Public reporting outcomes 2017

PUBLIC REPORTING OF OUTCOMES OF THE CANCER COMMITTEE

2015 Quality Improvement Measures 2017 Prevention Program: Low-Dose CT Lung Cancer Screening Program 2017 Prevention Program: CRM Mammography Campaign 2017 Community Benefits Campaign: Obesity and Cancer

2015 QUALITY IMPROVEMENT MEASURES

2015 QUALITY IMPROVEMENT MEASURES

Breast conservation surgery rate for women with AJCC clinical stage 0, I, or II breast cancer (Surveillance)

Tamoxifen or third generation aromotase inhibitor is considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1c or stage IB-III hormone receptor positive breast cancer (Accountability)

COMPARISON TO

EPR%

95% CI

# CASES

# FACILITIES

COMPARISON TO

EPR%

95% CI

# CASES

# FACILITIES

MY CANCER PROGRAM

79%

72.4-85

164

1

MY CANCER PROGRAM

98%

95.1-100

130

1

MY ACS DIVISION

76%

75. 2-77. 2

7063

94

MY ACS DIVISION

95%

94.8-96

4293

94

MY CENSUS REGION

76%

75. 2-77. 2

7063

94

MY CENSUS REGION

95%

94.8-96

4293

94

MY COC PROGRAM TYPE

65%

64.7- 65.7

39096

230

MY COC PROGRAM TYPE

91%

91-91.8

24504

230

MY STATE

79%

77.6-80.6

32999

39

MY STATE

95%

94.4-96.4

1822

39

ALL COC APPROVED PROGRAMS

66%

65.8- 66.4

122494

1337

ALL COC APPROVED PROGRAMS

92%

91.4-91.8

76842

1337

Image or palpation-guided needle biopsy (core or FNA) of the primary site is performed to establish diagnosis of breast cancer (Quality Improvement)

COMPARISON TO

EPR%

95% CI

# CASES

# FACILITIES

99.5%

98.6-100

218

1

MY ACS DIVISION

93%

92-93. 2

7997

94

MY CENSUS REGION

93%

92-93. 2

7997

94

MY COC PROGRAM TYPE

91%

91-91.6

36186

230

MY STATE

92%

91-92.8

3426

39

ALL COC APPROVED PROGRAMS

91%

91-91.4

129703

1337

MY CANCER PROGRAM

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Radiation therapy is considered or administered following any mastectomy within 1 year (365 days) of diagnosis of breast cancer for women with >= 4 positive regional lymph nodes (Accountability)

COMPARISON TO

EPR%

95% CI

# CASES

# FACILITIES

MY CANCER PROGRAM

100%

100 -100

13

1

MY ACS DIVISION

94%

91.8-97

301

94

MY CENSUS REGION

94%

91.8-97

301

94

MY COC PROGRAM TYPE

88%

86. 2-89

2163

230

MY STATE

95%

91. 2-98.6

138

39

ALL COC APPROVED PROGRAMS

87%

86. 2-87.8

6585

1337

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2015 QUALITY IMPROVEMENT MEASURES

2015 QUALITY IMPROVEMENT MEASURES

Radiation is administered within 1 year (365 days) of diagnosis for women under the age of 70 receiving breast conservation surgery for breast cancer (Accountability)

Adjuvant chemotherapy is considered or administered within 4 months (120 days) of diagnosis for patients under the age of 80 with AJCC stage III (lymph node positive) colon cancer (Accountability)

COMPARISON TO

EPR%

95% CI

# CASES

# FACILITIES

MY CANCER PROGRAM

97%

94.6-99.6

171

1

MY ACS DIVISION

94%

93.7-95.1

4105

MY CENSUS REGION

94%

93.7-95.1

MY COC PROGRAM TYPE

91%

MY STATE ALL COC APPROVED PROGRAMS

EPR%

95% CI

# CASES

# FACILITIES

MY CANCER PROGRAM

93%

79.4-100

14

1

94

MY ACS DIVISION

89%

86.4-92

462

94

4105

94

MY CENSUS REGION

89%

86.4-92

462

94

90.6-91.4

18992

230

MY COC PROGRAM TYPE

86%

84.8-87. 2

3005

230

94%

92.6-94.8

1893

39

MY STATE

89%

85-93.6

197

39

91%

91-91.4

57518

1337

ALL COC APPROVED PROGRAMS

88%

87-88. 2

9985

1349

Combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cN0, or stage IB - III hormone receptor negative breast cancer (Accountability)

