The overall goal of the expanded Parkland-UT Southwestern PROSPR Center is to optimize cervical and colon cancer screening in our integrated safety-net system. The population we contribute is the most diverse and disadvantaged in the PROSPR network, representing patients infrequently included in large scale research networks. Parkland's cervical cancer screen-eligible population of more than 78,000 adult women is 6 1% Hispanic, 24% African American, and 8% Non-Hispanic White. All are low-income and few have private insurance leading them to rely on public insurance or charity care. Thus, our patients represent the "traditionally underserved" groups experiencing cervical cancer disparities - higher incidence and mortality, and lower screening and HPV vaccination. Parkland delivers the full cervical cancer screening process (risk assessment, early detection, diagnostic evaluation, and treatment) through an integrated system of 11 neighborhood-based primary care clinics, 11 women's health centers, and specialty clinics (dysplasia, gynecology and oncology). All clinics share a comprehensive electronic medical record (EMR) through which eligibility for a test, test ordering, results, referrals, and treatmentis ascertainable electronically. Our Center will expand by adding a Cervical Screening Process Documentation Unit (SPDU) and a Cervical Research Core. The Cervical SPDU will: 1) harness Parkland's EMR to collect accurate data on the cervical cancer screening process at multiple levels including the patient, provider, clinic, system, and health policy, and 2) securely transfer de-identified data to the Statistical Coordinating Center, investigators in the Cervical Research Core will provide intellectual leadership to the PROSPR network by prioritizing, conceptualizing, and conducting collaborative projects that capitalize on the heterogeneity of the network with respect to patient population, health system, and context. Data contributed by the Parkland-UT Southwestern PROSPR Center to the Network will enable analyses that examine how recent changes in guidelines and newly available screening and vaccine technologies impact long-standing disparities in cervical cancer. This research will improve both the science and delivery of effective cervical cancer screening.
Assessing effectiveness of cervical cancer screening in safety-net settings is important because urban, uninsured, low SES minorities have higher incidence and mortality rates. The PROSPR network needs multilevel data on this underserved population to discover what can be done to impact disparities.
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