institute, Kampala, Uganda
| | - Breda Munoz
- RTI International, Waltham, Massachusetts USA
| | - Walter Mwanda
- University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | | | | | | | | | | | - Elijah Ogola
- University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | | | | | - Rose Rao
- Novo Nordisk A/S, Copenhagen, Denmark
| | | | | | | | - David Wata
- Kenyatta National Hospital, Nairobi, Kenya
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Tangka FKL, Subramanian S, Hoover S, Royalty J, Joseph K, DeGroff A, Joseph D, Chattopadhyay S. Costs of promoting cancer screening: Evidence from CDC's Colorectal Cancer Control Program (CRCCP). Eval Program Plann 2017; 62:67-72. [PMID: 27989647 PMCID: PMC5840873 DOI: 10.1016/j.evalprogplan.2016.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 12/11/2016] [Indexed: 05/02/2023]
Abstract
The Colorectal Cancer Control Program (CRCCP) provided funding to 29 grantees to increase colorectal cancer screening. We describe the screening promotion costs of CRCCP grantees to evaluate the extent to which the program model resulted in the use of funding to support interventions recommended by the Guide to Community Preventive Services (Community Guide). We analyzed expenditures for screening promotion for the first three years of the CRCCP to assess cost per promotion strategy, and estimated the cost per person screened at the state level based on various projected increases in screening rates. All grantees engaged in small media activities and more than 90% used either client reminders, provider assessment and feedback, or patient navigation. Based on all expenditures, projected cost per eligible person screened for a 1%, 5%, and 10% increase in state-level screening proportions are $172, $34, and $17, respectively. CRCCP grantees expended the majority of their funding on Community Guide recommended screening promotion strategies but about a third was spent on other interventions. Based on this finding, future CRC programs should be provided with targeted education and information on evidence-based strategies, rather than broad based recommendations, to ensure that program funds are expended mainly on evidence-based interventions.
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Affiliation(s)
- Florence K L Tangka
- Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-76, Atlanta, GA 30341-3717, USA.
| | - Sujha Subramanian
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452, USA
| | - Sonja Hoover
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452, USA
| | - Janet Royalty
- Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-76, Atlanta, GA 30341-3717, USA
| | - Kristy Joseph
- Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-76, Atlanta, GA 30341-3717, USA
| | - Amy DeGroff
- Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-76, Atlanta, GA 30341-3717, USA
| | - Djenaba Joseph
- Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-76, Atlanta, GA 30341-3717, USA
| | - Sajal Chattopadhyay
- Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-76, Atlanta, GA 30341-3717, USA
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Subramanian S, Tangka FKL, Hoover S, Royalty J, DeGroff A, Joseph D. Costs of colorectal cancer screening provision in CDC's Colorectal Cancer Control Program: Comparisons of colonoscopy and FOBT/FIT based screening. Eval Program Plann 2017; 62:73-80. [PMID: 28190597 PMCID: PMC5863533 DOI: 10.1016/j.evalprogplan.2017.02.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/06/2017] [Indexed: 05/18/2023]
Abstract
We assess annual costs of screening provision activities implemented by 23 of the Centers for Disease Control and Prevention's Colorectal Cancer Control Program (CRCCP) grantees and report differences in costs between colonoscopy and FOBT/FIT-based screening programs. We analysed annual cost data for the first three years of the CRCCP (July 2009-June 2011) for each screening provision activity and categorized them into clinical and non-clinical screening provision activities. The largest cost components for both colonoscopy and FOBT/FIT-based programs were screening and diagnostic services, program management, and data collection and tracking. During the first 3 years of the CRCCP, the average annual clinical cost for screening and diagnostic services per person served was $1150 for colonoscopy programs, compared to $304 for FIT/FOBT-based programs. Overall, FOBT/FIT-based programs appear to have slightly higher non-clinical costs per person served (average $1018; median $838) than colonoscopy programs (average $980; median $686). Colonoscopy-based CRCCP programs have higher clinical costs than FOBT/FIT-based programs during the 3-year study timeframe (translating into fewer people screened). Non-clinical costs for both approaches are similar and substantial. Future studies of the cost-effectiveness of colorectal cancer screening initiatives should consider both clinical and non-clinical costs.
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Affiliation(s)
- Sujha Subramanian
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452, USA.
| | - Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-76, Atlanta, GA 30341-3717, USA
| | - Sonja Hoover
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452, USA
| | - Janet Royalty
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-76, Atlanta, GA 30341-3717, USA
| | - Amy DeGroff
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-76, Atlanta, GA 30341-3717, USA
| | - Djenaba Joseph
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-76, Atlanta, GA 30341-3717, USA
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Hoover S, Subramanian S, Tangka FKL, Cole-Beebe M, Sun A, Kramer CL, Pacillio G. Patients and caregivers costs for colonoscopy-based colorectal cancer screening: Experience of low-income individuals undergoing free colonoscopies. Eval Program Plann 2017; 62:81-86. [PMID: 28153341 PMCID: PMC5847315 DOI: 10.1016/j.evalprogplan.2017.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 01/04/2017] [Indexed: 05/18/2023]
Abstract
Many studies have documented barriers to colorectal cancer screenings. However, there is lack of comprehensive information on the time and costs borne by low-income patients and the persons accompanying the patient (caregiver) for colonoscopies in the United States. We surveyed patients in three health clinics in Philadelphia retrospectively who had undergone free colonoscopies in the previous 18-month period. Participants were asked questions about time and out-of-pockets expenses for themselves and their caregivers. Even when colonoscopies were free to the patient through Colorectal Cancer Control Program funded by the Centers for Disease Control and Prevention, the patient and caregivers still incurred costs in relation to preparing for, undergoing, and recovering from a colonoscopy. These costs can be substantial and may account for some of the low colorectal cancer screening rates especially among the low-income populations. Patients' and caregivers' costs need to be considered when designing and implementing colorectal cancer control programs.
