Race and Prevalence of Large Bowel Polyps Among the Low-Income and Uninsured in South Carolina.

BACKGROUND: Compared to whites, blacks have higher colorectal cancer incidence and mortality rates and are at greater risk for early-onset disease. The reasons for this racial disparity are poorly understood, but one contributing factor could be differences in access to high-quality screening and medical care. AIMS: The present study was carried out to assess whether a racial difference in prevalence of large bowel polyps persists within a poor and uninsured population (n = 233, 124 blacks, 91 whites, 18 other) undergoing screening colonoscopy. METHODS: Eligible patients were uninsured, asymptomatic, had no personal history of colorectal neoplasia, and were between the ages 45-64 years (blacks) or 50-64 years (whites, other). We examined the prevalence of any adenoma (conventional, serrated) and then difference in adenoma/polyp type by race and age categories. RESULTS: Prevalence for ≥1 adenoma was 37 % (95 % CI 31-43 %) for all races combined and 36 % in blacks <50 years, 38 % in blacks ≥50 years, and 35 % in whites. When stratified by race, blacks had a higher prevalence of large conventional proximal neoplasia (8 %) compared to whites (2 %) (p value = 0.06) but a lower prevalence of any serrated-like (blacks 18 %, whites 32 %; p value = 0.02) and sessile serrated adenomas/polyps (blacks 2 %, whites 8 % Chi-square p value; p = 0.05). CONCLUSIONS: Within this uninsured population, the overall prevalence of adenomas was high and nearly equal by race, but the racial differences observed between serrated and conventional polyp types emphasize the importance of taking polyp type into account in future research on this topic.

The development and acceptability of symptom management quality improvement reports based on patient-reported data: an overview of methods used in PROSSES.

PURPOSE: Patient experiences with symptom care need to be assessed and documented to ensure successful management of cancer-related symptoms. This paper details one method for creating symptom management quality improvement (SMQI) reports, including case-mix adjustment of patient-reported measures. Qualitative data regarding the acceptability of these reports at participating cancer centers (CCs) are also provided. METHODS: Data were collected from 2226 patients treated at 16 CCs via mailed/Web questionnaires. Twelve items assessing patient perceptions of symptom management-pain, fatigue, emotional distress-served as key quality indicators. Medico-demographic variables suitable for case-mix adjustment were selected using an index score combining predictive power and heterogeneity across CCs. SMQI reports were designed with staff feedback and produced for each CC, providing crude and adjusted CC-specific rates, along with study-wide rates for comparison purposes. RESULTS: Cancer type and participant educational level were selected for case-mix adjustment based upon high index scores. The Kendall rank correlation coefficient showed that case-mix adjustments changed the ranking of CCs on the key quality indicators (% Δ rank range: 5-22 %). The key quality indicators varied across CCs (all p < 0.02). SMQI reports were well received by CC staff, who described plans to share them with key personnel (e.g., cancer committee, navigator). CONCLUSIONS: This paper provides one method for creating hospital-level SMQI reports, including case-mix adjustment. Variation between CCs on key quality indicators, even after adjustment, suggested room for improvement. SMQI reports based on patient-reported data can inform and motivate efforts to improve care through professional/patient education and applying standards of care.

Quality improvement in the national cancer institute community cancer centers program: the quality oncology practice initiative experience.

PURPOSE: The National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP) began in 2007; it is a network of community-based hospitals funded by the NCI. Quality of care is an NCCCP priority, with participation in the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) playing a fundamental role in quality assessment and quality improvement (QI) projects. Using QOPI methodology, performance on quality measures was analyzed two times per year over a 3-year period to enhance our implementation of quality standards at NCCCP hospitals. METHODS: A data-sharing agreement allowed individual-practice QOPI data to be electronically sent to the NCI. Aggregated data with the other NCCCP QOPI participants were presented to the network via Webinars. The NCCCP Quality of Care Subcommittee selected areas in which to focus subsequent QI efforts, and high-performing practices shared voluntarily their QI best practices with the network. RESULTS: QOPI results were compiled semiannually between fall 2010 and fall 2013. The network concentrated on measures with a quality score of ≤ 0.75 and planned voluntary group-wide QI interventions. We identified 13 measures in which the NCCCP fell at or below the designated quality score in fall 2010. After implementing a variety of QI initiatives, the network registered improvements in all parameters except one (use of treatment summaries). CONCLUSION: Using the NCCCP as a paradigm, QOPI metrics provide a useful platform for group-wide measurement of quality performance. In addition, these measurements can be used to assess the effectiveness of QI initiatives.

Community outreach: providing a comprehensive approach to smoking cessation.

The LEEP Program at the SRHS has completed its first year. Executing the strategic action plans could not have been accomplished without the collaboration of multiple agencies-the ACS, ALA, DHEC, SADAC, and the SRHS. Activities surrounding education, awareness, and the development of support programs during this year have moved us closer to achieving our goal-to develop and implement a systematic educational program including a collaborative community-wide smoking cessation initiative. We had many successes during the first year of the LEEP program. However, future opportunities remain. Offering Freshstart facilitator class twice a year will provide trained facilitators for the every-other-month Freshstart classes at the Gibbs Regional Cancer Center and community smoking cessation classes as needed. Moreover, smokers in the community can attend a smoking cessation support group that began in January 2002. The support group reinforces the safety net of services developed within the first year. Collaboration with other community organizations ensure that continued efforts are made to improve the health and quality-of-life for upstate South Carolina residents. "According to results from the 1994 National Health Interview Supplement (NHIS-2000), 70% of smokers indicated a strong desire to quit" (Westmaas, 2000). It is the role and responsibility of health care institutions to provide the safety net of services to enable patients and the community at large to be successful in their efforts to kick the cigarette habit.

Developing a comprehensive cancer center rehabilitation program.

As more oncology care is provided in the outpatient setting, cancer centers and oncology healthcare professionals are presented with greater opportunities to substantially enhance the quality of care given to patients. A diagnosis of cancer is a life-changing event that has many implications for the patient, as well as his or her family members. The stress of dealing with a new cancer diagnosis and the ensuing medical treatment can be overwhelming. Treatment for cancer may involve complex protocols, leaving patents mentally and physically exhausted. A multidisciplinary approach to the primary treatment plan-surgery, chemotherapy, and radiation therapy--is the standard of care. However, formalized rehabilitation programs for this patient population are unique. Many facilities rely on a centralized rehabilitation department within a medical center to meet the needs of oncology patients. Although this is the traditional approach, the growing complexity of cancer treatment provides an opportunity to enhance the rehabilitation process. The Gibbs Regional Cancer Center (GRCC), which is a part of Spartanburg Regional Healthcare System, teamed up with the hospital rehabilitation department to create a venue specifically designed for oncology patients. Described within this article is the developmental process of the GRCC Rehabilitation Program.