COMPARISON TO

EPR%

95% CI

# CASES

# FACILITIES

MY CANCER PROGRAM

100%

100 -100

25

1

MY ACS DIVISION

97%

95.7-98.3

636

94

MY CENSUS REGION

97%

95.7-98.3

636

94

MY COC PROGRAM TYPE

92%

91. 2-92.8

4288

230

MY STATE

99%

98.3-100

281

39

ALL COC APPROVED PROGRAMS

93%

92. 2-93. 2

12448

1337

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COMPARISON TO

At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer (Quality Improvement)

COMPARISON TO

EPR%

95% CI

# CASES

# FACILITIES

95.5%

90.5-100

66

1

MY ACS DIVISION

94%

93.4-95.4

2012

94

MY CENSUS REGION

94%

93.4-95.4

2012

94

MY COC PROGRAM TYPE

94%

93. 2-94. 2

10694

230

MY STATE

95%

93. 2-96

962

39

ALL COC APPROVED PROGRAMS

92%

91.7-92.3

39919

1349

MY CANCER PROGRAM

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2015 QUALITY IMPROVEMENT MEASURES

2015 QUALITY IMPROVEMENT MEASURES

Surgery is not the first course of treatment for cN2, M0 lung cases (Quality Improvement)

Chemotherapy and/or radiation administered to patients with Stage IIIC or IV Endometrial cancer (Surveillance)

COMPARISON TO

EPR%

95% CI

# CASES

# FACILITIES

MY CANCER PROGRAM

100%

100 -100

20

1

MY ACS DIVISION

92.5%

90.3-94.7

549

94

MY CENSUS REGION

92.5%

90.3-94.7

549

MY COC PROGRAM TYPE

91%

90. 2-92. 2

MY STATE

95%

ALL COC APPROVED PROGRAMS

92%

COMPARISON TO

EPR%

95% CI

# CASES

# FACILITIES

MY CANCER PROGRAM

100%

100 -100

4

1

MY ACS DIVISION

93%

88. 2-97

136

89

94

MY CENSUS REGION

93%

88. 2-97

136

89

3018

231

MY COC PROGRAM TYPE

85.5%

83.7-87.3

1460

228

92. 2-97.8

238

39

MY STATE

92%

84.5-99.5

50

38

91.6-92.6

9293

1339

ALL COC APPROVED PROGRAMS

83%

81.7-84.3

3015

1284

Systemic chemotherapy is administered within 4 months to day preoperatively or day of surgery to 6 months postoperatively, or it is considered for surgically resected cases with pathologic lymph node-positive (pN1) and (pN2) NSCLC (Quality Improvement)

COMPARISON TO

EPR%

95% CI

# CASES

# FACILITIES

MY CANCER PROGRAM

100%

100 -100

4

1

MY ACS DIVISION

94.5%

91.9-97.1

293

94

MY CENSUS REGION

94.5%

91.9-97.1

293

MY COC PROGRAM TYPE

90%

89-91.8

MY STATE

96%

ALL COC APPROVED PROGRAMS

90%

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Chemotherapy administered to cervical cancer patients who received radiation for stages IB2-IV cancer (Group 1) or with positive pelvic nodes, positive surgical margin, and/or positive parametrium (Group 2) (Surveillance)

COMPARISON TO

EPR%

95% CI

# CASES

# FACILITIES

MY CANCER PROGRAM

100%

100 -100

9

1

MY ACS DIVISION

93%

88.4-96.8

148

67

94

MY CENSUS REGION

93%

88.4-96.8

148

67

1705

231

MY COC PROGRAM TYPE

90%

88.7-91.5

1839

221

93.1-99.5

136

39

MY STATE

95%

88.7-100

56

28

89 -91

4268

1339

ALL COC APPROVED PROGRAMS

89%

88.4-90.4

3961

1111

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2015 QUALITY IMPROVEMENT MEASURES Preoperative chemo and radiation are administered for clinical AJCC T3N0, T4N0, or Stage III; or Postoperative chemo and radiation are administered within 180 days of diagnosis for clinical AJCC T1-2N0 with pathologic AJCC T3N0, T4N0, or Stage III; or treatment is considered; for patients under the age of 80 receiving resection for rectal cancer (Quality Improvement)

COMPARISON TO

EPR%

95% CI

# CASES

# FACILITIES

MY CANCER PROGRAM

94%

82-100

16

1

MY ACS DIVISION

87.5%

83.9-91.1

319

92

MY CENSUS REGION

87.5%

83.9-91.1

319

92

MY COC PROGRAM TYPE

87%

85.7-88.5

2247

228

MY STATE

84%

78.4-89.8

157

38

ALL COC APPROVED PROGRAMS

87%

86.3-88.1

5906

1322

2017 PREVENTION PROGRAM: LOW-DOSE CT LUNG CANCER SCREENING PROGRAM SUMMARY AND RESULTS Campaign Overview UMass Memorial Health Care launched a system-wide, multi-tiered marketing and communications campaign to create awareness and educate multiple audiences about the importance and effectiveness of the low-dose helical CT scan (also called a spiral CT scan) as a screening tool for lung cancer detection, particularly in non-symptomatic patients. The campaign targets men and women, ages 55 to mid-70s, with a 30-pack a year smoking history. Patients can be current or former smokers, having ceased smoking within the past 15 years. The campaign began in February 2016, and is ongoing.