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Affiliation(s)
- Sonja Hoover
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452, USA
| | - Sujha Subramanian
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452, USA.
| | - Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-76, Atlanta, GA 30341-3717, USA
| | - Maggie Cole-Beebe
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452, USA
| | - Amy Sun
- RTI International, 307 Waverley Oaks Road, Waltham, MA 02452, USA
| | - Cheryl L Kramer
- Philadelphia Department of Public Health, Health Center 4, 4400 Haverford Avenue, Philadelphia, PA 19104, USA
| | - Gina Pacillio
- Philadelphia Department of Public Health, Health Center 4, 4400 Haverford Avenue, Philadelphia, PA 19104, USA
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Koyande S, Subramanian S, Edwards P, Hoover S, Deshmane V, Tankga F, Dikshit R, Saraiya M. Economic evaluation of Mumbai and its satellite cancer registries: Implications for expansion of data collection. Cancer Epidemiol 2016; 45 Suppl 1:S43-S49. [PMID: 27726981 PMCID: PMC5847316 DOI: 10.1016/j.canep.2016.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/23/2016] [Accepted: 10/03/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Mumbai Cancer Registry is a population-based cancer registry that has been in operation for more than five decades and has successfully initiated and integrated three satellite registries in Pune, Nagpur, and Aurangabad, each covering specific urban populations of the Indian state Maharashtra. Data collectors at the satellites perform data abstraction, but Mumbai carries out all other core registration activities such as data analysis and quality assurance. Each of the three satellite registries follows the same data collection methodology as the main Mumbai Cancer Registry. This study examines the cost of operating the Mumbai and its satellite cancer registries. METHODS We modified and used the Centers for Disease Control and Prevention's (CDC's) International Registry Costing Tool (IntRegCosting Tool) to collect cost and resource use data for the Mumbai Cancer Registry and three satellites. RESULTS Almost 60% of the registration expenditure was borne by the Indian Cancer Society, which hosts the Mumbai Cancer Registry, and more than half of the registry expenditure was related to data collection activities. Across the combined registries, 93% of the expenditure was spent on labor. Overall, registration activities had a low cost per case of 226.10 Indian rupees (or a little less than 4.00 US dollars in 2014 [used average exchange rate in 2014: 1 US $=60 Indian rupees]). CONCLUSION The centralization of fixed-cost activities in Mumbai likely resulted in economies of scale in operating the Mumbai and satellite registries, which, together, report on almost 20,000 cancer cases annually. In middle-income countries like India, where financial resources are limited, the operational framework provided by the Mumbai and satellite registries can serve as a model for other registries looking to expand data collection.
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Affiliation(s)
| | - Sujha Subramanian
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, USA.
| | - Patrick Edwards
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, USA
| | - Sonja Hoover
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, USA
| | | | - Florence Tankga
- Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA, USA
| | | | - Mona Saraiya
- Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA, USA
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Zheng NT, Haber S, Hoover S, Feng Z. Access to Care for Medicare-Medicaid Dually Eligible Beneficiaries: The Role of State Medicaid Payment Policies. Health Serv Res 2016; 52:2219-2236. [PMID: 27767203 DOI: 10.1111/1475-6773.12591] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
STUDY OBJECTIVES Medicaid programs are not required to pay the full Medicare coinsurance and deductibles for Medicare-Medicaid dually eligible beneficiaries. We examined the association between the percentage of Medicare cost sharing paid by Medicaid and the likelihood that a dually eligible beneficiary used evaluation and management (E&M) services and safety net provider services. DATA SOURCES Medicare and Medicaid Analytic eXtract enrollment and claims data for 2009. STUDY DESIGN Multivariate analyses used fee-for-service dually eligible and Medicare-only beneficiaries in 20 states. A comparison group of Medicare-only beneficiaries controlled for state factors that might influence utilization. PRINCIPAL FINDINGS Paying 100 percent of the Medicare cost sharing compared to 20 percent increased the likelihood (relative to Medicare-only) that a dually eligible beneficiary had any E&M visit by 6.4 percent. This difference in the percentage of cost sharing paid decreased the likelihood of using safety net providers, by 37.7 percent for federally qualified health centers and rural health centers, and by 19.8 percent for hospital outpatient departments. CONCLUSIONS Reimbursing the full Medicare cost-sharing amount would improve access for dually eligible beneficiaries, although the magnitude of the effect will vary by state and type of service.
