A Collaboration between
the Rockland County Cancer Institute
of the Rockland County Department of Health,
Good Samaritan Hospital and
Rockland County Gastroenterologists

October 27, 2006

Ronda Rosman, RN, MS
Coordinator, Rockland County Cancer Institute
Rockland County Department of Health
Pomona, New York

C. Scott Vanderhoef - County Executive
Joan Facelle, MD, MPH - Commissioner of Health

(image: seal of Rockland County, NY)

An outreach, education, screening and referral program targeting the four most prevalent cancers in Rockland County: breast, colorectal, prostate and lung.

(image: Rockland Cancer Institute logo)

• In 1984, County Legislature created Rockland County Special Commission on Women's Issues.
• Breast Cancer Task Force was created to raise awareness about breast cancer and promote early detection.
• Several legislators, themselves prostate cancer survivors, also wanted to address the issue of prostate cancer in Rockland County.

• Legislature designated funds to address the issue of cancer in Rockland County.
• In 2001, County Executive C. Scott Vanderhoef asked the Health Department to develop an initiative to educate county residents and promote early detection of cancer through screening.
• A Medical Advisory Committee was convened and came up with recommendations which led to the formation of the Rockland County Cancer Institute.

• Health Department worked together with the Medical Advisory Committee, Good Samaritan and Nyack Hospitals, ACS and other local community agencies to develop programs to expand cancer services in the county.
• In 2005, new programs were initiated through RCCI funding and became operational.

Developed based on the:

• Medical Advisory Committee Recommendations
• NYSDOH Colorectal Cancer Screening Program and Breast Health Partnership Program
• Rockland County Community Health Assessment 2005-2010

• Diverse population
• Pockets of uninsured, underserved residents
• Pockets of poverty despite low overall poverty rates
• Substantial growth in the newly-immigrated, foreign-born population, and in the number of non-English speakers

• Cancer is the leading cause of death for Rockland residents aged 45-64, second leading cause for ages 65 and older.
• County has a higher incidence rates for colorectal cancer than New York State.

Provide 100 free screening colonoscopies, follow-up and treatment to eligible uninsured and underinsured county residents.

(image: colorful GOAL image)

Key players identified:

• Health Commissioner
• Local American Cancer Society Director
• Gastroenterologist
• Surgeon
• Pathologist
• Anesthesiologist
• Hospital Administrator
• RCCI Staff

Our lead gastroenterologist encouraged his colleagues to participate in the program.

13 out of 14 local gastroenterologists agreed to participate.

The gastroenterologists agreed to:

• provide office consultation visits in-kind.
• accept greatly reduced fees for performing the colonoscopies.

Good Samaritan Hospital and participating doctors (representing the following specialties) also agreed to accept greatly reduced fees:

• Anesthesiology
• Pathology
• Surgery
• Oncology

Funds for treatment were included in the grant for patients diagnosed with colorectal cancer.

• Program flyer was developed and translated by RCCI staff.
• Flyer was mailed by ACS to Breast Health Partnership participants and families.
• RCCI staff promoted the program in the community.

(image: Mass mailing of flyer titled "Are you 50 or older? It's time to get tested for colon cancer!" to the ACS database)

RCCI staff:

• scheduled appointments for the patient's office consultation with the gastroenterologist.
• provided frequent reminders (phone and mail).
• assisted with translation and transportation.
• referred patients to facilitated enrollers for health insurance.

RCCI staff also:

• translated the colonoscopy prep and
• post-colonoscopy instructions into Creole, Spanish and Russian.
• purchased Fleet Phospho-Soda prep.
• put together "prep kits" to include prep instructions, two 1.5 ounce bottles of Fleet Phospho-Soda, and county HIPPA form, and distributed to each office.

The gastroenterologists:

• examined patients
• obtained more extensive medical history
• educated patients about the colonoscopy procedure and prep instructions

After office consultation, medically eligible individuals were scheduled for colonoscopy at Good Samaritan Hospital on an outpatient basis.

(image: photos of adults)

Due to our efforts, clients kept their colonoscopy appointments 97% of the time.

(image: image of thumbs up, "Nice Job!")

(image: drawing of several men holding a large key)

RCCI staff developed and maintained strong working relationships with the health care providers and office staff.

(image: copy of "Thank You for Participating" advertisement which appeared in local paper)

RCCI staff developed and maintained an effective system of communication.

RCCI developed and maintained a successful system for vouchering and reimbursement.

• No colorectal cancer was detected.
• 18 patients had precancerous polyps identified and removed during their colonoscopies.
• 12 patients had hyperplastic polyps (not generally considered precancerous) identified and removed during their colonoscopies.
• Other diagnoses included internal hemorrhoids, diverticulosis, and other common findings.

• Look at your community needs assessment to demonstrate need
• Encourage buy in from key players
• Form partnerships with the medical community
• Advocate for funding - early detection saves lives ... and money!
• Start small, show success, then expand

Ronda Rosman, RN, MS
Coordinator, Rockland County Cancer Institute
Rockland County Department of Health
50 Sanatorium Road – Building J
Pomona, New York 10970

845-364-3857
rosmanr@co.rockland.ny.us