The National Colorectal Cancer Roundtable, the American Cancer Society, the Centers for Disease Control and Prevention, and the Office of the Assistant Secretary of Health announced a coordinated initiative to increase colorectal (colon) cancer screening of people with personal or familial risk factors and everyone over the age of 50 to 80 percent by 2018. These goals are of life-saving significance because the earlier colon cancer is diagnosed, the better the overall survival rates.
Kaiser Permanente is pleased to support yesterday’s announcement and the organization is well on its way to reaching the 80 percent target before 2018. Through a combination of a comprehensive electronic health record and effective patient outreach, Kaiser Permanente is currently almost at the 80 percent goal for screening its more than 9 million members who are at risk and/or over the age of 50, and the organization is already well above the HEDIS 90th percentile of 73.0 percent.
While the organization continues to seek ways to exceed the 80 percent goal before 2018, Kaiser Permanente is also examining and addressing disparities within its membership. For example, nationally, colon cancer screening rates for the general population are low; however, they are even lower among minorities and those without health insurance. A 2012 CDC survey found disparity between 66 percent of non-Latino whites who were adequately screened, compared to 53 percent of Latinos and 37 percent of uninsured patients.
“Kaiser Permanente’s overall screening rate for colon cancer among our membership is currently among the highest in the country, however, we are looking to improve our industry-leading efforts by eliminating disparities in the delivery of health care,” said Berny Gould, RN, MNA, senior director, Quality, Hospital Oversight and Equitable Care for Kaiser Permanente. “Kaiser Permanente is committed to eliminating gaps in care by evaluating our processes, using data from our electronic health records to track outcomes by patient populations, and implementing continuous improvements that focus on the needs of our diverse patients.”
“Kaiser Permanente’s history was built on equal access to care for all populations,” said Winston Wong, MD, director, Disparities Improvement and Quality Initiatives for Kaiser Permanente. “We know that the Affordable Care Act will increase access to care for the newly insured, and in particular the growing population of Latinos; therefore Kaiser Permanente has already taken steps at eliminating health care disparities by developing programs that decrease the impact of language barriers, cultural beliefs, low health literacy, and institutional processes that are often challenges to providing equitable care.”
In October 2011, Kaiser Permanente national and regional senior leaders in quality and diversity gathered for the organization’s first Equity Summit, charged with setting specific targets to reduce health care disparities across all Kaiser Permanente regions. Included in the targets was the goal to reduce the gap between Latino members and white members in the rate of colon cancer screening by 25 percent in 2012 and 2013 — and to close that gap within five years, while becoming the best in the nation for colon cancer screening for all populations. Kaiser Permanente is well on its way to achieving these goals by aligning quality improvement measures, population care and through diversity and inclusion.
“Through the deployment of electronic health records, the assessment of patient demographic data collection, and the rich diversity of our workforce reflecting the diversity of those we serve, Kaiser Permanente is transforming care delivery, making it more equitable, and culturally and linguistically personalized,” said Ronald L. Copeland, MD, FACS, senior vice president of National Diversity Strategy and Policy, and chief diversity and inclusion officer for Kaiser Permanente. “But there are many challenges ahead and more change is needed to continuously improve care delivery.”
According to the American Cancer Society, in 2014, there will be 136,830 new cases of colon cancer diagnosed and about 50,310 deaths, making it the third-leading cause of cancer-related deaths in the United States. While there have been significant improvements in screening rates over the last few years and colon cancer death rates have been steadily declining, there is still opportunity for improvement.
The earlier colon cancer is diagnosed, the better the overall survival rates — approximately 7 percent to 26 percent of people died when diagnosed at an early stage, compared to 25 percent to 44 percent at later stage, and 80 percent for those diagnosed at the latest stage. The incidence is higher in men than in women, and ranges from 46.1 per 100,000 per year in Latino men to 66.9 per year in African-American men. In women, it ranges from 31.9 per 100,000 per year in Latinas to 50.3 per 100,000 per year in African Americans.,
Current medical guidelines for adults at risk or over the age of 50 recommend an annual FIT, or fecal immunochemical test, which is one of several options to detect colorectal cancer. The test can be done at home, only takes a few minutes, and is a very good predictor of whether a patient has colorectal cancer. Other options recommended by the U.S. Preventive Services Task Force include a more invasive test called a sigmoidoscopy, which examines the lower colon and is recommended every five years, along with a stool test every three years. A colonoscopy, which examines the entire colon, is recommended every 10 years. People with no specific risks for colon cancer should start screening at age 50, and most people should continue until age 75.