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Affiliation(s)
- Nan Tracy Zheng
- End-of-Life, Palliative, and Hospice Care, Division for Research on Healthcare Value, Equity, and the Lifespan, RTI International, Waltham, MA
| | - Susan Haber
- Health Coverage for Low-Income and Uninsured Populations, Division for Research on Healthcare Value, Equity, and Lifespan, RTI International, Waltham, MA
| | - Sonja Hoover
- Health Coverage for Low-Income and Uninsured Populations, Division for Research on Healthcare Value, Equity, and Lifespan, RTI International, Waltham, MA
| | - Zhanlian Feng
- Aging, Disability and Long Term Care, Division for Research on Healthcare Value, Equity, and the Lifespan, RTI International, Waltham, MA
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Subramanian S, Tangka FKL, Hoover S, Nadel M, Smith R, Atkin W, Patnick J. Recommendations From the International Colorectal Cancer Screening Network on the Evaluation of the Cost of Screening Programs. J Public Health Manag Pract 2016; 22:461-5. [PMID: 27479308 PMCID: PMC6003240 DOI: 10.1097/phh.0000000000000386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Worldwide, colorectal cancer is the fourth leading cause of death from cancer and the incidence is projected to increase. Many countries are exploring the introduction of organized screening programs, but there is limited information on the resources required and guidance for cost-effective implementation. To facilitate the generating of the economics evidence base for program implementation, we collected and analyzed detailed program cost data from 5 European members of the International Colorectal Cancer Screening Network. The cost per person screened estimates, often used to compare across programs as an overall measure, varied significantly across the programs. In addition, there were substantial differences in the programmatic and clinical cost incurred, even when the same type of screening test was used. Based on these findings, several recommendations are provided to enhance the underlying methodology and validity of the comparative economic assessments. The recommendations include the need for detailed activity-based cost information, the use of a comprehensive set of effectiveness measures to adequately capture differences between programs, and the incorporation of data from multiple programs in cost-effectiveness models to increase generalizability. Economic evaluation of real-world colorectal cancer-screening programs is essential to derive valuable insights to improve program operations and ensure optimal use of available resources.
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Affiliation(s)
- Sujha Subramanian
- RTI International, Waltham, Massachusetts (Dr Subramanian and Ms Hoover); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Tangka and Nadel); Department of Cancer Control, American Cancer Society, Atlanta, Georgia (Dr Smith); Department of Surgery and Cancer, Imperial College London, London, England (Dr Atkin); and University of Oxford, Oxford, United Kingdom (Ms Patnick)
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Abstract
Every 5 years, the federal government reviews the Medicare Fee Schedule for changes in the work effort physicians personally devote to office visits. Using physician face-to-face times reported in the Centers for Disease Control and Prevention's National Ambulatory Care Survey (NAMCS), guideline office visit times associated with the 1997-1998 mix of Medicare claims averaged 9 percent longer versus NAMCS; Medicare billed visits with new patients were 32 percent longer. Surgeons and dermatologists had the largest discrepancies in Medicare versus NAMCS times. If CPT guideline times currently in use are now overstated, then intraservice work effort is likely overstated given the high correlation of time with work effort, and Medicare payment levels need to be reduced. Upcoding visit content to higher paid CPT visit codes may also explain seemingly longer Medicare billed times and call for payment reductions as well.
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Abstract
Little is known about what happens to children who disenroll from public health-insurance programs. A telephone survey was conducted of children who recently had disenrolled from either Oregon's State Children's Health Insurance Program (SCHIP) or FHIAP (premium assistance) programs, both of which have identical eligibility requirements. Access for these disenrolled children was driven largely by health insurance coverage. Insured children were more likely to have a usual source of care and to have seen a physician when they needed one. While FHIAP-disenrolled children were more likely to have private health-insurance coverage than those leaving SCHIP, absolute levels were low (53 percent and 33 percent, respectively). Thus, these programs generally did not provide a bridge to nonsubsidized private health insurance. Despite higher incomes (the main reason for losing coverage), many families did not purchase private health insurance, presumably because they still could not afford to do so.
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Gorham PW, Nam J, Romero-Wolf A, Hoover S, Allison P, Banerjee O, Beatty JJ, Belov K, Besson DZ, Binns WR, Bugaev V, Cao P, Chen C, Chen P, Clem JM, Connolly A, Dailey B, Deaconu C, Cremonesi L, Dowkontt PF, DuVernois MA, Field RC, Fox BD, Goldstein D, Gordon J, Hast C, Hebert CL, Hill B, Hughes K, Hupe R, Israel MH, Javaid A, Kowalski J, Lam J, Learned JG, Liewer KM, Liu TC, Link JT, Lusczek E, Matsuno S, Mercurio BC, Miki C, Miočinović P, Mottram M, Mulrey K, Naudet CJ, Ng J, Nichol RJ, Palladino K, Rauch BF, Reil K, Roberts J, Rosen M, Rotter B, Russell J, Ruckman L, Saltzberg D, Seckel D, Schoorlemmer H, Stafford S, Stockham J, Stockham M, Strutt B, Tatem K, Varner GS, Vieregg AG, Walz D, Wissel SA, Wu F. Characteristics of Four Upward-Pointing Cosmic-Ray-like Events Observed with ANITA. Phys Rev Lett 2016; 117:071101. [PMID: 27563945 DOI: 10.1103/physrevlett.117.071101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Indexed: 06/06/2023]
Abstract
We report on four radio-detected cosmic-ray (CR) or CR-like events observed with the Antarctic Impulsive Transient Antenna (ANITA), a NASA-sponsored long-duration balloon payload. Two of the four were previously identified as stratospheric CR air showers during the ANITA-I flight. A third stratospheric CR was detected during the ANITA-II flight. Here, we report on characteristics of these three unusual CR events, which develop nearly horizontally, 20-30 km above the surface of Earth. In addition, we report on a fourth steeply upward-pointing ANITA-I CR-like radio event which has characteristics consistent with a primary that emerged from the surface of the ice. This suggests a possible τ-lepton decay as the origin of this event, but such an interpretation would require significant suppression of the standard model τ-neutrino cross section.
