St. Elizabeth’s Innovative Cancer Screening Outreach Model

Michael Gieske, MD, Medical Director of Lung Cancer Screening at St. Elizabeth Health Care, and Jamie Ries, RN, BSN, Manager of Population Health Support Services at St. Elizabeth Cancer Center, speak about the development of a care delivery model that demonstrates sustainable outreach for cancer screening, with a specific focus on at-risk and underserved patient populations. 

Transcript: 

Michael Gieske, MD: I'm Dr. Michael Gieske. I'm a family physician with Saint Elizabeth health care in North Kentucky and Southeast Indiana, and I'm the director of our lung cancer screening program.

Jamie Ries, RN, BSN: and I am Jamie Ries, and I am the manager of Population Health support services at St. Elizabeth Physicians. 

Give us a little background about what led to the development of St. Elizabeth Health Care’s cancer care delivery model.

Dr Gieske: Yeah, I can just give a little bit of the background of our program and how we arrived here, we began our lung cancer screening program in 2013. And we did 7 screens that year. And then we've grown exponentially really, since that time. You realize the importance of reaching out to primary care. And we are now one of the busiest lung cancer screening programs in the country. We've done over 36,000 lung cancer screens now. And it's not just lung cancer we concentrate on, of course. We're concentrating efforts on colon cancer screening, breast cancer screening, cervical cancer screening. And we realized as we got busier and started establishing some success and some very helpful metrics, that there were still patients that we would place an order for a screen, and it wouldn't be completed. That was lung cancer, screening, colorectal cancer screening, breast cancer screening. And we looked at our system and thought, well, who can we utilize to perform this task. And at the time there really wasn't a process in place to address those outstanding orders. And so at one point we utilized the social workers that we had hired through comprehensive primary care, and they weren't very busy at first, and we used them to in their spare time, reach out to these patients. You could just see the tick up and the uptake for lung cancer screening, for example. And then they became busier. And so then we looked at virtual health as an option to help us with the outreach, because they just hired a number of folks that weren't busy when the virtual health program first began, and they also did an excellent job. As they became busier we lost that capability. We had a medical assistant was hired through our innovative integrative health program, who initially, was not very busy at all because we opened up our new cancer center right at the beginning of the pandemic. But she was very enthusiastic, very energetic, and she reached out to these patients, and we saw very significant uptick and the uptake for these tests. And then she wasn't very busy and wanted to be busy with lots of other things, and so she went back to her former job. So we're kind of left out in the cold again, and then I'll kind of turn it over to Jamie because they really finally, you know, filled the need, and we have a nice sustainable program in place.

Jamie Ries: Yes, absolutely. And to echo Dr. Gieske, so we knew as an organization that it was so vital to hire a team of outreach specialists that was specifically making you know, outreach calls to schedule payment patients for these preventative cancer screening. Just like Dr. Gieske said, we were using resources with virtual health and our MAs and social workers. But really, I think at the end of the day it was, we see how important this is, the education behind it, and the need for really honing in on one specialized team to make these outreach calls.

Dr Gieske: And it's just it's human nature. If you are given an order by your provider to have a test done of any kind, whether be a colon, lung, or breast cancer screening or a lab test, you know. Sometimes those orders get forgotten. Not with that … they intend to do that, but it's just human nature. They hang it on the refrigerator their desk and falls into the garbage, or but if you get that patient an actual appointment, they're much more likely to then show up, of course, for the appointment and complete the test. So if, for example, with lung cancer screening and mammography, if those patients have gone more than 72 hours, and they don't have an actual appointment, then this team will reach out to them and try to get them connected with an appointment.

How was the outreach program conducted?

Jamie Ries: So back to Dr. Gieske’s point, so after we quickly identified the need for a team to outreach to these patients. We began to build that team up. We originally had data back in 2019, where we did an analysis report, where not only was it good for patient care to schedule these preventive cancer screenings, but also we were getting some return on investment. So in 2021 we hired 6 additional FTE nurse navigators to our already 6 nurses. At that point in time we were working off of what we call order completion. So like Dr Gieske was mentioning, and any patient that had these orders in place, we knew that that provider was having that conversation at the time. So it was really important for our nurses to educate that patient and to get them scheduled for any of our focuses of breast cancer, lung cancer and colon cancer screenings.

Dr Gieske: Yeah, so clearly, we were doing the right thing for the best patient care. And that's, of course, very important. But it's also very, very fortunate if you can prove that there is downstream revenue, that there is a return on your investment. A lot of this outreach is resource, intensive, it can be expensive. But if you have the revenue coming in to support that process, it really makes it all that much better for the system and for the care of the patients.

What was the outcome of the program?

Jamie Ries: Well, I think the results are exciting, because we were quickly seeing that uptick, like Dr. Gieske was saying of patients getting scheduled, and 2022 we were able to schedule just over 6,400 mammograms, just over 6,200 Cologuards, which is the screening tool that we use for colon cancer, and just under 5,000 low dose CTs, which is a a tool that we use to identify lung cancer, lung cancers. And we know, too, the importance of catching these and early detection and stage 1, stage 2.

Dr Gieske: Yeah, 2022 is the first full year that we had this team in place, and the results were really astounding. For example, we did 8,200 lung cancer screens in 2022 and just shy of 4,000 of those were scheduled through the outreach program that Jamie leads.

What aspects of the program do you think were instrumental to its success?

Dr Gieske: I think a lot of it is having a good team based approach, having a multidisciplinary approach, having members that are engaged that are energetic and enthusiastic, and we have some wonderful chemistry here at St. Elizabeth Health Care, and we were very fortunate to get those types of individuals involved, and it really helped to propel that program. 

Jamie Ries: Absolutely and just to echo on that, too, the collaboration and the network that we have with our providers, with our lung cancer, nurse navigators, even when we are outreaching to patients, and let's say, we identify a patient who has transportation needs and maybe they're not able to get to you know their mammogram appointment, being able to reach out to care management and place that referral to help assist that patient to get to that appointment. It's just been really pretty incredible.

Looking forward, what impact do you hope the success of the outreach program will have on improving health equity in the health care system?

Dr Gieske: Yeah, they will definitely continue to expand their focus. And right now, a lot of their efforts are placed on colorectal cancer screening, lung cancer, screening and breast cancer screening, but they certainly intend to expand into the other screening efforts that we have in our health care system. I had a very interesting conversation today with a company that's looking at biomarker testing for lung cancer screening. And I talked to about our outreach program, I said that would be a perfect place for our nurse nurses at work, the outreach specialists there to talk to patients about biomarker testing. For example, when a patient has a colon cancer recommendation. There's several approaches you could use. You could use a colonoscopy or a colorectal cancer screen and a colorectal cancer screen through Cologuard is is a as an option for that patient that maybe doesn't want to have the colonoscopy, but is certainly willing to do a cologuard, and same thing when it comes to the technology as it advances with lung cancer screening, there's a biomarker test that's in development now that they can offer to the patient if they're expressing some hesitancy to go into the hospital and have a low dose CT lung cancer screen, even though it's one of the simplest tests you could ever have.

Jamie Ries: Yes, and I think this is exciting, I think, by building up this team in this department with the collaboration and the team-based approach that we have. It's definitely opening up doors and windows of other opportunities to come, plus not to mention what we're doing right now. It's just saving patients’ lives and what we like to say, changing family trees.