DCC Retreat Meg Maley


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2nd Annual DCC Retreat

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  • (first bullet) CIAA signed May 31 2002 on World no tobacco day. Went into effect November 27, 2002. 2 nd state I the nation to go smoke-free. (second bullet) Excise tax was 24 cents when the original “green book was published. The most recent increase went into effect July 31 st of 2009. The tax is now $1.60. That is a 667% increase from 2002. Delaware is ranked 18 th in the nation. Average of all US states excise tax is $1.32. (third bullet) Decrease in smoking prevalence for both youth and adults are at all time lows. (fourth bullet) Cessation: Delaware Quitline. Telephone or face-to-face counseling, cessation products for eligible program participants. 33% quit rate after 6 months. (fifth bullet) Community programs. Best prevention is to get kids to never start. (seventh bullet) Menu labeling bill (SB 81) was introduced, Would provide information on calories, saturated fat, carbohydrates, sodium for menu items. (eighth bullet) Tanning bed legislation (SB 90). Introduced and passed this year. Minors under age 18 need parental permission to use tanning beds. Minors under 14 need a prescription from a healthcare professional. Additionally, Delaware was one of a handful of states (4 or 5 depending on the year) to meet the CDC recommendations. The recommendations for Delaware were updated in October 2007 from $8.6 million to $13.9 million. No state meets the current recommendations but DE funding has in the past remained relatively consistent.
  • (first bullet) Cancer Care Coordinators assisted with medical referrals, financial issues, acquisition of equipment or treatment needs, delivery of psychosocial services, and educating about clinical trials (second bullet) Cancer treatment validation study conducted and determined: Standard/appropriate treatment was provided Data collection differences between central and hospital registries (fifth bullet) Delaware Cancer Registry Advisory Committee’s (DCRAC) Delaware Cancer Registry maintains Gold standard for timeliness, completeness and quality of incidence data for 4 consecutive years
  • For your information - (BRFSS) – Behavioral Risk Factor Surveillance Survey (last bullet on slide) Initiating an investigation into statewide cancer treatment patterns using a targeted approach: Includes - Breast cancer time-to-treat project Which will evaluate time-lag from: 1. Abnormal mammogram  2. Diagnostic confirmation  3. Definitive surgery
  • (third bullet on slide) DATAS represents the largest and most comprehensive study of air toxic contaminants and the risks to human health undertaken in the Mid-Atlantic region (fifth bullet on slide) Over 2,300 finfish consumption advisory signs were posted on water streams throughout the state to notify the public of potential hazards.
  • (fourth bullet on slide) Delaware Cancer Treatment Program - Nearly 650 people have received services through the Delaware Cancer Treatment Program (DCTP) between July 2004 and June 2009. (fourth bullet on slide) AND Over $24 million dollars has been reimbursed to Delaware Medicaid Assistance Providers for cancer treatment through DCTP between July 2004 and June 2009
  • (first bullet) Delaware had been on of a small handful of states to fund tobacco prevention efforts at recommended levels. In Oct 2007 the recommendations, based on more evidence, were increased. The recommendation for DE is now $13.9 million/year. It was $8.6 million/year. NOTE: Report cards will now use the midpoint levels not the minimum recommendations as in the past. The lower end estimates for DE are $9.3 million. We do meet that lower estimate. The estimate for what DE spent on tobacco prevention and control effort was $10.6 million in FY09. (second bullet) There is concern that since we have been very effective that this problem has been solved. (third bullet) Cessation coverage needs to be provided and barriers removed. (fourth bullet) Obesity is a risk factor for many cancers. Physical activity, nutrition and obesity prevention programs needs to be increased.
