MCC Spotlight Michigan BCCCP Receives Outstanding Program Success Award from CDC
About the Award The Michigan Breast and Cervical Cancer Control Program (BCCCP) was one of only five programs nationwide honored at the August 2007
National Breast and Cervical Cancer Early Detection Program
Directors Meeting with an Outstanding Program Success Award.
The Michigan program competed against 36 other success stories from across the nation for this recognition, submitting a success story profile on the program's transition from a comprehensive centralized continuous quality improvement (CQI) program to a decentralized one.
Impetus for the CQI Program
In 2000, Michigan identified several problem areas relating to the quality of data submitted to the Centers for Disease Control and Prevention (CDC). Specifically, Michigan was not in compliance with CDC performance indicators of timeliness and completeness for breast or cervical abnormalities, yet data from annual chart reviews demonstrated that program participants were receiving appropriate care.
Michigan began to look at processes that would aid in bringing the state's data in line with the clinical care that was given. Information from the 2000 chart audit showed that BCCCP women were receiving timely and appropriate care as defined by the CDC performance standards. However, the provision of this care was not always accurately reflected in the computer database.
About the CQI Program
In January 2001, with the assistance of MPRO, Michigan’s Quality Improvement Organization, the state BCCCP team implemented a CQI process that incorporated changes to the program's current data evaluation process.
Clinical staff taught data staff about medical protocols, and data staff taught clinical staff about the layout and reporting of CDC data. With this increased understanding of each other’s domain, both teams began to work toward processes that would help the local agency staffers understand the complex interaction between the delivery of clinical care and the appropriate recording of data reflecting this care.
Clinical decision making algorithms were implemented to assist local clinical and data staff in interpreting the medical protocol. New reporting processes were instituted, as well as improved methods of communicating with local agencies. In response to the findings of the review, Michigan began using a team approach at the state level to monitor clinical care and data quality.
This improved collaboration at the state level transitioned to an increased collaboration at the local level. Michigan has improved on the completeness of abnormal Pap test data, moving from 79.4 percent in January 2001 to 92.2 percent in the most current data. Timeliness of Pap test data also has improved, from a median of 64.5 days, with 56.6 percent taking over 60 days, to a median of 44 days, with 32.6 percent over 60 days. Mammogram data has improved from 79.1 percent complete to 94.1 percent complete; the proportion of mammograms taking more than 60 days has improved from 27.8 percent to 13.2 percent.
Once Michigan had achieved these goals, the next step was to transition the program that was conducted exclusively at the state level to the local level. Although the current process in reviewing documentation of clinical care at the state level was successful, agencies voiced concern with delays in relaying clinical care data back to them in instances in which interventions could be implemented in a more timely manner.
In 2005, the BCCCP instituted a pilot study that enabled five agencies to conduct their own chart reviews instead of sending charts to MPRO and the state for review. The pilot was such a success that it was expanded to all agencies in 2006. At that time, indicators measuring short-term follow-up of clients with Pap test results of ASC-US and mammogram results of ACR 3 — Probably Benign were added in addition to those measuring the CDC Performance indicators of timeliness and completeness.
Measuring adherence to short-term indicators was an eye-opening experience for many agencies. Although they had processes in place to track these women, they had never formally reviewed medical record data to ensure this was occurring on a program-wide basis. Doing so gave them a new understanding of specific issues on a program-wide basis that could prevent a woman from receiving the recommended short-term follow-up in the time frame indicated.
In 2007, a further step was implemented enabling agencies to not only review their own charts, but also calculate their compliance to clinical care indicators. Receiving immediate feedback was gratifying for all of the agencies, not to mention the state staff. Clinical care or data issues that were identified during the chart reviews were immediately addressed by local and state staff, thereby saving months of time that would have been wasted waiting for data to review that was six to eight months old by the time the report was written.
Impact of the CQI Program
Using a comprehensive CQI process, Michigan has improved adherence to the CDC performance indicators; expanded monitoring of clinical care through chart reviews to include not only those clients requiring immediate follow-up, but also those clients requiring short-term follow-up; and transitioned the responsibility of conducting the chart reviews and evaluating adherence to program indicators exclusively to the local agencies.
This recognition would not have been possible without the unwavering cooperation of the Michigan program's local coordinating agency staff. Their commitment to the BCCCP and their desire to provide the highest quality care to the women in Michigan is exemplary.