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Affiliation(s)
- P W Gorham
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - J Nam
- Department of Physics, Graduate Institute of Astrophysics and Leung Center for Cosmology and Particle Astrophysics, National Taiwan University, Taipei 10617, Taiwan
| | - A Romero-Wolf
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - S Hoover
- Department of Physics and Astronomy, University of California, Los Angeles, Los Angeles, California 90095, USA
| | - P Allison
- Department of Physics, Ohio State University, Columbus, Ohio 43210, USA
- Center for Cosmology and Particle Astrophysics, Ohio State University, Columbus, Ohio 43210, USA
| | - O Banerjee
- Department of Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - J J Beatty
- Department of Physics, Ohio State University, Columbus, Ohio 43210, USA
- Center for Cosmology and Particle Astrophysics, Ohio State University, Columbus, Ohio 43210, USA
| | - K Belov
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - D Z Besson
- Department of Physics and Astronomy, University of Kansas, Lawrence, Kansas 66045, USA
| | - W R Binns
- Department of Physics, Washington University in St. Louis, St. Louis, Missouri 63130, USA
| | - V Bugaev
- Department of Physics, Washington University in St. Louis, St. Louis, Missouri 63130, USA
| | - P Cao
- Department of Physics, University of Delaware, Newark, Delaware 19716, USA
| | - C Chen
- Department of Physics, Graduate Institute of Astrophysics and Leung Center for Cosmology and Particle Astrophysics, National Taiwan University, Taipei 10617, Taiwan
| | - P Chen
- Department of Physics, Graduate Institute of Astrophysics and Leung Center for Cosmology and Particle Astrophysics, National Taiwan University, Taipei 10617, Taiwan
| | - J M Clem
- Department of Physics, University of Delaware, Newark, Delaware 19716, USA
| | - A Connolly
- Department of Physics, Ohio State University, Columbus, Ohio 43210, USA
- Center for Cosmology and Particle Astrophysics, Ohio State University, Columbus, Ohio 43210, USA
| | - B Dailey
- Department of Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - C Deaconu
- Department of Physics, Enrico Fermi Institute, Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - L Cremonesi
- Department of Physics and Astronomy, University College London, London WC1E 6BT, United Kingdom
| | - P F Dowkontt
- Department of Physics and Astronomy, University of California, Los Angeles, Los Angeles, California 90095, USA
| | - M A DuVernois
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - R C Field
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - B D Fox
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - D Goldstein
- Department of Physics, University of California, Irvine, California 92697, USA
| | - J Gordon
- Department of Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - C Hast
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - C L Hebert
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - B Hill
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - K Hughes
- Department of Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - R Hupe
- Department of Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - M H Israel
- Department of Physics, Washington University in St. Louis, St. Louis, Missouri 63130, USA
| | - A Javaid
- Department of Physics, University of Delaware, Newark, Delaware 19716, USA
| | - J Kowalski
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - J Lam
- Department of Physics and Astronomy, University of California, Los Angeles, Los Angeles, California 90095, USA
| | - J G Learned
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - K M Liewer
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - T C Liu
- Department of Physics, Graduate Institute of Astrophysics and Leung Center for Cosmology and Particle Astrophysics, National Taiwan University, Taipei 10617, Taiwan
| | - J T Link
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - E Lusczek
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - S Matsuno
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - B C Mercurio
- Department of Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - C Miki
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - P Miočinović
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - M Mottram
- Department of Physics and Astronomy, University College London, London WC1E 6BT, United Kingdom
| | - K Mulrey
- Department of Physics, University of Delaware, Newark, Delaware 19716, USA
| | - C J Naudet
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - J Ng
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - R J Nichol
- Department of Physics and Astronomy, University College London, London WC1E 6BT, United Kingdom
| | - K Palladino
- Department of Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - B F Rauch
- Department of Physics, Washington University in St. Louis, St. Louis, Missouri 63130, USA
| | - K Reil
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - J Roberts
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - M Rosen
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - B Rotter
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - J Russell
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - L Ruckman
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - D Saltzberg
- Department of Physics and Astronomy, University of California, Los Angeles, Los Angeles, California 90095, USA
| | - D Seckel
- Department of Physics, University of Delaware, Newark, Delaware 19716, USA
