Colorectal Cancer Screening Data Sets What are they and what do they tell us?

July 30th, 2015

Webinar

Purpose of Today’s Webinar • Provide an overview of five major data sets that track

colorectal cancer screening: BRFSS, NHIS, HEDIS, UDS and Medicare claims data

• Answer key questions about each data set, such as:

– How to access

– What they measure

– Strengths and weaknesses of each,

• Help you understand when you might use each in your work

• Q&A

Presenters: Andi Dwyer (Moderator) Co-Chair, National Colorectal Cancer Evidence Based Education and Outreach Task Group University of Colorado, Denver School of Public Health Djenaba Joseph, MD, MPH Medical Director Colorectal Cancer Control Program at CDC Carrie Klabunde, PhD Office of Disease Prevention Office of the Director at National Institutes of Health

Presenters (continued): Mary Barton, MD, MPP

Vice President of Performance Measurement

NCQA

Laura Makaroff, DO

Senior Clinical Advisor

Office of Quality Improvement

HRSA Bureau of Primary Health Care

Matt Allison

Health Systems, American Cancer Society

Djenaba A. Joseph, MD, MPH

CDR, U.S. Public Health Service

Medical Director, Colorectal Cancer Control Program

Division of Cancer Prevention and Control

Centers for Disease Control and Prevention

Behavioral Risk Factor Surveillance System (BRFSS)

Division of Cancer Prevention and Control

National Center for Chronic Disease Prevention and Health Promotion

Overview

Established 1984

Cross-sectional telephone survey

Conducted by state health departments

Landline and cellular telephones

Technical and methodological assistance from CDC

Collects state data about U.S. residents regarding

Health-related risk behaviors

Chronic health conditions

Use of preventive services

How often is data collected?

BRFSS

Annual

Core questions

• Fixed, rotating, and emerging

Optional modules

State added questions

CRC questions

Rotating core, even years (2012, 2014, etc.)

What is measured?

FOBT

Sigmoidoscopy

Colonoscopy

Fixed time interval responses (within the past year, 2

years, 3 years, 5 years, 10 years, more than 10 years

ago)

CRC screening prevalence

What gets reported?

How is the data accessed? http://www.cdc.gov/brfss

How is the data accessed?

http://www.cdc.gov/brfss

County level data

Advantages

State-based

County level data

Large dataset

Validated questions

Standardized

Disadvantages

Tends to over-estimate screening prevalence

Cannot differentiate screening vs. diagnostic/follow-

up

Self-reported data

Limited tests

Change in weighting methodology starting 2011

Cannot analyze trends across change

How is BRFSS used?

For more information please contact Centers for Disease Control and

Prevention 1600 Clifton Road NE, Atlanta, GA 30333

Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348

E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official

position of the Centers for Disease Control and Prevention.

Questions?

dajoseph@cdc.gov

Carrie Klabunde, Ph.D.

Office of Disease Prevention

Office of the Director

National Institutes of Health

NCCRT 80% by 2018 Webinar

July 30, 2015

CRC Screening Data Sets: National Health Interview Survey

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About the National Health Interview Survey

(NHIS) Principal source of information on the health of the U.S.

population.

Conducted by the National Center for Health Statistics (NCHS)

among a nationally-representative sample of households every

year since 1957.

Data collected through in-person interviews of 75,000-100,000

individuals by trained interviewers from the U.S. Census Bureau.

An NHIS interview takes about an hour to conduct. The

questionnaire has two main parts:

1. Core items—unchanged from year to year

2. Supplemental questions that change depending on current issues

and sponsors

3. Cancer Control Supplement is the source of CRC screening data

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NHIS Cancer Control Supplements

Sponsored by the National Cancer Institute (NCI) since 1987.

CDC’s Division of Cancer Prevention and Control has co-

sponsored since 2000.

Used to collect nationally-representative information on cancer

screening and prevention behaviors (i.e., tobacco use, diet,

physical activity, genetic counseling, etc.).

Full supplement fielded every five years to approximately 35,000

adults.

Interim supplements are fielded at the mid-point of the 5 year

intervals to monitor cancer screening and new/emerging cancer

control issues (e.g., HPV vaccine use).

CRC screening data have been collected in 2000, 2003, 2005,

2008, 2010, and 2013. 2015 NHIS is currently in the field.

