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The FL Breast and Cervical Canter Enhancement Monitoring System

State: FL Type: Promising Practice Year: 2019


The Florida Breast and Cervical Cancer Early Detection Program (FBCCEDP) is a subdivision of the Florida Department of Health (FL- DOH), Volusia County is one of 16 regions representing the 67 counties in Florida. The Volusia region is comprised of 5 counties Flagler, Lake, Marion, Volusia and St. Johns. The FBCCEDP provides low income women with no health insurance breast and cervical cancer screening, for women age 50-64 that meet the income and resident requirements. The FBCCEDP program can provide Clinical Breast Exams, Mammograms and PAP tests.  If a client receives a positive diagnosis of Breast or Cervical Cancer, the FBCCEDP program can enroll the client in Medicaid which will then cover all their treatment including reconstructive surgery we are the only program that has the authorization to enroll clients in Medicaid.

The program uses data to evaluate the quality of its service delivery, the CDC has assigned program indicators to assess whether a woman received quality and timely care.  Each indicator uses a combination of data elements that provide a snapshot of care provided to each client. Central office shares a summary of the progress indicators with each of the 16 regions. The indicators provide a systematic approach for rapid assessment of program progress and intentionally highlight program areas where there is variability.

Federal money is allocated through the CDC which provides oversight the CDC prepares an annual report that summarizes how funds are utilized. This report includes information such as the number of women served, ages, race and ethnic backgrounds, screening results or cancer diagnosed and how these clients are managed medically. The report serves as a mechanism for the CDC to demonstrate the need for increase funding each region must submit data to receive federal dollars to for the screenings.

The enhancements to the database aided in the development of a mechanism for improving the results, follow-up, budget, reporting and the case management of clients and outcomes, this locally developed application is saving hours of staff time.  There was no cost incurred with purchasing new software, this tool was needed to manage daily operations and make informed decisions.   This innovative product establishes best practice and productivity management that was not feasible across the organization previously. The outdated database was not able to provide any reliable reports to determine which clients had breast or cervical cancer, clients could be lost in the system, overspending budget allocations and tracking critical indicators:

i.e. Abnormal Mammogram Screening Results; Time from Screening to Diagnosis >= 60 Days <=25%.


The 16 Regional coordinators all had 16 different way to report the data collected and tracked outcomes, it was a tedious an inaccurate method. The enhancements to the program allows for best practices as well as to alert potential problems.


The Volusia team strategized on the current operational processes, identified improvements measures to track effectiveness and quality of service.  We looked at what the key elements needed to improve the efficiency and the accountability of system. We first looked at the quarterly indicators and goals required by the CDC we the created report that could be generated daily to ensure that we are on track to meet the requirements. There was also a need to track the client's status were appointments kept what were the results of the mammogram screens did the client require additional follow-up. Were those case that required no follow up closed utilizing the Patient Referral Form (PRF) which is the trigger for the program office to ensure that clients are seen within the appropriate time frame assigned by the CDC. Additional reports were developed to see the status of the clients that were no-shows, monitor the budget since this program has a budget separate from the Schedule C state allocations there is also a budget that each regional coordinator must maintain to issue reimbursement for services.  


While these enhancements to the data base system started with Volusia, the program office and the other regional coordinators started showing an interest. The program was showcased at our regional coordinators meeting and the interest was overwhelming, the program office was most impressed that this database would have all 16 regions tracking and monitoring the program the same way and the program office would have the ability to look at any County's data to identify any issues that might need to be addressed.  Currently 9 out of the 16 regions have contracted with FDOH-Volusia and we are working with the other counties there is a slight cost of $1,000.00 for yearly maintenance.  