| | - H Schoorlemmer
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - S Stafford
- Department of Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - J Stockham
- Department of Physics and Astronomy, University of Kansas, Lawrence, Kansas 66045, USA
| | - M Stockham
- Department of Physics and Astronomy, University of Kansas, Lawrence, Kansas 66045, USA
| | - B Strutt
- Department of Physics and Astronomy, University College London, London WC1E 6BT, United Kingdom
| | - K Tatem
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - G S Varner
- Department of Physics and Astronomy, University of Hawaii, Manoa, Hawaii 96822, USA
| | - A G Vieregg
- Department of Physics, Enrico Fermi Institute, Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - D Walz
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - S A Wissel
- Physics Department, California Polytechnic State University, San Luis Obispo, California 93407, USA
| | - F Wu
- Department of Physics and Astronomy, University of California, Los Angeles, Los Angeles, California 90095, USA
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Story KT, Hanson D, Ade PAR, Aird KA, Austermann JE, J. A. Beall, Bender AN, Benson BA, Bleem LE, Carlstrom JE, Chang CL, Chiang HC, Cho HM, Citron R, Crawford TM, Crites AT, Haan TD, Dobbs MA, Everett W, Gallicchio J, Gao J, George EM, Gilbert A, Halverson NW, Harrington N, Henning JW, Hilton GC, Holder GP, Holzapfel WL, Hoover S, Hou Z, Hrubes JD, Huang N, Hubmayr J, Irwin KD, Keisler R, Knox L, Lee AT, Leitch EM, Li D, Liang C, Luong-Van D, McMahon JJ, Mehl J, Meyer SS, Mocanu L, Montroy TE, Natoli T, Nibarger JP, Novosad V, Padin S, Pryke C, Reichardt CL, Ruhl JE, Saliwanchik BR, Sayre JT, Schaffer KK, Smecher G, Stark AA, Tucker C, Vanderlinde K, Vieira JD, Wang G, Whitehorn N, Yefremenko V, Zahn O. A MEASUREMENT OF THE COSMIC MICROWAVE BACKGROUND GRAVITATIONAL LENSING POTENTIAL FROM 100 SQUARE DEGREES OF SPTPOL DATA. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/810/1/50] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Keisler R, Hoover S, Harrington N, Henning JW, Ade PAR, Aird KA, Austermann JE, Beall JA, Bender AN, Benson BA, Bleem LE, Carlstrom JE, Chang CL, Chiang HC, Cho HM, Citron R, Crawford TM, Crites AT, de Haan T, Dobbs MA, Everett W, Gallicchio J, Gao J, George EM, Gilbert A, Halverson NW, Hanson D, Hilton GC, Holder GP, Holzapfel WL, Hou Z, Hrubes JD, Huang N, Hubmayr J, Irwin KD, Knox L, Lee AT, Leitch EM, Li D, Luong-Van D, Marrone DP, McMahon JJ, Mehl J, Meyer SS, Mocanu L, Natoli T, Nibarger JP, Novosad V, Padin S, Pryke C, Reichardt CL, Ruhl JE, Saliwanchik BR, Sayre JT, Schaffer KK, Shirokoff E, Smecher G, Stark AA, Story KT, Tucker C, Vanderlinde K, Vieira JD, Wang G, Whitehorn N, Yefremenko V, Zahn O. MEASUREMENTS OF SUB-DEGREEB-MODE POLARIZATION IN THE COSMIC MICROWAVE BACKGROUND FROM 100 SQUARE DEGREES OF SPTPOL DATA. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/807/2/151] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Crites AT, Henning JW, Ade PAR, Aird KA, Austermann JE, Beall JA, Bender AN, Benson BA, Bleem LE, Carlstrom JE, Chang CL, Chiang HC, Cho HM, Citron R, Crawford TM, Haan TD, Dobbs MA, Everett W, Gallicchio J, Gao J, George EM, Gilbert A, Halverson NW, Hanson D, Harrington N, Hilton GC, Holder GP, Holzapfel WL, Hoover S, Hou Z, Hrubes JD, Huang N, Hubmayr J, Irwin KD, Keisler R, Knox L, Lee AT, Leitch EM, Li D, Liang C, Luong-Van D, McMahon JJ, Mehl J, Meyer SS, Mocanu L, Montroy TE, Natoli T, Nibarger JP, Novosad V, Padin S, Pryke C, Reichardt CL, Ruhl JE, Saliwanchik BR, Sayre JT, Schaffer KK, Smecher G, Stark AA, Story KT, Tucker C, Vanderlinde K, Vieira JD, Wang G, Whitehorn N, Yefremenko V, Zahn O. MEASUREMENTS OF E-MODE POLARIZATION AND TEMPERATURE-E-MODE CORRELATION IN THE COSMIC MICROWAVE BACKGROUND FROM 100 SQUARE DEGREES OF SPTPOL DATA. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/805/1/36] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tangka FKL, Subramanian S, Sabatino SA, Howard DH, Haber S, Hoover S, Richardson LC. End-of-Life Medical Costs of Medicaid Cancer Patients. Health Serv Res 2014; 50:690-709. [PMID: 25424134 DOI: 10.1111/1475-6773.12259] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To quantify end-of-life (EOL) medical costs for adult Medicaid beneficiaries diagnosed with cancer. DATA SOURCES We linked Medicaid administrative data with 2000-2003 cancer registry data to identify 3,512 adult Medicaid beneficiaries who died after a cancer diagnosis and matched them to a cohort of beneficiaries without cancer who died during the same period. STUDY DESIGN We used multivariable regression analysis to estimate incremental per-person EOL cost after controlling for beneficiaries' age, race/ethnicity, sex, cancer site, and state of residence. PRINCIPAL FINDINGS End-of-life costs during the final 4 months of life were about $10,000 higher for Medicaid cancer patients than for those without cancer. Medicaid cancer patients are more intensive users of inpatient and ambulatory services than are Medicaid patients without cancer. Medicaid cancer patients who die soon after diagnosis have higher costs of care and use inpatient services more intensely than do Medicaid patients without cancer. CONCLUSIONS Medicaid cancer patients incur substantially higher EOL costs than noncancer patients. This increased cost may reflect the cost of palliative care. Future studies should assess the types and timing of services provided to Medicaid cancer patients at the EOL.