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Significance of NHIS CRC Screening Data

Covers the major CRC screening modalities:

FOBT (distinguishes between home and office-based testing)

Sigmoidoscopy

Colonoscopy

CT colonography (in 2010 and 2015)

For each modality, ability to determine:

Ever had the test

When had most recent test

Main reason for having the test

For respondents who are not up-to-date with screening:

Whether they received a doctor recommendation to be tested

Which CRC screening tests were recommended

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Sociodemographics:

Age

Sex

Race/ethnicity

Marital status

Educational attainment

Family income

Immigration status

Employment

Health Status:

Body Mass Index (BMI)

General health status self-rating

Personal & family history of

cancer

Comorbid health conditions

Smoking history

Activity limitations

NHIS Covariates Available for CRC Screening

Analyses Health Care Access:

Health insurance

Usual source of care

Physician visits

Health Behaviors:

Diet, including fruit & vegetable

consumption

Alcohol use

Physical activity

Screening for other cancers:

breast, cervical, prostate

Geography:

Census region is publicly

available. State-level and

urban/rural estimates may be

obtained upon request through

NCHS Research Data Center

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NHIS Advantages & Disadvantages Advantages:

Large sample size that gives national estimates

High response rate (>60%)

Detailed questions on CRC screening

Rich set of covariates for assessing CRC screening use

Can examine trends over time

Designated data source for Healthy People monitoring

Items are cognitively tested and widely analyzed

Survey datasets are publicly available and well-documented

Disadvantages:

Working with NHIS public use datasets requires some programming ability (end-user must decide how to create screening and other variables)

Access to data at geographic units smaller than Census region requires explicit permission and working with NCHS Research Data Center

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Timeline for NHIS CCS Data

2000, 2003, 2005, 2008, 2010, and 2013 CCS data are

available now.

2015 NHIS is currently in the field (January-December).

First half of 2016: NCHS will work on data cleaning, quality

checks, and dataset preparation.

Estimated timeframe for 2015 NHIS public use dataset

release: June 2016

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0

10

20

30

40

50

60

70

80

90

100

2000 2003 2005 2008 2010 2013

% u

p-t

o-d

ate

wit

h s

cre

en

ing

Year

Percentage of adults up-to-date with screening for breast, cervical and colorectal cancers, by test, sex and

year – United States, 2000-2013 (NHIS)

Pap test*

Mammogram†

Any CRC test (male)‡

Any CRC test (female)‡

Abbreviations: CRC = colorectal cancer; Pap = Papanicolaou *Among women aged 21-65 with no prior hysterectomy. †Among women aged 50-74. ‡Among persons aged 50-75. Source: Sabatino et al. (2015), MMWR, 64 (17): 464-468

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Useful Websites

National Health Interview Survey homepage (contains questionnaires, datasets, and related documentation):

www.cdc.gov/nchs/nhis.htm

National Center for Health Statistics Research Data Center (provides access to restricted data):

www.cdc.gov/rdc

About the NHIS Cancer Control Supplement:

Healthcaredelivery.cancer.gov/nhis/what.html

State-based survey patterned on the NHIS: California Health Interview Survey (CHIS)--

www.cdph.ca.gov/data/surveys/Pages/CHIS.aspx

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Mary B. Barton, MD MPP

Vice President, Performance Measurement

HEDIS and the National Committee for

Quality Assurance

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What is NCQA?

• NCQA is 25 years old this year

• We accredit health care insurance plans,

holding them accountable for quality via

the reporting of performance measures

• Measures in HEDIS® cover most insured

patients in the US

• Include measures relevant to young and

old, mostly related to ambulatory care

• Prevention including a Colorectal Cancer

Screening measure HEDIS ® is a registered trademark

of NCQA

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Colorectal Cancer screening measure

• Denominator: adults aged 50 – 75 years

• Continuously enrolled for two years

• Receipt of

– FOBT within 2 years

– Flexible Sigmoidoscopy within 5 years

– Colonoscopy within 10 years

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Transparency and Public Reporting

• Measures reported annually in June on

data covering prior year

• Published each fall in Quality Compass

• Publically available (by subscription)

• Results presented by plan with local/

regional or national benchmarks

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SAMPLE REPORT FROM COMMERCIAL PLANS IN

CALIFORNIA, 2015 DATA

NCQA HEDIS report

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Considerations

• Advantages:

– Results updated annually

– Based on claims or medical records, may be

more accurate than patient recall via survey

• Disadvantages:

– Potential for under-ascertainment with chart

review approach

– Covers only the insured population

– Burden (to health plans) of chart review

measures

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Horizon for this measure

• Long look back period means that many

organizations use chart review of sample

of patients

• Broader use of electronic health records

hold promise for measures such as this,

that rely on more detailed information

than available in a claims dataset

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Where to get the data

• www.ncqa.org

• Quality Compass:

http://www.ncqa.org/qualitycompass.asp

x

• Questions: Mary Barton barton@ncqa.org

Colorectal Cancer Screening Rates

and the Uniform Data System (UDS)

July 30, 2015

Laura Makaroff, D.O.