Multiple print and digital marketing tactics have been used. A CRM Lung Cancer Screening Campaign was scheduled to launch in the Fall of 2017. However, the initial wave of marketing tactics created a sharp, increased spike in patient volume. The CRM campaign is slated for mid-2018 to avoid problems with patient access or follow-up.

Time Frame February 2016 to present

Audiences • Physicians, including primary care physicians, and family medicine specialists, and when possible nursing and office staff • Patients ages 50 to 80, men and women • Families of patients • UMass Memorial Health Care employees

Background Lung cancer is the leading cause of death from cancer in the United States. In 2002, the American College of Radiologist Imaging Network in conjunction with the Lung Screening Study Group launched the National Lung Screening Trial (NLST), an NIH-funded study to determine if low-dose helical CT scans (also called spiral CT scans) were more effect at detecting lung cancer than standard chest X-rays. It was intended to be a ten-year study; however, the trial was stopped at the five-year mark because the data was so compelling that CT scans were far more effective than X-rays in detecting lung cancer. In June 2011, the New England Journal of Medicine published the study results, in which scientists found a 20 percent reduction in deaths from lung cancer among current or former heavy smokers who were screened with low-dose spiral CT scans versus those screened by standard chest X-ray.

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Screening Costs and Insurance Coverage One of the direct impacts of the study was that it changed insurance coverage and reimbursements for lung cancer screening CT scans. Prior to the study, patients had to pay out of pocket for a screening lung CT scan. UMass Memorial Health Care offered the service for a flat rate of $250, and patients would self-refer for this service. Private insurers started changing reimbursement rates around 2012, with most covering low-dose CT scans for patients who met specific criteria. Beginning on January 1, 2016, Medicare also put into place reimbursement guidelines.

SUMMARY OF MARKETING TACTICS & METRICS AUDIENCE

ACTIVITY

PHYSICIANS

GroupTalk Article

1,700 employed physicians

Links to Handouts

Also included with GroupTalk article distributed to 1,700 employed physicians

Physician Outreach

Employed, managed care and private physicians No fixed number

Screening Guidelines and Physician Referral Private (commercial) insurers and the Centers for Medicare and Medicaid Services (CMS) mandate patients meet specific criteria for reimbursement of low-dose CT scanning for lung cancer. There are variances, but in general:

2016 Annual Report of the Cancer Committee

• Age 55 to mid-70s (74, 77) • A 30-pack a year smoking history • Current or former smoker, within the past 15 years

PATIENTS (AGES 50+)

Simply Well Blog November 2016

• If a current smoker: shared decision making of some options for smoking cessation

Facebook Posts

In most instances, a patient must have a referral from a physician for insurance coverage.

Twitter Feeds

Screening Locations UMass Memorial Health Care provides low-dose CT scans at four locations in Central Massachusetts.

Each facility is certified by the American College of Radiology (ACR) as a “Designated Lung Screening Center,” as well as being linked to the National Lung Screening Data Registry. The facilities are in the following locations:

Health Watch Video

Cancer Walk

• Clinton • Marlborough

On Hold Messaging

• Leominster • Worcester

EMPLOYEES

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METRICS

Profile on services and comprehensive team, as well as participation in the Interdisciplinary Collaborative for the Enhancement of Patient Care in Lung Cancer (ICEPaC).

Distributed in print and electronic form, as well as available on the hospital web site and shared through social media tactics.

9,000 readers (2,000 direct via email; 7,000 via mailchimp) Multiple boosted posts from Fall 2016 to present; over 15,00 Followers Multiple boosted tweets; Audience reach ranges from 7,328 to 9,534 Video shared through Facebook and News & Views Fall 2016 to present Handout distributed at hospital’s table in the Wellness Tent to event participants; approximately 14,000 participants in attendance Callers to 855-UMASS-MD hear a 30-second message.

Average monthly calls to the number: 16,000

Media Feature

Profile of Radiology Team in local and regional newspaper outlets, highlighting the scope of our CT scanning facilities, awareness of importance of early screening, and the multidisciplinary team approach to patient care.