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Affiliation(s)
- Florence K L Tangka
- Division of Cancer Prevention and Control, CDC, 4770 Buford Highway, NE, MS F-76, Atlanta, GA
| | | | - Susan A Sabatino
- Division of Cancer Prevention and Control, CDC, 4770 Buford Highway, NE, MS F-76, Atlanta, GA
| | - David H Howard
- Rollins School of Public Health, Emory University, Atlanta, GA
| | | | | | - Lisa C Richardson
- Division of Cancer Prevention and Control, CDC, 4770 Buford Highway, NE, MS F-76, Atlanta, GA
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Subramanian S, Tangka FKL, Hoover S, Beebe MC, DeGroff A, Royalty J, Seeff LC. Costs of planning and implementing the CDC's Colorectal Cancer Screening Demonstration Program. Cancer 2014; 119 Suppl 15:2855-62. [PMID: 23868480 DOI: 10.1002/cncr.28158] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 08/17/2012] [Accepted: 08/20/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) initiated the Colorectal Cancer Screening Demonstration Program (CRCSDP) to explore the feasibility of establishing a large-scale colorectal cancer screening program for underserved populations in the United States. The authors of the current report provide a detailed description of the total program costs (clinical and nonclinical) incurred during both the start-up and service delivery (screening) phases of the 4-year program. METHODS Tailored cost questionnaires were completed by staff at the 5 CRCSDP sites. Cost data were collected for clinical services and nonclinical programmatic activities (program management, data collection, and tracking, etc). In-kind contributions also were measured and were assigned monetary values. RESULTS Nearly $11.3 million was expended by the 5 sites over 4 years, and 71% was provided by the CDC. The proportion of funding spent on clinical service delivery and service delivery/patient support comprised the largest proportion of cost during the implementation phase (years 2-4). The per-person nonclinical cost comprised a substantial portion of total costs for all sites. The cost per person screened varied across the 5 sites and by screening method. Overall, economies of scale were observed, with lower costs resulting from larger numbers of individuals screened. CONCLUSIONS Programs incur substantial variable costs related to clinical services and semivariable costs related to nonclinical services. Therefore, programs that serve large populations are likely to achieve a lower cost per person.
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Tangka FKL, Subramanian S, Beebe MC, Hoover S, Royalty J, Seeff LC. Clinical costs of colorectal cancer screening in 5 federally funded demonstration programs. Cancer 2014; 119 Suppl 15:2863-9. [PMID: 23868481 DOI: 10.1002/cncr.28154] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 11/05/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention initiated the Colorectal Cancer Screening Demonstration Program (CRCSDP) to explore the feasibility of establishing a large-scale colorectal cancer (CRC) screening program for underserved populations in the United States. The authors of this report assessed the clinical costs incurred at each of the 5 participating sites during the demonstration period. METHODS By using data on payments to providers by each of the 5 CRCSDP sites, the authors estimated costs for specific clinical services and overall clinical costs for each of the 2 CRC screening methods used by the sites: colonoscopy and fecal occult blood test (FOBT). RESULTS Among CRCSDP clients who were at average risk for CRC and for whom complete cost data were available, 2131 were screened by FOBT, and 1888 were screened by colonoscopy. The total average clinical cost per individual screened by FOBT (including costs for screening, diagnosis, initial surveillance, office visits, and associated clinical services averaged across all individuals who received screening FOBT) ranged from $48 in Nebraska to $149 in Greater Seattle. This compared with an average clinical cost per individual for all services related to the colonoscopy screening ranging from $654 in St. Louis to $1600 in Baltimore City. CONCLUSIONS Variations in how sites contracted with providers and in the services provided through CRCSDP affected the cost of clinical services and the complexity of collecting cost data. Health officials may find these data useful in program planning and budgeting.
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Affiliation(s)
- Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA.