Senior Clinical Advisor

Office of Quality Improvement, Bureau of Primary Health Care

Health Resources and Services Administration

U.S. Department of Health and Human Services

Primary Health Care Mission

Improve the health of the Nation’s underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary health care services

39

40

• Improve health outcomes for patients

• Promote a performance-driven and innovative organizational culture

• Modernize the primary health care safety net infrastructure and delivery system

• Increase access to primary health care services for underserved populations

Increase Modernize

Promote Improve

Primary Care: Key Strategies

Health Center Program National Impact

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Health Center Program

Increase Access - National Presence

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What is the UDS?

Standardized set of data reported by health

centers:

– PHS Section 330 Grantees– Community Health

Centers (CHC), Migrant Health Centers (MHC),

Health Care for the Homeless (HCH) and Public

Housing Primary Care Program (PHPC)

– Health Center Look-alikes

– Urban Indian Health programs

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Why is the UDS Important?

• UDS data are used by the Bureau of Primary

Health Care (BPHC) to: – Ensure compliance with legislative and regulatory requirements

– Report program achievements

– Monitor performance and identify TA needs

• UDS data are used by health centers to monitor

and improve performance

• UDS data describes patient populations served

by health centers

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What Data is Collected in the UDS?

• The UDS is comprised of

12 tables and an

Appendix (EHR

capabilities, PCMH,

Accreditation etc.)

• Captures annual,

aggregate data at the

health center organization

level

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Table Description

ZIP Codes

Patients by ZIP code (by primary medical insurance)

3A, 3B, 4

3A: Patients by age and gender 3B: Patients by race and ethnicity 4: Patients by income, insurance, and target populations

5 Utilization and staffing

5A Tenure for health center staff

6A Selected diagnoses and services

6B Quality of care indicators

7 Health outcomes and disparities

8A Financial costs

9D Patient related revenue

9E Other revenue

UDS CRC Screening Measure

Percentage of patients aged 50 to 75 who had appropriate

screening for colorectal cancer

• Numerator: Number of patients aged 51 through 74 with

appropriate screening for colorectal cancer.

• Denominator: Number of patients who were aged 51

through 74 at some point during the measurement year,

who had at least one medical visit during the reporting

year

30.2% 32.6%

70.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

UDS 2012 UDS 2013 HP 2020 Goal

Colorectal Cancer Screening Health Center National Average and HP 2020 Goal

CRC Screening

Health Center National Average

0 100 200 300 400 500 600

Less than 10%

10-30%

30-50%

50-70%

Greater than 70%

Number of Health Center Program Grantees

Co

lore

ctal

Can

cer

Scre

en

ing

Rat

e

HRSA-Funded Health Center Colorectal Cancer Screening Rates UDS 2013

CRC Screening

Health Center National Average

Annual UDS Performance Data publicly available at:

http://bphc.hrsa.gov/datareporting/index.html

UDS Website:

http://bphc.hrsa.gov/datareporting/reporting/index.html

• Reporting Resources

• UDS Training Resources

UDS Mapper: www.udsmapper.org

• HRSA has developed a mapping and support tool driven primarily

from data within the UDS

• Webinar trainings on using Mapper functionality available:

http://www.udsmapper.org/webinars.cfm

UDS Web Tools

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Thank You!

Laura Makaroff Senior Clinical Advisor

Office of Quality Improvement Bureau of Primary Health Care

Health Resources and Services Administration U.S. Department of Health and Human Services

301-594-4479 lmakaroff@hrsa.gov

Using Medicare Data for CRC

Matt Allison

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American Cancer Society

Medicare Dataset Overview • Mainly 65+ • 6-8 month data lag for claims processing • Updates typically available quarterly • Can breakdown screening by test, race, ethnicity,

zip code, county, and provider • Available through ResDAC or QIO • Research Identifiable Files are available for custom

reports • Used by CMS to calculate provider reimbursement

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Dataset issues

• Only 65+ age group

• Patient attribution can be difficult

• No record of screening before Medicare coverage

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How to get it

• Talk to your state QIO • http://www.ahqa.org/quality-improvement-

organizations

• Provide basic report specifications • http://nccrt.org/wp-

content/uploads/Sample.NQF_.VendorrequestforCRCscreeningrates.pdf

• Contact ResDAC • http://www.resdac.org/about-resdac/contact-us

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Example by County and Test

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Example by Zip Code

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Example Provider Scorecard

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Example Screening Rate Mapping

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Thank You!

• Today’s speakers

• Wilder Research

• NCCRT Evidence-based Education & Outreach Task Group

This webinar series was made possible in part by funding from the Centers for Disease Control and Prevention Cooperative Agreement Number 5U38DP004969-02. The views expressed in the materials and by speakers and moderators do not necessarily reflect the official policies of the Dept. of Health and Human Services.

Questions Join us for our next webinar on evaluating social media

Tuesday, August 11th at 2:30pm EST

For more information contact:

Mary Doroshenk, MA

Mary.doroshenk@cancer.org

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