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Cancer

Cover image for Vol. 119 Issue S15

Special Issue: Comprehensive Evaluation of the Centers for Disease Control and Prevention's Colorectal Cancer Screening Demonstration Program, Supplement to Cancer

1 August 2013

Volume 119, Issue Supplement S15

Pages i–iii, 2817–2946

  1. Supplement

    1. Top of page
    2. Supplement
    3. Original Articles
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  2. Original Articles

    1. Top of page
    2. Supplement
    3. Original Articles
    1. You have free access to this content
      Lessons learned from the CDC's Colorectal Cancer Screening Demonstration Program (pages 2817–2819)

      Laura C. Seeff and Elizabeth A. Rohan

      Article first published online: 18 JUL 2013 | DOI: 10.1002/cncr.28165

      This introduction includes a brief overview of each article in this supplement and summarizes all components of the evaluation (ie, clinical, cost, and a qualitative case study) of the implementation period of the Centers for Disease Control and Prevention's 4-year Colorectal Cancer Screening Demonstration Program. The multimethod design and interdisciplinary nature of the program evaluation are highlighted.

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      Clinical outcomes from the CDC's Colorectal Cancer Screening Demonstration Program (pages 2820–2833)

      Laura C. Seeff, Janet Royalty, William E. Helsel, William G. Kammerer, Jennifer E. Boehm, Diane M. Dwyer, William R. Howe Jr., Djenaba Joseph, Dorothy S. Lane, Melinda Laughlin, Melissa Leypoldt, Steven C. Marroulis, Cynthia A. Mattingly, Marion R. Nadel, Ellen Phillips-Angeles, Tanner J. Rockwell, A. Blythe Ryerson and Florence K. L. Tangka

      Article first published online: 18 JUL 2013 | DOI: 10.1002/cncr.28163

      The Centers for Disease Control and Prevention designed and established a 4-year Colorectal Cancer Screening Demonstration Program (CRCSDP) in 2005 for low-income, under-insured or uninsured men and women aged 50 to 64 years in 5 participating US program sites. This report documents the successful implementation of the CRCSDP and describes the clinical outcomes of this 4-year initiative, patterns in program uptake and test choice, challenges in implementation of fecal occult blood test screening programs, and comparative test performance characteristics of fecal occult blood testing versus colonoscopy.

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      Assessing screening quality in the CDC's Colorectal Cancer Screening Demonstration Program (pages 2834–2841)

      Marion R. Nadel, Janet Royalty, Jean A. Shapiro, Djenaba Joseph, Laura C. Seeff, Dorothy S. Lane and Diane M. Dwyer

      Article first published online: 18 JUL 2013 | DOI: 10.1002/cncr.28164

      Examination of the quality of screening provided in the Centers for Disease Control and Prevention's Colorectal Cancer Screening Demonstration Program indicated that cecal intubation rates and adenoma detection rates met recommended levels. The authors identified the need for improvement in the follow-up of positive fecal occult blood tests, documentation of important elements in colonoscopy reports, and recommendations for rescreening or surveillance intervals after colonoscopy.

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      Delivering colonoscopy screening for low-income populations in Suffolk County: Strategies, outcomes, and benchmarks (pages 2842–2848)

      Dorothy S. Lane, Catherine R. Messina, Mary F. Cavanagh and Joseph C. Anderson

      Article first published online: 18 JUL 2013 | DOI: 10.1002/cncr.28160

      An academic medical center model for providing high-quality colonoscopy screening services to meet the increasing needs of low-income populations is described. Quality indicators for colonoscopy screening were met by faculty gastroenterologists and supervised fellows, with facilitation of patient adherence and satisfaction achieved through coordination by a preventive medicine clinician and patient navigator.

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      Outpatient colonoscopy complications in the CDC's Colorectal Cancer Screening Demonstration Program: A prospective analysis (pages 2849–2854)

      Georgina Castro, M. Fuad Azrak, Laura C. Seeff and Janet Royalty

      Article first published online: 18 JUL 2013 | DOI: 10.1002/cncr.28159

      This article reports the rate of complications from colonoscopy in the Centers for Disease Control and Prevention's Colorectal Cancer Screening Demonstration Program. The overall incidence of serious complications from colonoscopy was 2.38 per 1000 procedures.

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      Costs of planning and implementing the CDC's Colorectal Cancer Screening Demonstration Program (pages 2855–2862)

      Sujha Subramanian, Florence K. L. Tangka, Sonja Hoover, Maggie C. Beebe, Amy DeGroff, Janet Royalty and Laura C. Seeff

      Article first published online: 18 JUL 2013 | DOI: 10.1002/cncr.28158

      This report provides a detailed description of the total program (clinical and nonclinical) costs incurred during both the start-up and service delivery (screening) phases of the 4-year Colorectal Cancer Screening Demonstration Program implemented by the Centers for Disease Control and Prevention.

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      Clinical costs of colorectal cancer screening in 5 federally funded demonstration programs (pages 2863–2869)

      Florence K. L. Tangka, Sujha Subramanian, Maggie C. Beebe, Sonja Hoover, Janet Royalty and Laura C. Seeff

      Article first published online: 18 JUL 2013 | DOI: 10.1002/cncr.28154

      By using data on payments to providers from each of the 5 Colorectal Cancer Screening Demonstration Program (CRCSDP) sites, the authors estimate costs for specific clinical services and overall clinical costs for each of the 2 colorectal cancer screening methods used: colonoscopy and fecal occult blood test. The results indicate that variations in how sites contracted with providers and in the services provided through the CRCSDP affected the cost of clinical services and the complexity of collecting cost data.