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Hanson D, Hoover S, Crites A, Ade PAR, Aird KA, Austermann JE, Beall JA, Bender AN, Benson BA, Bleem LE, Bock JJ, Carlstrom JE, Chang CL, Chiang HC, Cho HM, Conley A, Crawford TM, de Haan T, Dobbs MA, Everett W, Gallicchio J, Gao J, George EM, Halverson NW, Harrington N, Henning JW, Hilton GC, Holder GP, Holzapfel WL, Hrubes JD, Huang N, Hubmayr J, Irwin KD, Keisler R, Knox L, Lee AT, Leitch E, Li D, Liang C, Luong-Van D, Marsden G, McMahon JJ, Mehl J, Meyer SS, Mocanu L, Montroy TE, Natoli T, Nibarger JP, Novosad V, Padin S, Pryke C, Reichardt CL, Ruhl JE, Saliwanchik BR, Sayre JT, Schaffer KK, Schulz B, Smecher G, Stark AA, Story KT, Tucker C, Vanderlinde K, Vieira JD, Viero MP, Wang G, Yefremenko V, Zahn O, Zemcov M. Detection of B-mode polarization in the cosmic microwave background with data from the South Pole Telescope. Phys Rev Lett 2013; 111:141301. [PMID: 24138230 DOI: 10.1103/physrevlett.111.141301] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Indexed: 06/02/2023]
Abstract
Gravitational lensing of the cosmic microwave background generates a curl pattern in the observed polarization. This "B-mode" signal provides a measure of the projected mass distribution over the entire observable Universe and also acts as a contaminant for the measurement of primordial gravity-wave signals. In this Letter we present the first detection of gravitational lensing B modes, using first-season data from the polarization-sensitive receiver on the South Pole Telescope (SPTpol). We construct a template for the lensing B-mode signal by combining E-mode polarization measured by SPTpol with estimates of the lensing potential from a Herschel-SPIRE map of the cosmic infrared background. We compare this template to the B modes measured directly by SPTpol, finding a nonzero correlation at 7.7σ significance. The correlation has an amplitude and scale dependence consistent with theoretical expectations, is robust with respect to analysis choices, and constitutes the first measurement of a powerful cosmological observable.
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Affiliation(s)
- D Hanson
- Department of Physics, McGill University, Montreal, Quebec H3A 2T8, Canada
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Subramanian S, Tangka FKL, Sabatino SA, Howard D, Richardson LC, Haber S, Halpern MT, Hoover S. Impact of chronic conditions on the cost of cancer care for Medicaid beneficiaries. Medicare Medicaid Res Rev 2013; 2:mmrr2012-002-04-a07. [PMID: 24800160 DOI: 10.5600/mmrr.002.04.a07] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND No study has assessed the cost of treating adult Medicaid cancer patients with preexisting chronic conditions. This information is essential for understanding the cost of cancer care to the Medicaid program above that expended for other chronic conditions, given the increasing prevalence of chronic conditions among cancer patients. RESEARCH DESIGN We used administrative data from 3 state Medicaid programs' linked cancer registry data to estimate cost of care during the first 6 months following cancer diagnosis for beneficiaries with 4 preexisting chronic conditions: cardiac disease, respiratory diseases, diabetes, and mental health disorders. Our base cohort consisted of 6,212 Medicaid cancer patients aged 21 to 64 years (cancer diagnosed during 2001-2003) who were continuously enrolled in fee-for-service Medicaid for 6 months after diagnosis. A subset of these patients who did not die during the 6-month follow-up (n=4,628), were matched with 2 non-cancer patients each (n=8,536) to assess incremental cost of care. RESULTS The average cost of care for cancer patients with the chronic conditions studied was higher than for cancer patients without any of these conditions. The increase in cancer treatment cost associated with the chronic conditions ranged from $4,385 for cardiac disease to $11,009 for mental health disorders. CONCLUSIONS Chronic conditions, especially the presence of multiple conditions, are associated with a higher cost of care among Medicaid cancer patients, and these increased costs should be reflected in projections of future Medicaid cancer care costs. The implementation of better care-management processes for cancer patients with preexisting chronic conditions may be one way to reduce these costs.
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Affiliation(s)
| | | | | | - David Howard
- Rollins School of Public Health Emory University
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Whitehead NS, Hammond JA, Williams MA, Huggins W, Hoover S, Hamilton CM, Ramos EM, Junkins HA, Harlan WR, Hogue CJ. The PhenX Toolkit pregnancy and birth collections. Ann Epidemiol 2012; 22:753-8. [PMID: 22954959 DOI: 10.1016/j.annepidem.2012.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/03/2012] [Accepted: 08/07/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE Pregnancy and childbirth are normal conditions, but complications and adverse outcomes are common. Both genetic and environmental factors influence the course of pregnancy. Genetic epidemiologic research into pregnancy outcomes could be strengthened by the use of common measures, which would allow data from different studies to be combined or compared. Here, we introduce perinatal researchers to the PhenX Toolkit and the Collections related to pregnancy and childbirth. METHODS The Pregnancy and Birth Collections were drawn from measures in the PhenX Tooklit. The lead author selected a list of measures for each Collection, which was reviewed by the remaining authors and revised on the basis of their comments. We chose the measures we thought were most relevant for perinatal research and had been linked most strongly to perinatal outcomes. RESULTS The Pregnancy and Birth Health Conditions Collection includes 24 measures related to pregnancy and fertility history, maternal complications, and infant complications. The Pregnancy and Birth Outcome Risk Factors Collection includes 43 measures of chemical, medical, psychosocial, and personal factors associated with pregnancy outcomes. CONCLUSIONS The biological complexity of pregnancy and its sensitivity to environmental and genomic influences suggest that multidisciplinary approaches are needed to generate new insights or practical interventions. To fully exploit new research methods and resources, we encourage the biomedical research community to adopt standard measures to facilitate pooled or meta-analyses.
