Chinatown NORC Program Partners with New York City on Colon Cancer Screenings - Continued

Generating a Community-Based Response
Having settled on colonoscopies as a focus, the NORC program partners reached out to other health and social service agencies with deep roots in the community to form a task force, known as the Chinatown Colon Health Group. The Charles B. Wang Community Health Center and the Confucius Pharmacy, both well-respected Chinatown institutions, joined this task force, which also included representatives from VNSNY, the city health department, Beth Israel Hospital, the American Cancer Society, New York City’s Department for the Aging, and the five core partners, as well as the program.

“What was unique about the Chinatown partnership was that it included many different kinds of stakeholders,” said Ms. Krauskopf. “That gave us an important entrée to champions who have credibility at the local level. The on-the-ground intelligence of local people can inform the development of tailored program strategies and create a potential dissemination network.”

Using information from the NORC program’s Health Indicators survey, the Colon Health Group created a registry of the NORC program clients who had not had colonoscopies in the past ten years. To identify the barriers to colonoscopy screening, the health department developed a five-question survey, which NORC program staff translated into Chinese—substituting other characters for the word “cancer,” which is considered bad luck in the community. “We learned from the survey that people are frightened of the preparation that is necessary, or they have heard that it is terrible,” said Karen Bassuk.

Those findings helped to inform an aggressive, multipronged outreach and education strategy that began in 2008. Task force members tailored health department materials to the cultural sensitivities of an Asian audience, and sponsored a workshop for NORC residents that brought together a physician, a pharmacist and a patient to demystify the procedure.

Another step, possible only in an environment of mutual trust, was for the NORC program to provide the health department with a list of physicians who treat their NORC program clients so that department staff could contact these doctors to underscore the importance of colonoscopies. Health department personnel also increased the issue’s visibility with a panel presentation to some 200 community leaders at the Chinese Consolidated Benevolent Association’s annual meeting.

Two other innovations were core components of the colonoscopy initiative:

Creating a Colonoscopy Patient Navigator Program at Downtown Hospital: The Navigator Program, launched by the city health department in a number of hospitals in 2003, provides patients with a knowledgeable and supportive contact to guide them through the colonoscopy referral, preparation, and testing process. Data from public hospitals show that having a navigator in place increases colonoscopy rates.

The Colon Health Group encouraged Downtown Hospital to apply for a navigator position through the city program, which covers staffing costs for a year, and includes ongoing training and data collection. With a history of a 40 percent no-show rate for colonoscopies, Downtown recognized the potential benefit both to patient care and its bottom line, and willingly put a Chinese-speaking navigator in place, along with a hotline number to ensure easy access.

Building a Relationship with Confucius Pharmacy: Before a colonoscopy, patients must take prescription medication to clean out the colon. Pharmacists at the Confucius Pharmacy noticed that their customers often seemed uncertain about what to do and asked a lot of questions about the preparation. While pharmacists answered willingly, there was no follow-up to ensure that people actually understood the instructions or showed up for the procedure.

Once the Confucius Pharmacy became a member of the Chinatown Colon Health Group, it became more proactive, handing out tailored educational materials with contact information for the Downtown Hospital navigator, and asking customers if they were willing to receive follow-up phone calls from NORC program staff. “The pharmacy became a key juncture point,” noted Bassuk. “It helped make the connection to care.”

All of these efforts were widely covered in the local Chinese-language media, another important source of information for this population.

Lessons Learned
While the Chinatown neighborhood NORC program continues to grow, and its partnership with the city health department is ongoing, the experience already offers some lessons learned.

In its initial planning, the NORC program had not set out to focus on colon health, but instead discovered a need and an opportunity, and took advantage of both. “This is not what we started concentrating on as our main thing, but results from the Health Indicators survey told us it was an important area,” said Ms. Bassuk. “Once we set a goal of doing that, the next step was to find the resources. This has been an evolutionary process.”

In 2010, colon cancer screening remains an emphasis of the NORC program, the health department’s expertise and resources are a continuing asset, and the Chinatown Colon Health Group is reaching beyond the registry to find other seniors who have not had colonoscopies. Beyond the immediate objectives, the emphasis on screening has become a way to connect with seniors and draw attention to the broader package of case management, social work, and nursing services that are available within the 24-block neighborhood NORC. “Our goal is to reach as many people as possible so they know we do more than just colon health,” said Helen Hing Lin Sit, director of the Chinatown NORC program.

For its part, the health department has discovered a new and more systematic approach to advancing its cancer screening goals through the Chinatown experience. Connecting not only with individual providers, but with the “influentials” who are known and trusted by the local population, has proven useful. “Mobilizing champions in lots of different sectors helped us expand our reach,” said Ms. Krauskopf. So, too, did the sharp focus on a well-defined community, a strategy that spurred the health department to direct attention to the Russian community in Brooklyn, where colonoscopy rates are also low.

Inevitably, there have been challenges and detours along the way. “Change is the only thing that is a constant,” said Karen Bassuk. “Sometimes we have to shift gears and figure out what is realistic for us to do given the resources we have.”

“It all takes time and energy and focus,” said Ms. Krauskopf, acknowledging that these commodities are always in limited supply.

Over time, partnerships have been renegotiated and new task force participants have been added. “What people perceive as being able to give to a partnership, and what they can actually give are not always the same,” warned Bassuk. “Some partners have more limited time or don’t have the staff to address certain things so we have had to think differently about how we split things up. The process requires us to be open and flexible.”

One big change is that Downtown Hospital no longer has discrete funding for a navigator, so new ways of supporting patients scheduled for colonoscopies are necessary. “Recognizing that Downtown is not going to be able to provide as much hands-on attention without a navigator, we will have to come together as a group and say, ‘okay, how will we do this differently?’” Bassuk said.

Despite the inevitable transitions, the NORC program - health department collaboration remains a noteworthy model. The success to date reflects, at least in part, the recognition of shared interests and respect for what each player can bring to the table. “We drew on one another’s expertise,” said Helen Sit. “We were all learning.”

Marian Krauskopf agreed. “What was helpful here is that the NORC program leadership saw its agenda as very collaborative with ours. We were working from the same page.”

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