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      Implementing the CDC's Colorectal Cancer Screening Demonstration Program: Wisdom from the field (pages 2870–2883)

      Elizabeth A. Rohan, Jennifer E. Boehm, Amy DeGroff, Rebecca Glover-Kudon and Judith Preissle

      Article first published online: 18 JUL 2013 | DOI: 10.1002/cncr.28162

      Findings from this qualitative, multiple case study evaluation of program implementation processes highlight the following themes: the complexity of colorectal cancer screening, teamwork and collaboration, integration of the program into existing systems, the ability of programs to use wisdom at the local level, and the influence of social norms. Implications include using patient navigation, engaging in transdisciplinary teamwork, assimilating new programs into existing clinical settings, and deferring to local-level wisdom to help address complexity and enhance program implementation; public health efforts must confront negative social norms around colorectal cancer screening.

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      Fostering partnerships and program success (pages 2884–2893)

      Ellen Phillips-Angeles, Lin Song, Peggy A. Hannon, Megan Celedonia, Steven Stearns, Kris Edwards, Scott Feest and Amy Shumann

      Article first published online: 18 JUL 2013 | DOI: 10.1002/cncr.28157

      The authors report that fostering partnerships was critical to the success of the Colon Health Program (CHP) in Greater Seattle. The CHP partners developed clinic policies, procedures, and systems to increase colorectal screening and improve tracking and follow-up; expanded access to colonoscopies; and initiated dissemination of the CHP in Washington State.

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      Clinical case management and navigation for colonoscopy screening in an academic medical center (pages 2894–2904)

      Mary F. Cavanagh, Dorothy S. Lane, Catherine R. Messina and Joseph C. Anderson

      Article first published online: 18 JUL 2013 | DOI: 10.1002/cncr.28156

      Through Project SCOPE (Suffolk County Preventive Endoscopy), an academic medical center model for colorectal cancer screening, existing barriers to colonoscopy screening among community health center patients are removed. Clinical case management coupled with patient navigation provides individualized patient support, which facilitates the screening of 800 patients over a 40-month screening period.

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      Collaborating across multiple health care institutions in an urban colorectal cancer screening program (pages 2905–2913)

      Robert Villanueva, Donna Gugel and Diane M. Dwyer

      Article first published online: 18 JUL 2013 | DOI: 10.1002/cncr.28153

      Baltimore City used a model involving the Maryland state health department as the grant recipient and 5 hospitals funded as colonoscopy screening sites in the demonstration program. This article describes the successful planning and collaboration that enabled 696 people (86% of minority race or ethnicity) to be screened, data to be collected, quality to be assured, and costs to be reported for program evaluation.

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      Recruiting patients into the CDC's Colorectal Cancer Screening Demonstration Program: Strategies and challenges across 5 sites (pages 2914–2925)

      Jennifer E. Boehm, Elizabeth A. Rohan, Judith Preissle, Amy DeGroff and Rebecca Glover-Kudon

      Article first published online: 18 JUL 2013 | DOI: 10.1002/cncr.28161

      Despite removing financial barriers to colorectal cancer screening, sites funded for the Colorectal Cancer Screening Demonstration Program (CRCSDP) found unexpected challenges in recruiting patients for their services and altered their strategies to patient recruitment by adopting more comprehensive approaches. To optimize colorectal cancer screening, public health practitioners must work closely with the health care sector to implement evidence-based, comprehensive strategies across individual, environmental, and systems levels.

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      Developmental milestones across the programmatic life cycle: Implementing the CDC's Colorectal Cancer Screening Demonstration Program (pages 2926–2939)

      Rebecca Glover-Kudon, Amy DeGroff, Elizabeth A. Rohan, Judith Preissle and Jennifer E. Boehm

      Article first published online: 18 JUL 2013 | DOI: 10.1002/cncr.28166

      In a longitudinal qualitative evaluation of 5 sites that the Centers for Disease Control and Prevention funded to provide colorectal cancer screening programs for uninsured, low-income populations, a developmental model was discovered to represent the programs' maturation over time. Demonstration sites evolved through common stages during screening implementation, suggesting key areas of technical assistance to more efficiently move programs along their maturation trajectory.

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      Moving forward: Using the experience of the CDCs' Colorectal Cancer Screening Demonstration Program to guide future colorectal cancer programming efforts (pages 2940–2946)

      Laura C. Seeff, Amy DeGroff, Djenaba A. Joseph, Janet Royalty, Florence K. L. Tangka, Marion R. Nadel and Marcus Plescia

      Article first published online: 18 JUL 2013 | DOI: 10.1002/cncr.28155

      The Centers for Disease Control and Prevention (CDC) supported a 4-year Colorectal Cancer Screening Demonstration Program (CRCSDP) from 2005 to 2009 for low-income, under- or uninsured men and women aged 50-64 at 5 participating US sites. A multiple methods evaluation was conducted in conjunction with program implementation including 1) a longitudinal, multiple case study of program implementation; 2) analysis of client-level screening and diagnostic services outcome data; and 3) a cost study. Several themes emerged from the series of articles in this supplement including the benefit of building on an existing infrastructure, strengths and weaknesses the 2 most frequently used screening tests (colonoscopy and fecal occult blood tests), costs of the screening tests used in this program, and the continued importance of measuring the quality of screening tests. Critical lessons were learned through the implementation and evaluation of the CDC's CRCSDP, which informed the development of a larger follow-up population-based program.

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