As reported by the New Britain Herald, December 16, 2008.

Screening Part of Push for Preventive Care

UConn, Health Centers Offering Colonoscopies For Uninsured

By Scott Whipple

FARMINGTON – The University of Connecticut Health Center is partnering in a pilot program to screen for colorectal cancer. An estimated 600 uninsured or underinsured state residents are expected to participate.

"The colonoscopy is a major prevention tool, but not everyone has access," explained Dr. Joseph C. Anderson, UConn Health Center's clinical director of the Colon Cancer Prevention Program. "The more people we can screen, the more people we can help. Polyps in the colon will become cancerous whether you have insurance or not. People who can't afford a colonoscopy also can't afford not to get screened."

Anderson was lead endoscopist in a Centers for Disease Control and Prevention-funded program in 2005 while at Stony Brook University Medical Center in Long Island. Before that, he was a key adviser to a similar undertaking of the South Carolina Gastroenterological Association. As medical director of the Connecticut Colorectal Cancer Screening Demonstration Project, he is one of several physicians providing colonoscopies.

Eight community health centers in the state are referring eligible patients to participating endoscopists, collecting patient data and making follow-up referrals.

The Newington-based Community Health Center Association of Connecticut received a $951,379 grant from the Connecticut Department of Public Health for the project. The association is a not-for-profit service organization enabling federally qualified health centers to provide Connecticut's underserved citizens access to the highest-quality health care and social services.

"The goal is to promote, improve and optimize the appropriate use of high-quality colorectal cancer screening and follow-up services, and eliminate or decrease racial, ethnic and socioeconomic disparities in access to these screenings," Jennifer Granger, the association's chief operating officer, said in a prepared statement.

State funding for the grant was available through the Connecticut Cancer Partnership, a coalition working to reduce the burden of cancer and improve the quality of life of cancer patients. In addition to providing colonoscopies, the pilot project aims to educate the public and provide outreach and training to the participating community health centers. Though physicians expect to find warning signs in only a small percent of all patients (Anderson says less than 1 percent actually contract colon cancer), surveillance is important to track higher-risk patients.

"When you break down barriers to preventative medicine, the result is a healthier public," said Public Health Commissioner J. Robert Galvin, who believes the initiative will result in saved lives.

The UConn Health Center has received $353,206 to cover the costs of reimbursement for cancer screenings, Anderson's medical directorship and program quality oversight, training and education, data collection and analysis.

"Dr. Anderson has led the effort to bring this crucial program to Connecticut," said Dr. Carolyn D. Runowicz, director of the health center's Carole and Ray Neag Comprehensive Cancer Center. "He's a top expert in colon-cancer prevention, and prevention is what this is all about. We could almost eradicate colon cancer if only more people were screened."

The community health center partners are Community Health Services in Hartford, StayWell Health Center in Waterbury, Fair Haven Community Health Center in New Haven, Hill Health Center in New Haven, Southwest Community Health Center in Bridgeport, Optimus Health Care in Stamford, Generations Family Health Center in Willimantic, and the Community Health and Wellness Center of Torrington. Other participating endoscopists are in New Haven, Bridgeport, Stamford, Willimantic and Torrington.

"This program is screening for colonoscopies for patients who can't afford the procedure," Anderson explained. "These are men and women ages 50 to 64 who don't have insurance to pay for colonoscopies; most are low income. Patients with precancerous polyps are identified for eligibility in the primary-care centers and referred to endoscopists."

Anderson hopes the program, that started two weeks ago, will expand on both the state and national levels.

To Scott Selig, CHCAC's director of clinical quality, the pilot program is one aspect of a larger concept, Medical Homes.

The Medical Home Concept

Scott Selig, director of clinical quality for the Community Health Center Association of Connecticut, said, "What we're really trying to do here is promote the concept of the Medical Home." Though open to interpretation, the concept of "Medical Home" is based on several characteristics. The patient-centered Medical Home concept is described as follows:

  • Each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.
  • This personal physician leads a team of individuals at the practice level who collectively take responsibility for ongoing patient care.
  • He or she is responsible for providing all the patient's healthcare needs at all stages of life or taking responsibility for appropriately arranging care with other qualified professionals.
  • Care is coordinated and integrated across all domains of the health care system, facilitated by registries, information technology, health information exchange and other means to assure patients receive care on their terms.
  • Quality and safety are hallmarks of the medical home. This includes using electronic medical records and technology to provide decision-support for evidencebased treatments and patient and physician involvement in continuous quality improvement.
  • Enhanced access to care is available through systems such as open scheduling, expanded hours and new options for communication between patients, physicians and practice staff.
  • Payment reflects the added value provided patients in a Patient-Centered Medical Home. The American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians and American Osteopathic Association released the Joint Principles of the Patient-Centered Medical Home in 2007.