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Colorectal Cancer Screening

Scientest looking in microsopeOnce a company has conducted assessment and planning for colorectal cancer screeningScreening means checking your body for cancer before there are signs or symptoms of the disease. The routine performance of screening tests may find many kinds of cancer early, when treatment is likely to work best. programs, and developed the specific tasks of implementation for these programs, it is time to develop the evaluation plan. This evaluation plan should be in place before any program implementation has begun.  

Metrics for worker productivity, health care costs, heath outcomes, and organizational change allow measurement of the beginning (baseline), middle (process), and results (outcome) of workplace health programs. It is not necessary to use all these metrics for evaluating programs. Some information may be difficult or costly to collect, or may not fit the operational structure of a company. These lists are only suggested approaches that may be useful in designing an evaluation plan.

These measures are designed for employee group assessment. They are not intended for examining an individual’s progress over time, which would raise concerns of employee confidentiality. For employer purposes, individual-level measures should be collected anonymously and only reported (typically by a third party administrator) in the aggregate, because the company’s major concerns are overall changes in productivity, health care costs, and employee satisfaction.

In general, data from the previous 12 months will provide sufficient baseline information and can be used in establishing the program goals and objectives in the planning phase, and in assessing progress toward goals in the evaluation phase. Ongoing measurements every 6 to 12 months after programs begin are usually appropriate measurement intervals, but measurement timing should be adapted to the expectations of the specific program. 

Colorectal cancer screening is a valuable early detection tool that can identify colorectal cancer at an early stage when treatment is more effective and less expensive.

  • The estimated annual national expenditure for colorectal cancer treatment is $5.5-$6.5 billion; inpatient hospital care accounts for 80% of this cost1
  • Because colorectal cancer is a disease of middle and old age, the costs related to colorectal cancer treatment are likely to increase as the population ages1
  • In 2007, 142,672 people were diagnosed with colorectal cancer, and 53,219 people died from it2

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Worker productivity measures for colorectal cancer screening3-10

Healthier employees are less likely to call in sick. Companies can sometimes assess sick day use to determine whether health programs are increasing worker productivity.

Baseline

Process
  • Re-assess the average number of sick days per employee at the first follow-up evaluation
    • If employee education programs are successful, these measures may increase in the short term as screening and detection rates increase
  • Periodic repeats of other baseline measures
Outcome
  • Assess changes in the average number of sick days per employee in repeated follow-up evaluations
  • Assess changes in costs from baseline

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Health care costs measures for colorectal cancer screening3-6

In contrast with the worker productivity costs described above, health care costs are measures of the direct medical expenses of providing employee health care and preventive health programs.

Baseline

  • Determine costs and use for health care such as outpatient visits, screening, diagnostic procedures (e.g., biopsies), hospitalizations, and treatment (e.g., surgery or chemotherapy) for colorectal cancer related illness and disability
  • Determine the health care use and costs of program participants before education and other programs are initiated and after operation of these programs
Process
  • Periodic repeats of baseline measures
Outcome

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Health outcomes measures for colorectal cancer screening3-6,11-14

The effectiveness of colorectal cancer screening programs depends on the intensity of program effort and the use of multiple interventions. A rule of thumb is that the more programs implemented together as a package or campaign, the more successful the interventions will be.

Baseline
Process
  • Periodic repeats of baseline measures
Outcome
  • Assess changes in levels of employee colorectal cancer screening rates such as:
    • Increases in the number of employees screened
    • Changes in the percentage of employees reaching colorectal cancer screening guidelines
  • Assess changes in the percentage of employees with health behaviors or conditions where individuals have a higher risk associated with colorectal cancer such as being overweight; drinking alcohol; using tobacco; or being physically inactive
  • Determine levels of diagnostic and treatment procedures from health care and pharmaceutical claims data
  • Assess changes in employee knowledge, attitudes, and beliefs about colorectal cancer screening
    • Evaluate changes in employee knowledge of current colorectal cancer screening health benefits and guidelines
    • Measure changes in employee’s knowledge of their risks for colorectal cancer
    • Assess changes in employee awareness of existing workplace colorectal cancer screening programs, policies, and benefits
    • Assess changes in employee awareness of behaviors that may reduce colorectal cancer risk

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Organizational change measures for colorectal cancer screening3-6

Colorectal cancer screeningScreening means checking your body for cancer before there are signs or symptoms of the disease. The routine performance of screening tests may find many kinds of cancer early, when treatment is likely to work best., along with other health habits, requires ongoing support from employers. New programs can be added over time and evaluated periodically for their effectiveness. For best results, recognition of the benefits of colorectal cancer screening should become an inherent part of organizational change and corporate culture.

Measuring organization change is an assessment of company-initiated programs and policies that affect most employees regardless of their health status (e.g., communications/media campaign). These efforts need to be integrated for greatest effectiveness and will require time for full implementation. Regular measures of employee attitudes and program development are key in determining whether new programs are effective or require further adaptation to prevent continuing investment in ineffective efforts.