  • (fourth bullet) Facilitating data exchange with private insurers Replicate methods used by BCBS of Ohio and NCDB Collaborate with BCBSDE representatives Create framework for future data exchange opportunities with other health insurance companies (fifth bullet) Capitalize on Delaware’s (relatively) small number of treatment facilities Improve collection of outpatient cancer treatment data Explore opportunities associated with electronic medical records Enhance acquisition of first course treatment data Promote standardized data acquisition and analysis procedures
  • The Delaware Cancer Consortium has received recognition from national organizations and federal agencies as being a model for cancer control and prevention. Most recently, the Delaware Cancer Consortium received the 2009 C-Change award for Best Implementation Plan for Cancer Control. The DCC and former Delaware Governor Minner have been the 2006, 2008 and 2009 C-Change award winners The only state to have won all three C-Change Awards
  • DCC Retreat Meg Maley

    1. 1. Turning Action into Results February 15, 2010 Meg Maley, RN, BSN Chair, Environment Committee Delaware Cancer Consortium
    2. 2. The Sub-Committees <ul><li>Early Detection and Prevention </li></ul><ul><li>Tobacco and Other Risk Factors </li></ul><ul><li>Disparities </li></ul><ul><li>Quality Cancer Care/Quality of Life </li></ul><ul><li>Data </li></ul><ul><li>Environment </li></ul><ul><li>Communication and Public Education and Workplace/Workforce </li></ul><ul><li>Insurance </li></ul>
    3. 3. Our Goals <ul><li>Create comprehensive statewide screening program that would navigate and provide case management to Delawareans through the screening and follow up process </li></ul><ul><li>Reimburse screening and treatment costs for the uninsured </li></ul><ul><li>Achieve 80% Colorectal Cancer Screening rate for Delawareans over age 50 </li></ul><ul><li>Improve prostate cancer screening and mortality rates among Delaware’s African-American men </li></ul><ul><li>Reduce colorectal and breast cancer mortality in Delaware among African-American women </li></ul><ul><li>Achieve equal rates of clinical trial participation between minorities and Caucasians </li></ul>
    4. 4. Our Goals <ul><li>Maintain DE leadership in comprehensive tobacco programs </li></ul><ul><li>Prevent youth initiation to tobacco products </li></ul><ul><li>Reduce exposure to secondhand smoke </li></ul><ul><li>Decrease social acceptability of tobacco use </li></ul><ul><li>Encourage healthy lifestyles, decrease risky behaviors </li></ul><ul><li>Reduce exposure to carcinogenic substances in the ambient environment </li></ul><ul><li>Coordinate with Department of Labor’s Occupational Safety & Health Office to reduce workplace carcinogenic risk and exposure </li></ul><ul><li>Reduce exposure to carcinogens in the indoor environment </li></ul>
    5. 5. Our Goals <ul><li>Ensure Delawarean’s access to the highest quality cancer screening and cancer care </li></ul><ul><li>Ensure continuity of care through cancer care coordination </li></ul><ul><li>Ensure availability of accurate complete data to allow effective surveillance of cancer incidence, care delivery and treatment </li></ul><ul><li>Eliminate gaps in quality of life services to meet the needs of patients, survivors and co-survivors without duplicating current services </li></ul><ul><li>Support quality of life training and education services for healthcare providers with an emphasis on palliation, survivorship, rehabilitation and end-of-life care </li></ul>
    6. 6. Our Goals <ul><li>Develop and implement health claims data acquisition methods </li></ul><ul><li>Acquire, analyze, and integrate data from electronic sources </li></ul><ul><li>Improve cancer surveillance methods statewide </li></ul><ul><li>Form and maintain a statewide, permanent alliance to coordinate and promote public education on cancer </li></ul>
    7. 7. Our Accomplishments <ul><li>Increased Colonoscopy CRC Screening over age 50 </li></ul><ul><ul><li>Increased from 52% (2002) to 74% (2008) </li></ul></ul><ul><ul><li>Highest state screening rate in the nation 2008 </li></ul></ul><ul><li>Since the programs inception navigators have successfully helped 4,168 through the CRC screening process </li></ul><ul><li>Over 3,000 CRC screenings through SFL FY02-FY09 </li></ul><ul><ul><li>1,475 clients had polyps removed </li></ul></ul><ul><ul><li>34 Cancers detected and treated </li></ul></ul><ul><li>Distributed over 2,600 doses of the HPV vaccine to providers </li></ul><ul><li>Added the availability of prostate screenings as a covered screening through the Screening for Life program </li></ul>
    8. 8. Our Accomplishments <ul><li>Clean Indoor Air Act passed </li></ul><ul><li>Six-fold increase in state excise tax (24¢ to $1.60) </li></ul><ul><li>Youth and adult smoking prevalence decreased </li></ul><ul><li>Cessation efforts: Quitline & Quitnet </li></ul><ul><li>Community outreach: youth programs & mini-grants </li></ul><ul><li>Increased awareness and knowledge of tobacco issues </li></ul><ul><li>Menu labeling bill </li></ul><ul><li>Tanning bed legislation </li></ul>
    9. 9. Our Accomplishments <ul><li>Between 2002 and 2008, colorectal cancer screenings among African Americans increased by 53.8% </li></ul><ul><li>In Delaware, the colorectal cancer screening rate disparity between African Americans and Caucasians has been eliminated (BRFS 2008, AA 73.5% and White 74.7%) </li></ul><ul><ul><li>The national the rates are 58.6% African American and 64.0% White </li></ul></ul><ul><li>In Delaware, in 2008, African Americans were significantly more likely than Caucasians to have had a sigmoidoscopy or colonoscopy within the last 12 months (45.5% vs. 27.8%, respectively). </li></ul><ul><li>In 2001, only 15% of African American colorectal cancer cases were caught in the local stage; by 2007, this number had increased to 33%. </li></ul>