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McDonald M, Bayliss M, Benson BA, Foley RJ, Ruel J, Sullivan P, Veilleux S, Aird KA, Ashby MLN, Bautz M, Bazin G, Bleem LE, Brodwin M, Carlstrom JE, Chang CL, Cho HM, Clocchiatti A, Crawford TM, Crites AT, de Haan T, Desai S, Dobbs MA, Dudley JP, Egami E, Forman WR, Garmire GP, George EM, Gladders MD, Gonzalez AH, Halverson NW, Harrington NL, High FW, Holder GP, Holzapfel WL, Hoover S, Hrubes JD, Jones C, Joy M, Keisler R, Knox L, Lee AT, Leitch EM, Liu J, Lueker M, Luong-Van D, Mantz A, Marrone DP, McMahon JJ, Mehl J, Meyer SS, Miller ED, Mocanu L, Mohr JJ, Montroy TE, Murray SS, Natoli T, Padin S, Plagge T, Pryke C, Rawle TD, Reichardt CL, Rest A, Rex M, Ruhl JE, Saliwanchik BR, Saro A, Sayre JT, Schaffer KK, Shaw L, Shirokoff E, Simcoe R, Song J, Spieler HG, Stalder B, Staniszewski Z, Stark AA, Story K, Stubbs CW, Šuhada R, van Engelen A, Vanderlinde K, Vieira JD, Vikhlinin A, Williamson R, Zahn O, Zenteno A. A massive, cooling-flow-induced starburst in the core of a luminous cluster of galaxies. Nature 2012; 488:349-52. [DOI: 10.1038/nature11379] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 07/12/2012] [Indexed: 11/09/2022]
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Subramanian S, Hoover S, Wagner JL, Donovan JL, Kanaan AO, Rochon PA, Gurwitz JH, Field TS. Immediate financial impact of computerized clinical decision support for long-term care residents with renal insufficiency: a case study. J Am Med Inform Assoc 2011; 19:439-42. [PMID: 22101906 DOI: 10.1136/amiajnl-2011-000179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In a randomized trial of a clinical decision support system for drug prescribing for residents with renal insufficiency in a large long-term care facility, analyses were conducted to estimate the system's immediate, direct financial impact. We determined the costs that would have been incurred if drug orders that triggered the alert system had actually been completed compared to the costs of the final submitted orders and then compared intervention units to control units. The costs incurred by additional laboratory testing that resulted from alerts were also estimated. Drug orders were conservatively assigned a duration of 30 days of use for a chronic drug and 10 days for antibiotics. It was determined that there were modest reductions in drug costs, partially offset by an increase in laboratory-related costs. Overall, there was a reduction in direct costs (US$1391.43, net 7.6% reduction). However, sensitivity analyses based on alternative estimates of duration of drug use suggested a reduction as high as US$7998.33 if orders for non-antibiotic drugs were assumed to be continued for 180 days. The authors conclude that the immediate and direct financial impact of a clinical decision support system for medication ordering for residents with renal insufficiency is modest and that the primary motivation for such efforts must be to improve the quality and safety of medication ordering.
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Subramanian S, Tangka FKL, Hoover S, Degroff A, Royalty J, Seeff LC. Clinical and programmatic costs of implementing colorectal cancer screening: evaluation of five programs. Eval Program Plann 2011; 34:147-153. [PMID: 21036399 DOI: 10.1016/j.evalprogplan.2010.09.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 08/02/2010] [Accepted: 09/27/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) initiated the Colorectal Cancer Screening Demonstration Program (CRCSDP) in 2005 to explore the feasibility of establishing a colorectal cancer screening program for underserved US populations. We provide a detailed overview of the evaluation and an assessment of the costs incurred during the service delivery (screening) phase of the program. METHODS Tailored cost questionnaires were completed by staff at the five CRCSDP sites for the first 2 years of the program. We collected cost data for clinical and programmatic activities (program management, data collection and tracking, etc.). We also measured in-kind contributions and assigned values to them. RESULTS During the first 2 years of the demonstration excluding the start-up cost, the average cost per person was $2569. Per person cost of clinical services alone ranged from $264 to $1385, while per person programmatic costs ranged from $545 to $3017. CONCLUSION Colorectal cancer screening programs can incur substantial costs for some non-clinical activities, such as data collection/tracking, and these support activities should be managed carefully to control costs and ensure successful program implementation. Our findings highlight the importance of performing economic evaluation to guide the design of future colorectal cancer screening programs.
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Affiliation(s)
- Sujha Subramanian
- RTI International, 1440 Main Street, Waltham, MA 02451-1623, United States.
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Detrixhe M, Besson D, Gorham PW, Allison P, Baughmann B, Beatty JJ, Belov K, Bevan S, Binns WR, Chen C, Chen P, Clem JM, Connolly A, De Marco D, Dowkontt PF, DuVernois MA, Frankenfeld C, Grashorn EW, Hogan DP, Griffith N, Hill B, Hoover S, Israel MH, Javaid A, Liewer KM, Matsuno S, Mercurio BC, Miki C, Mottram M, Nam J, Nichol RJ, Palladino K, Romero-Wolf A, Ruckman L, Saltzberg D, Seckel D, Varner GS, Vieregg AG, Wang Y. Ultrarelativistic magnetic monopole search with the ANITA-II balloon-borne radio interferometer. Int J Clin Exp Med 2011. [DOI: 10.1103/physrevd.83.023513] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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