Baseline

  • Determine workplace barriers to employee’s engagement in colorectal cancer screening
  • Assess current workplace colorectal cancer screeningScreening means checking your body for cancer before there are signs or symptoms of the disease. The routine performance of screening tests may find many kinds of cancer early, when treatment is likely to work best. programs
    • List current colorectal cancer screening options for employees through worksite and identify number of employees (i.e., participation) using each option. Examples:
      • Number of colorectal cancer screening programs (e.g., education seminars) and participation in these programs
      • Availability of educational materials on colorectal cancer screening
      • Number of communications/media campaigns regarding colorectal cancer screening
        • Percentage of employees receiving a telephone call (or a reminder) to obtain a colorectal cancer screening among
          • Employees due or overdue for a colorectal cancer screening test
          • Employees turning age 50 years
          • Employees 50 years and older who are new health plan members
        • Percentage of employees who scheduled a colorectal cancer screening appointment during a telephone reminder call
      • Number of colorectal cancer screening related policies
      • Number of environmental strategies to reduce structural barriers
      • Number of partnerships with community resources for colorectal cancer screening such as the American Cancer Society or a local health department
    • Determine costs of current company colorectal cancer screening programs such as:
      • Staffing, equipment, and space
      • Employee time to participate in colorectal cancer screening programs during work hours (e.g., education)
      • Reimbursements/subsidies for colorectal cancer screening to reduce out-of-pocket costs and structural barriers such as classes, reducing co-payments, or transportation (see implementation for health benefits examples)
      • Incentives tied to colorectal cancer screening programs
    • Conduct survey of employee satisfaction with workplace supported current colorectal cancer screening programs
Process

  • Reassess barriers to employee engagement in colorectal cancer screening programs
  • Document steps taken and progress toward implementing each intervention selected
    • List numeric goals (e.g., desired increases in employee screening rates) in each form of intervention within a designated time period (e.g., 12 months from startup):
      • Employee reach (e.g., number of educational pamphlets distributed; number of employee reminders sent)
      • Employee participation (e.g., number of desired participants in colorectal cancer screening; number of screening appointments scheduled; number of screenings delivered)
    • Describe timeline for implementation of each planned intervention (e.g., length of time and timing of tasks to develop, initiate, and conduct a mass campaign)
    • Create a baseline budget for new interventions including classes, instructors, classroom space, materials, incentives, etc
    • Identify opportunities for new partnerships with community groups who provide colorectal cancer screening programs (e.g., The American Cancer Society, local health department, local hospital, etc.)
  • Reassess employee satisfaction regarding workplace supported colorectal cancer screening programs
Outcome
  • Measure reductions in the number and type of employee barriers to colorectal cancer screening
  • Assess changes in workplace colorectal cancer screening programs including progress in achieving goals and in implementation of each intervention (e.g., length of time and timing of tasks to develop, initiate, and conduct a mass campaign)
    • Measure changes in the number of colorectal cancer screening options for employees through the worksite and changes in employee participation using each option before and after the colorectal cancer screening program or campaign. Examples:
      • Number of new programs developed and offered to employees
        • Measure participation (e.g., number of screenings delivered) in screening programs
        • Number of employees identified as recommended for colorectal cancer screening who have been sent a reminder for screening
        • Number of employees sent reminder who actually scheduled a screening test and received the screening
      • Number of new educational materials developed and made available to employees
      • Number of new workplace communications/media campaigns, including posters, brochures, employee success stories, organized buddy support systems, etc., established
        • Was there an increase in colorectal cancer screening appointments directly following an informational or awareness campaign
        • What was the percentage increase in screening appointments
      • Number of new workplace policies regarding colorectal cancer screening developed and implemented compared to baseline
      • Number of new environmental strategies to reduce structural barriers developed and implemented compared to baseline
      • Number of new partnerships with community groups created to enhance access and opportunity for employee colorectal cancer screening
    • Assess changes in program costs from baseline
      • Increases in staffing or equipment needs due to new program offerings
      • Changes in employee participation time during work hours (e.g., education)
      • Changes in reimbursement/subsidy for colorectal cancer screening to reduce out-of-pocket costs and structural barriers such as classes, reducing co-payments, or transportation
      • New incentives or benefits or changes in existing incentives or benefits based on employee participation
    • Assess changes in survey responses for employee satisfaction following implementation of a workplace supported colorectal cancer screening program and compare with baseline

Depending on goal success, evaluate the need to adjust workplace programs.

Tools and Resources

Colorectal Cancer Screening Baseline Measures

The assessment tools described in the assessment module include specific questions related to colorectal cancer screening.

  Health-related Programs

  • Q11; Q12; Q20h; Q22; Q23; Q24a,b,d,e,h,i; Q26; Q27; Optional Questions A, B, I, J, K, M, JJ, OO

  Health-related Policies

  • Q28a

  Health Benefits

  • Q29; Q30; Q31; Q32; Q33; Q36; Q37; Optional Questions T, V, W, Z

  Environmental Support

  • Q39; Q40; Q41; Q47; Optional Questions CC

Additional Tools

  • In addition to the following suggestions for measures of worker productivity, health care costs, health outcomes, and organization change in colorectal cancer screening programs, see measurement recommendations for obesity, physical activity, nutrition, and tobacco use
  • The CEO Roundtable on Cancer, Inc. sponsors the CEO Cancer Gold Standard which provides accreditation for any company that demonstrates it has met all criteria for the Gold Standard
  • Health Risk Appraisals at the Worksite: Basics for HRA Decision Making [PDF - 2.3MB] is a guide developed by the National Business Coalition on Health in collaboration with the Centers for Disease Control and Prevention (CDC) in the selection and use of health risk appraisals in the workplace available for employers
  • The CDC Healthy Communities Program developed the Community Health Assessment and Group Evaluation (CHANGE) assessment tool to provide communities with a picture of the policy, systems, and environmental change strategies currently in place throughout the community, where gaps exists and facilitate action planning for making improvements. The CHANGE tool address five community sectors including worksites and health indicators related to physical activity, nutrition, tobacco use, chronic disease management, and leadership

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