Getting to the Next Level in Reducing Maine’s Cancer Burden

Commission to Study the Incidence of and Mortality Related to Cancer

Friday, October 25, 2013

Timothy Cowan, MSPHDirector, Health Index Initiative, MaineHealth

Our System MaineHealth is a not-for-profit family of leading high-quality providers and other healthcare organizations working together so their communities are the healthiest in America.

MaineHealth is ranked among the nation's top 100 integrated healthcare delivery networks

Decrease Cancer Mortality

Getting to the Next Level

1. Reduce tobacco use

2. Reduce obesity

3. Increase screenings • Colorectal cancer

4. Implement MaineHealth Regional Oncology Plan

CRC Screening Rates Differ by Demographics & Geography

Opportunity: Fecal Immunochemical TestsRandomized Control Trial in 16 Rural Family Medicine Offices in IowaIntervention Number of

Patients (743 total)

% screened for colorectal cancer

(any type)

Usual Care 185 17.8%

Physician chart reminder 185 20.5%Physician reminder + mailed educational materials & FIT 186 56.5%

Physician reminder + mailed educational materials & FIT + Telephone call

187 57.2%

JABFM, September-October 2013, Vol. 26 No. 5; p 486-497doi: 10.3122/jabfm.2013.05.130041

Opportunity:Maine Colorectal Cancer Control Program

Last year of current funding (federal $$).•Policy Issues•System Interventions•Screening for Low Income, underinsured and uninsured Mainers

Planning to apply for additional $$ to continue

Program Manager: Jessica Schaefer

Source: America’s Health Rankings®

Tobacco Use Prevalence0% 10% 20% 30% 40% 50%

18-4950-64

65+

up to $25,000$25,000-$50,000

$50,000+

HS or lessCollege 1-3College 4+

Commercial <65MaineCare/Medicare <65

Medicare +65Uninsured

Adult Smoking % by Demographic -- Maine (2010 )

= Youth Smoking Rates 19% or higher

Youth Tobacco Use 2011: ME USCigarettes 16% 18%Cigars, little cigars 13% 23%Smokeless 7% 7%

Half of Smokers Making Serious Quit Attempts

% Adult Smokers: Maine vs. U.S.- ‘06/07

Maine one of eight states made change: more smokers made quit attempts in 2006/2007

= significant increase in “Ever smokers” who quit 92/93 vs. 06/07

Tobacco Use Prevalence0% 10% 20% 30% 40% 50%

18-4950-64

65+

up to $25,000$25,000-$50,000

$50,000+

HS or lessCollege 1-3College 4+

Commercial <65MaineCare/Medicare <65

Medicare +65Uninsured

Adult Smoking % by Demographic -- Maine (2010 )

= Youth Smoking Rates 19% or higher

Youth Tobacco Use 2011: ME USCigarettes 16% 18%Cigars, little cigars 13% 23%Smokeless 7% 7%

Example: Decrease Tobacco Use

Macro Population Health Strategies (e.g., Community/Policy Settings)• Education in schools• Community “No Butts” policies in parks or playgrounds• Limit advertising in convenience stores• Insurer coverage of tobacco treatment• Employer adoption of higher health insurance premiums• “Helpers” Program• Media outreach • Increase tobacco tax

Example: Decrease Tobacco Use

Micro Population Health Strategies (e.g., Clinical Settings)

• Target tobacco users in primary care and hospital settings to receive brief counseling

• Increase referrals to the Maine Tobacco HelpLine• Increase access to nicotine replacement therapy• Provide provider training in motivational interviewing• Increase access to tobacco treatment for inpatients,

outpatients and employees

Clinician Support for Quitting- 2010

Comments and Questions

Contacts:

Timothy Cowan, MSPHDirector, Health Index Initiative

cowant@mainehealth.org