There was a need to enhance the outdated database to improve the availability of information that was input in the system but not easily reported out. Many reports were either created or enhanced to track the screening results, client follow-up, the budget, and the overall case management of clients and outcomes, this locally developed application is saving hours of staff time.  There was no cost incurred with purchasing new software, this tool was needed to manage daily operations and make informed decisions. The outdated database was not able to provide any reliable reports to determine which clients had breast or cervical cancer, clients could be lost in the system, overspending budget allocations and tracking critical indicators. Since there are 16 FBCCEDP regions many of the counties were maintain information on excel spreadsheets duplicating efforts since a PRF must be completed on all clients with the status of their case. The changes made eliminates the need for multiple tracking logs and manually inputting client information in multiple formats. What started to improve the reporting and tracking of client data for Volusia county, the other 16 regions as well as the program office shown interest in this database system when it was showcased at the regional Coordinators meeting. Currently 9 counties are using the system and additional request for reporting and to streamline the process are being considered and implemented. As the program grows with additional counties further enhancements and reports will be created this database saves money in staff time and still ensures the information is readily available resulting in managing by fact. This real-time process allows timely access to reports and information which can be generated independently run on-demand as needed.   

I think is obvious since we have received overwhelming buy-in from the program office as all16 regions that we have more than achieved the original goal of improving the reporting and managing of the 5 counties that are supported by the Volusia region to encompass all 67 counties in Florida.

There are 16 FBCCEDP regions that cover the 67 counties in Florida and the program office, currently FDOH-Volusia has agreements with 9 regions and the program office with the other 7 regions planning to have the database in their region. Has this program expands additional requests for enhancements and reporting are being evaluated and implemented.  This database will become the statewide system for the FBCCEDP program allowing for consistency between all regions and all counties. What started as improvements for the Volusia region has more than exceed its original goal of the 5 counties that are managed by Volusia. The team is comprised of Kathy Diaz, FBCCEDP Regional Coordinator for Volusia, Vickie Lawrence, Health Educator, Marcus Ray and Richard Gadrim, System Project Analyst all that are house in FDOH-Volusia.

The original objectives were an innovated process that ensures that the information for client's results are followed up timely, clients that had a diagnosis of cancer treatment was started with-in 60 to improve their outcome, client no shows were identified and rescheduled, budget allocations were monitored any adjustments could be easily identified and information reported to the CDC is accurate. Since all 16 regions are assigned a yearly mammogram screening goal

which the funding received is based on another report created tracks your goals so that you are aware of your productivity.  This tool provides a uniform method to track outcomes indicators and goals required by the CDC, it has become the state standard. The Original database was created in 2012 no modifications were made until recent changes to the local structure of the FBCCEDP program at that time the effectiveness of the system was annualized and the enhancements to the database were made.

i.e. Abnormal Mammogram Screening Results; Time from Screening to Diagnosis >= 60 Days <=25%.


The 16 Regional coordinators all had 16 different way to report the data collected and tracked outcomes, it was a tedious an inaccurate method. The enhancements to the program allows for best practices as well as to alert potential problems.


The Volusia team strategized on the current operational processes, identified improvements measures to track effectiveness and quality of service.  We looked at what the key elements needed to improve the efficiency and the accountability of system. We first looked at the quarterly indicators and goals required by the CDC we the created report that could be generated daily to ensure that we are on track to meet the requirements. There was also a need to track the client's status were appointments kept what were the results of the mammogram screens did the client require additional follow-up. Were those case that required no follow up closed utilizing the Patient Referral Form (PRF) which is the trigger for the program office to ensure that clients are seen within the appropriate time frame assigned by the CDC. Additional reports were developed to see the status of the clients that were no-shows, monitor the budget since this program has a budget separate from the Schedule C state allocations there is also a budget that each regional coordinator must maint

While these enhancements to the data base system started with Volusia, the program office and the other regional coordinators started showing an interest. The program was showcased at our regional coordinators meeting and the interest was overwhelming, the program office was most impressed that this database would have all 16 regions tracking and monitoring the program the same way and the program office would have the ability to look at any County's data to identify any issues that might need to be addressed.  Currently 9 out of the 16 regions have contracted with FDOH-Volusia and we are working with the other counties there is a slight cost of $1,000.00

for yearly maintenance.  

There is future enhancement that are requested but since the database has expanded to 9 regions the goal is to have a committee to analyze that any new modifications are voted to ensure that there is a benefit to all regions therefore ensuring that the database remains a statewide system and not go back to individually regions creating different subsystems.


ain to issue reimbursement for services.  


  



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