    10. 10. Our Accomplishments <ul><li>Between 2001- 2007, the proportion of local stage colorectal cancers detected for African Americans increased 113% compared to 31% for Caucasians </li></ul><ul><li>From 1999-2008, African American adult smoking rate declined by 43% </li></ul><ul><ul><li>The decline among Caucasians for the same period was 27% </li></ul></ul><ul><li>DE’s all site incidence rate for African Americans is declining more than four times faster than for Caucasians </li></ul><ul><li>Incidence rates for African Americans and Caucasians are similar for colorectal cancer </li></ul><ul><li>Racial disparities in DE’s cancer mortality rates are shrinking </li></ul>
    11. 11. Our Accomplishments <ul><li>Cancer Care Coordination Program served over 2,111 patients and their families </li></ul><ul><li>Cancer treatment validation study conducted </li></ul><ul><li>Delaware Cancer Registry Advisory Committee </li></ul><ul><li>Trained nearly 400 nurses in end-of-life care through the End-of-Life Nursing Education Consortium. </li></ul><ul><li>Delaware Cancer Registry Advisory Committee’s (DCRAC) active role in guiding improvements in our state’s cancer data collection. </li></ul>
    12. 12. Our Accomplishments <ul><li>Conducted an investigation into census tract-level rates of six environmentally-based cancers. </li></ul><ul><li>Analyzed data from the Indian River Community-Level Survey (IRCLS). </li></ul><ul><li>Reviewed available cancer-screening items included in state- and national-level surveillance efforts (e.g., BRFSS). </li></ul><ul><li>Evaluated cancer cluster methodologies used by the Division of Public Health. </li></ul><ul><li>Reviewed and refined the methodology for “ Cancer Incidence and Mortality in Delaware ” and “ Delaware’s Cancer Rates by Census Tract ” (annual DPH reports). </li></ul><ul><li>Initiating an investigation into statewide cancer treatment patterns using a targeted approach </li></ul>
    13. 13. Our Accomplishments <ul><li>Implemented education initiative per Delaware Code to inform the public and realtors of the requirement of realtors to distribute radon rights and risk information to potential home buyers </li></ul><ul><li>Analyzed source water for pharmaceuticals and radiological contaminants </li></ul><ul><li>Completed Phase I and II of the Delaware Air Toxics Assessment Study (DATAS). </li></ul><ul><li>Initiated a statewide quarterly quality assessment of the Columbia Aquifer to investigate potential links between drinking water supplied to individual shallow wells and cancer incidence </li></ul><ul><li>Increased public awareness of the dangers of eating fish from certain Delaware waterways. </li></ul><ul><li>Established an Occupational Health Program to identify populations at risk from occupational exposure to carcinogens </li></ul>
    14. 14. Our Accomplishments <ul><li>Outfitted bused in New Castle County with diesel particulate filters </li></ul><ul><li>Development of Phase III of the Multi-Media Body Burden study and progress being made on identifying funding to complete Phase I and Phase II of the study </li></ul><ul><li>Established a statewide Delaware Cancer Education Alliance </li></ul><ul><li>Developed the Delaware Cancer Treatment Program </li></ul><ul><li>Increased eligibility from 12 months to 24 months </li></ul><ul><li>Connected Delaware Cancer Treatment Program clients with a Cancer Care Coordinator at hospital </li></ul>
    15. 15. <ul><li>Prevention of Cervical Cancer by large scale adoption of HPV Vaccine </li></ul><ul><li>Identify screening coverage barriers for Medicare recipients </li></ul><ul><li>Access existing data bases (Medicaid, commercial insurance) to identify and reach unscreened individuals </li></ul><ul><li>Funding to claim “ Universal Cancer Screening ” for all Delawareans </li></ul><ul><li>Determining why mortality rates among African Americans remain higher than those of Caucasians </li></ul><ul><li>Achieving equal rates of participation in clinical trials between African Americans and Caucasians </li></ul><ul><li>Using what we have learned in cancer to eliminate other racial and ethnic health disparities in Delaware </li></ul>Challenges and Opportunities
    16. 16. <ul><li>Maintain adequate funding for comprehensive tobacco programs </li></ul><ul><li>Sustain interest in tobacco prevention as a major health issue </li></ul><ul><li>Seek insurance coverage for cessation </li></ul><ul><li>Unify current activities into strategies for nutrition and physical activity </li></ul><ul><li>Increase programs for “other” lifestyle risk factors </li></ul>Challenges and Opportunities - tobacco
    17. 17. <ul><li>Creating methods/tools to promote primary care cancer screening </li></ul><ul><li>Quality “Report Cards”: annual, facility-specific reports to inform Delawareans of performance on quality measures </li></ul><ul><li>Extend Cancer Care Coordination services beyond the treatment phase </li></ul><ul><li>Collection of complete first course of treatment data in the Delaware Cancer Registry to support studies of quality of cancer care, facilitated by electronic reporting system and insurance claims data merging, etc </li></ul><ul><li>Facilitating data exchange with private insurers </li></ul><ul><li>Capitalize on Delaware’s (relatively) small number of treatment facilities </li></ul>Challenges and Opportunities - QCC
    18. 18. <ul><li>Public interest in and concern about environmental issues has created a sense of urgency to our projects </li></ul><ul><li>How to stay focused on current projects, while at the same time being sensitive to public concerns about new environmental challenges </li></ul><ul><li>The opportunity to truly help reduce cancer incident rates through the breadth of focus and depth of our resources </li></ul><ul><li>The ability to incorporate existing environmental monitoring into new initiatives that are bold and transformative </li></ul>Challenges and Opportunities
    19. 19. Awards and Recognition