News & Views

Multiple posts starting late Summer 2016 to present; include tie-in with smoking cessation and lung cancer awareness month. Read rates average 4,800 to 5,700 per week

OurNet Blog Posts

Multiple posts starting late Summer 2016 to present; include tie-in with smoking cessation and lung cancer awareness month. Distributed to 11,000 plus employees

Wallpaper & Screensavers

Information shared on hospital’s wallpaper and screensavers, which is distributed on all employee computers; no fixed number on viewing. Approximately 11,000 employees

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CAMPAIGN RESULTS The campaign began in February 2016 and is ongoing. Preliminary results including projected 2017 volume is as follows:

SUMMARY AND RESULTS

CT Lung Screening Volume

Campaign Overview

Since 2014 projected annual volume has increased from 159 to 624 CTs/year (projected 2017 from first 4 months) 700 600

624

500 483

400 300

UMass Memorial Health Care launched a system-wide, rolling 12-month campaign to encourage women in Central Massachusetts to go for a screening mammogram. The campaign targeted women aged 39 to 75 encouraging a screening at one of the system’s ten mammography locations. The primary tactic was a direct mail piece sent during their birthday month, with a follow-up reminder after 60 days for those who did not schedule an appointment. Exclusion criteria included patients who have had a mammogram in the prior 18 months or one scheduled in the upcoming 13 months, those who had a cancer diagnosis or any cancer-related treatments, and those who had breast surgery or reconstructive surgery. The campaign began on October 31, 2016, and is slated to continue through early 2018.

MARKETING SUMMARY

311

Target Demographic

200 100

2017 PREVENTION PROGRAM: CRM MAMMOGRAPHY CAMPAIGN

• Women

159

• Ages 39 to 75

0 2014

2015

2016

2017

Exclusion Criteria Patients identified with any one of the following criteria are excluded from the campaign: • Had a mammogram with UMMHC in the past 18 months • Has a mammogram scheduled with UMMHC in the upcoming 13 months • Cancer diagnosis • Breast surgery • Reconstructive surgery • Radiation and/or chemotherapy treatments

Campaign Message • Encourage baseline screening mammogram • UMass Memorial has ten mammography locations throughout its system • Message: You’re in the Right Place • We can provide first-available or best location, depending on patient preference

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2017 COMMUNITY BENEFITS CAMPAIGN: OBESITY AND CANCER

Tactics and Timing • Rolling Campaign • Timing: Twelve (12) months • Launch Date: October 31, 2016

SUMMARY AND RESULTS

• Direct mail post card to women during their known birthday month

Campaign Overview

• Follow-up direct mail post card 60 days later if no action taken

Call to Action • Patients call into 855-UMASS-MD to schedule their appointment • A campaign landing page is also included on mailer to have additional information

In early 2017, UMass Memorial Health Care launched a system-wide campaign to create awareness and educate multiple audiences about the increasing evidence connecting obesity to cancer. The campaign was originally developed for teenagers. However, initial outreach determined that expanding the focus to reach adults, including pediatricians, parents and guardians, would provide benefits and support to teenagers seeking to achieve a healthy lifestyle, including a healthy Body Mass Index (BMI).

MARKETING SUMMARY PRELIMINARY RESULTS

Project Summary

The campaign began on October 31, 2016, and is slated to continue through early 2018. Preliminary

A comprehensive marketing campaign to educate and create awareness with multiple audiences about the link between obesity and cancer. The campaign includes specific tactics aimed at combating childhood obesity.

results through July 31, 2017 are as follows: MAILED (INITIAL & 60 -DAY FOLLOW-UP)

UTILIZED

FIRST TIME MAMMOGRAMS

8,044

161

NON-COMPLIANT/ OVERDUE MAMMOGRAMS

8,539

1,357

20,877

925

TARGETS

AT RISK FOR BREAST CANCER TOTAL

37,460

2,443

Time Frame April 2017 to present

Audiences • Physicians, including pediatricians, primary care physician, and family medicine specialists, and when possible nursing and office staff • Parents of boys and girls, especially those between the ages of 9 to 21 years old who are struggling with weight issues (overweight, obese, and morbidly obese) • Patients/Young adults ages 22 and older who are struggling with weight issues (overweight, obese, and morbidly obese) • UMass Memorial Health Care employees, including physicians, medical staff, and administration

Medical Expert Louis Messina, MD, Vascular Surgeon, UMass Memorial Medical Center

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MARKETING MESSAGE

SUMMARY OF MARKETING TACTICS & METRICS

Message to all Audiences There is a definitive link between obesity and cancer. The NIH and the National Cancer Institute noted that in 2014, about 40% of all cancers diagnosed in the United States were obesity-related. In the same year, about two out of three adults in the United States were considered obese as defined per BMI, but only half of Americans were aware of the link between cancer and obesity. Dr. Messina has calculated that in the near future, obesity will surpass smoking as the most preventable cause of cancer. Being overweight or obese has been proven to be the cause of thirteen different cancers:

AUDIENCE

ACTIVITY

METRICS

PHYSICIANS

GroupTalk Article

Distributed to 1,700 employed physicians To be published in First Quarter 2018

Handouts for patients/parents

Information about our Good Fit: Teen Weight and Wellness Center. Links to materials to be included with GroupTalk article

• Adenocarcinoma of the esophagus • Breast

Physician Outreach

• Colon and rectum • Gallbladder • Kidney • Liver • Meningioma (cancer of the tissue covering the brain and spinal cord)

PARENTS OF PATIENTS

Simply Well Blog December 2017

YOUNG ADULTS/ PATIENTS (AGES 18 TO 26)

Facebook Posts

• Multiple myeloma (cancer of blood cells) Twitter Feeds

• Ovaries

Employed, managed care and private physicians No fixed number 9,000 readers (2,000 direct via email; 7,000 via MailChimp) Multiple boosted posts. Facebook followers: Almost 13,000 reached, more when posts are boosted on specific tactics Multiple boosted tweets; audience reach ranges from 7,328 to 9,534; engagements range from 150 to 209

• Pancreas Health Watch Video

• Thyroid • Upper stomach

Proactive Media

Slated for the First Quarter 2018 About research, Good Fit Clinic, Cancer Walk Event

• Uterus Message to Physicians

Cancer Walk & Run

Through our Good Fit Clinic: all current and past patients will be offered to chance to participate in the 2017 Cancer Walk & Run. For those who pre-register and participate, they will be given a bag of items, including a t-shirt, ear buds, chap stick healthy snacks, wrist band, and a finisher’s certificate.

News & Views

Multiple posts sent between January 2017 and November 2017, with continued posts slated for 2018. Read rates average 4,800 to 5,700 per week

Vascular surgeon Louis Messina, MD, is at the forefront of research around high cholesterol levels damaging the stem cells that produce cancer-fighting immune cells. One focus of this campaign is sharing the results of his research with physicians.

PRELIMINARY RESULTS Multiple tactics were used to create awareness about our Good Fit: Teen Weight and Wellness Center (for teenagers) and the UMass Memorial Weight Center (for adults). The campaign message was the importance of achieving and maintaining a healthy lifestyle as a critical step to prevent cancer. The initial call-to-action was to encourage teens to take part in the 2017 Cancer Walk. However, after initial marketing efforts, it was determined that the Good Fit Center had limited access and there were concerns about meeting patient needs in a timely manner. The campaign shifted to focus on providing healthy lifestyle support to the current patients, which number just over 60 teenagers and include five who have had bariatric surgery.

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EMPLOYEES

OurNet blog posts

Multiple posts sent between January 2017 and November 2017, with continued posts slated for 2018. No fixed number of blog reads

Wallpaper & Screensavers

Information shared on hospital’s wallpaper and screensavers, which is distributed on all employee computers; no fixed number on viewing. Approximately 11,000 employees

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Patients and families trust UMass Memorial Medical Center as the region’s leading academic medical center, committed to improving the health of our communities in Central Massachusetts. With our partner, the University of Massachusetts Medical School, we are committed to excellence in primary and specialty care, community service, teaching and research. The Medical Center offers advanced technology and support services for patients and families, providing the region with specialists renowned for their expertise in caring for adults and children.

Visit www.umassmemorial.org. General information: 508-334-1000

UMass Memorial Health Care is the largest not-for-profit health care system in Central Massachusetts with more than 13,000 employees and 1,700 physicians, many of whom are members of UMass Memorial Medical Group. Our member hospitals and entities include UMass Memorial HealthAlliance-Clinton Hospital, UMass Memorial – Marlborough Hospital, UMass Memorial Medical Center and UMass Memorial – Community Healthlink, our behavioral health agency. With our teaching and research partner, the University of Massachusetts Medical School, our extensive primary care network and our cancer, diabetes, heart and vascular, orthopedic and surgery programs, UMass Memorial delivers safe, high-quality and compassionate care.

Visit www.umassmemorialhealthcare.org.

To find a physician in your community, call 855-UMASS-MD (855-862-7763).

UMass Memorial Medical Center - University Campus 55 Lake Avenue North, Worcester, MA 01655

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